Homoeopathic approach in cataract

Dr Neeta

ABSTRACT
Cataract occurs when crystallin proteins in the lens partially unfold and subsequently aggregate. As far, surgery is the only treatment, but there are many numbers of homeopathic remedies for the treatment of cataract. This article deals with an overview of cataract, classification, clinical feature and its homoeopathic approach in the treatment of the cataract and improving the quality of life by reducing Disability- adjusted life years of the patient.

INTRODUCTION
Cataract means opacity of the lens. Lens being the avascular structure, cannot develop an inflammatory disease. Common most disease is degenerative process leading to opacity of the lens known as cataract ^[1].

EPIDEMIOLOGY
The World Health Organisation (WHO) / National Program for Control of Blindness (NPCB) survey has shown that there is backlog of over 22 million blind eyes in India, and 80.1% of there are due to cataract. The annual incidence is about 3.8 million.

Economic impact of cataract: Cataract is one of the most common causes of visual impairment around the world, which can significantly reduce patients Quality of life ^[2].

The importance of cataract blindness is more than 90% of the total Disability- adjusted life years (DALY) ^[3].

CLASSIFICATION OF CATARACT ^[1]

1. A) Congenital and Developmental Cataract

Congenital cataract is present at birth. Developmental cataract which develops during the development of the lens. This type of cataract is due to disturbance at certain phase of growth of lens, lens fibres.

CAUSES

Maternal malnutrition, maternal infections especially German Measles, Deficient oxygenation due to placental haemorrhage.

VARIOUS TYPES OF CONGENITAL AND DEVELOPMENTAL CATARCT

1. a) Blue- dot cataract
2. b) Coronary cataract
3. c) Capsular or Polar cataract
4. d) Sutural cataract
5. e) Coralliform cataract
6. f) Floriform cataract
7. g) Central cataract
8. h) Lamellar or Zonular cataract
9. i) Total cataract –soft type

— membranous type

1. B) Acquired cataract
2. a) Senile cataract

•    – Conical type
•    – Nuclear type
•    – Cupuliform type

1. b) Traumatic cataract

– Mechanical trauma: due to concussion, contusion, penetrating injury to eyeball.

– Chemical trauma: Absorption of chemicals like Naphthalene, Lactose, Glucose, Thallium.

– Radiation trauma: Infra- red rays, Ultra violet rays, Deep X-rays.

1. c) Endocrine cataract: In Diabetes mellitus, Hypoparathyroidism, Cretinism.
2. d) Cataract due to systemic diseases as in Mongolian idiocy, Myotonic dystrophy, Generalized dermatitis.
3. e) Complete cataract.

SENILE CATARACT: General features are

Age: Usually above 50 years

Gender: Equal in both sex

Bilaterality: Usually bilateral but develops earlier in one eye

Hereditary: Genetic influence is marked.

PATHOGENESIS
The lens fibres of cortex are mainly affected. There is hydration due to accumulation of water droplets in between the fibres, followed by changes in colloid system within the fibres. Proteins are denatured and then coagulated forming opacity.

CLINICAL FEATURES: SYMPTOMS

– Gradual impairment of vision

– Polyopia means one object appears multiple

– Raintiow habes around the light due to accumulation of water droplets in between the lens fibres.

CLINICAL SIGNS: Depends upon the stages of cataract.

1. a) Incipient stage: wedge- shaped spokes of opacity with clear areas in between.
2. b) Progressive stage: further wedge- shaped opacity develops.
3. c) Immature stage: lens appears greyish, Iris shadow is visible.

IRIS SHADOW: It is the shadow of pupillary margins on the lens produced when light rays thrown obliquely.

1. d) Intumescent stage: lens is swollen, anterior chamber become shallow.
2. e) mature stage: entire cortex become opaque, white. Iris shadow disappeared.

DIAGNOSIS

– Pupils must be dilated with 1% atropine solution and lens must be examined with a torch and a loupe or with the help of slit lamp for any evidence of opacity.

– Pearly white appearance of the lens
– Absent fourth purkinje’s images
– No red fundal glow when examined in dark room with plane mirror.

CONVENTIONAL TREATMENT
Cataract surgery is the only known treatment for cataract. It is to removes the clouded lens and replaces it with new, artificial lens known as Intraocular lens (IOL).

HOMOEOPATHIC INTERPRETATION OF CATARACT ^[4]
Homeopathy is the one of the best systems of medicine for treating any kind of diseases on the principle of holism and individualization. There is always correlation between body and mind in development of any diseases. What mind thinks, body reacts. Mental origin of development of cataract is explained by German New Medicine as, Visual separation conflict of having lost sight of someone, for example, of a loved one who has moved away, left, or has died. The conflict also relates to not being allowed to see someone or not wanting to see someone. The fear of not being able or not being permitted to see a certain person might already trigger the conflict.

RUBRICS RELATED TO CATARACT GIVEN IN VARIOUS REPERTORIES

1. A) KENT REPERTORY ^[5]

EYE- CATARACT: Am-c, am-m, apis, bar-c, calc, calc-f, calc-p, cann-s, carb-an, caust, chel,     Colch, con, euph, jab, kali-c, lyc, mag-c, nit-ac, phos, puls, sec, seo, sil, 

         sulph, zinc.

•       Right eye: Am-c, kali-c, nit-ac, sil
•        Left eye: Sulph
•        Can see better on a dark day: Euph
•        Capsular: Am-m, colch
•        Contusion from: Arn, con
•        Cortical: sulph
•        Foot-sweat suppressed, after: Sil
•        Incipient: Caust, puls, sec, sep
•        Operation, after: Arn, saneg
•        Perpendicular high-light, with: Caust
•        Reticularis: Caust, plb
•        Senile: carb-an, sec
•        Soft: Colch, sec, merc
•        Viridis: Colch, phos, puls
•        Women, in: Sep.

1. B) MURPHY’S REPERTORY ^[6]

EYE- CATARACT, opacity of lens: acon., agar., alumn., am-c., am-m., anac., anag., ant-t., apis., arg-i., arn., aur., bar-c., bar-s., bell., bov., bry., CALC., CALC-F., calc-p., calc-s., calc-sil., calen., cann-s., caps., carb-an., CAUST., chel., chim., chin., cholin., cina., cina., cocc., coch., colch., coloc., con., croc., dig., digin., dulc., euph., graph., hed., hep., hyos., ign., iod., jab., kali-c., kali-m., kali-s., kali-sil., kreo., lac-c., led., lyc., MAG-C., merc., nat-c., nat-m., nat-s., nit-ac., op., phos., plb., podo., psor., puls., rhust-t., ruta., sars., sec., seneg., sep., SIL., spig., stann., staph., SUPLH., thiosin., thuj., verat., x-ray, zinc., zinc-p.

1. C) COMPLETE REPERTORY TO THE HOMEOPATHIC MATERIA MEDICA DISEASESS OF THE EYES- E.W. BERRIDGE ^[7]

LENS, CATARACT: acon., aga, alli, amm-ca., amm-cl., arn., art-v., as-o., atp., au., ba-ca., bry., buf., ca-ca., ca-pa., ca-s., can., cap., cch., chd., chi., clv., con., cro., cub., dig., dl-s., dt., euph., euphr., glp., gui., hg., hyo., kre., lyc., mg-ca., mn-ca., n-x., na-ca., na-cl., p, pb, pol, ppv, pul, rs, rut, s, sang, sep, smi, spi, str-I, te, val, vr-a.

HOMEOPATHIC REMEDIES ^[8]

CALCAREA CARB: Lachrymation in open air and early in morning. Sensitive to light. Dilatation of pupils. Suppurating fistula. Cannot read in gas light. Feels as if squinted. Dimness of vision, as if looking through a mist, by constant reading, writing, etc. Ulceration of the cornea. Spots and ulcers on cornea. Cataract. Ophthalmia in new born after taking cold.

CALCAREA FLUORICA: Cataract. Cornea opaque spots. Keratitis. Flickering and sparks before the eyes. Aching in eyes better closing and pressure.

CAUSTICUM: Continuous eye pain with constant inclination to touch and rub the eyes which seems to relieve the pressure in it. Vision obscured as from gauze, on blowing nose. Sparks and dark spots before the eyes. Cataract with motor disturbances.

EUPHRASIA: Catarrhal conjunctivitis, discharge of acrid matter. Acrid lachrymation with bland coryza. Pressive and cutting pains in the eyes. Cataract with watery eyes. Opacities of cornea after injury.

LYCOPODIUM: Sparks before the eyes in the dark. Ulceration and redness of lids. Cataract with suppressed menses.

MAGNESIA CARB: Black mots before the eyes. Opacity of cornea. Cataract, lenticular.

PHOSPHORUS: Hollow with blue rings around eyes. Lachrymation in the wind. Cataract, vitreous opacities. Sensation as if everything were covered with a mist or something pulled tightly over eyes. Green halo about the candlelight. Black points seem to float before the eyes. Patient sees better by shading eyes with hand.

SENEGA: Staring, lachrymation. Flickering, must wipe eyes frequently. Dryness with sensation as if too large for orbits. Objects looks shaded. Opacities of the vitreous humour. Promotes the absorption of fragments.

SEPIA: Muscular asthenopia, black spots in the field of vision. Sees, black spots, veil, points, sparks, flashes zigzags and streaks of light before eyes. Vision was dimmed from sexual excess, masturbation or uterine diseases. Arrests cataract in women.

SILICA: Spotted vision. Objects appear pale. Aversion to light especially daylight, it produces dazzling. Opacity of cornea after smallpox. Cataract in office workers after suppressed foot sweat. Perforating or sloughing ulcers in the cornea. Vision confused; letters run together on reading. Objects as if in a fag.

SULPHUR: Heat and burning in the eyes. First degree ulceration of cornea. Obscuration of vision like black gauze or motes before eyes. Keratitis, cornea appears like ground glass.

CONCLUSION
Cataract is opacity of lens presenting as visual impairment. It may be due to malnutrition, infection, trauma, endocrine disorder or old age. Invasive surgical treatment can be prevented by Homeopathic approach and reduce the Disability- adjusted life years.

REFERENCE

1) Chatterjee BM. Handbook of ophthalmology. New Delhi, India: CBS publishers and Distributors; 2008. P: 269-277.
2) Vajpayee RB, Joshi S, Saxena R, Gupta SK. Epidemiology of cataract in India: combating plans and strategies. Ophthalmic Res.1999;(2);82-92. [cited 2023 Feb 20] Sci-Hub | Epidemiology of Cataract in India: Combating Plans and Strategies. Ophthalmic Research, 31(2), 86–92 | 10.1159/000055518
3) Hashemi H, Pakzad R, Yekta A, Aghamirsalim M , Pakbin M, Ramin S, et al. Global and regional prevalence of age-related cataract: a comprehensive systematic review and meta-analysis. 2020;34(8):1357-70. [cited 2023 Feb 16] Global and regional prevalence of age-related cataract: a comprehensive systematic review and meta-analysis | Eye (nature.com)
4) Index A-Z [Internet]. Learninggnm.com. [cited 2023 Feb 17] Eyes (learninggnm.com)
5) Kent JT. Repertory of the homeopathic materia medica. New Delhi, India: B Jain; 2021.P:
6) Murphy RR. Homeopathic medical repertory: A modern alphabetical repertory.  Hahnemann Academy of North America; 1993.P: 616.
7) U S Government, Berridge EW. Complete repertory to the homaeopathic materia medica. Diseases of the eyes. Rarebooksclub.com; 2012.P: 36.
8) Boericke W. Pocket Manual of Homoeopathic Materia Medica & Repertory: Comprising of the Characteristic and Guiding Symptoms of All Remedies (clinical and Pahtogenetic [sic]) Including Indian Drugs. B. Jain publishers; 2002.P:144-145, 149, 182, 279, 410, 414, 508, 584, 586, 591, 620.

Dr Neeta
PG Scholar Department of Practice Of Medicine
Government Homoeopathic Medical College and Hospital,
Dr. Siddhaiah Puranic Road, Basaveshwar Nagar, Bangalor, 560079.