Age related macular degeneration and homoeopathy

Dr Ananthakrishnan VA

ABSTRACT
This work is about macular degeneration of eye and how to approach homoeopathically. Most of the homoeopaths send such cases directly to the specialists without knowing the effectiveness of homoeopathic remedies in managing the case.So this article will help in brushing up the knowledge regarding the condition as well as homoeopathic perspectives.

Abbreviation : ARMD – Age related macular degeneration.

Key words : constitutional remedy, miasm, predisposition, diathesis.

Macular degeneration is a pathological condition that occurs in macular area of retina. The macula is that area of retina responsible for the central vision or that which gives us the greater details in our vision. The pathological changes primarily occurs in choroid (vascular layer of the eye which lies in between sclera and retina) and pigmented retinal epithelium (PRE – the layer that separates choroid from retina). This may lead to accumulation of fluid, hemorrhage and scar tissue. Then loss of central vision occurs, but this rarely leads total blindness because the peripheral vision will be preserved. Macular degeneration usually affects people over the age of sixty-five, but certain hereditary conditions may cause it to develop in younger people. Persons over the age of seventy-five have a thirty percent chance of developing it. It usually affects people with less complexion than in people with dark complexion, due to less pegment in retina. It affects men and women equally. People who are nearsighted (myopic) have a greater tendency of developing this condition.

Symptoms of ARMD
When a patient has ARMD, the center of the visual field gets fainter and fainter until it becomes hard to see objects in the center of the visual field. The first thing most people will experience is lessening of their sight as they look straightahead at things, like the printed word, faces or clocks. This could be a dimming, a blurring, or actual “holes” or black spots in the vision. Extreme light sensitivity and poor night vision also precede ARMD in many cases. Light-to-dark adaptation becomes very slow.

Macular degeneration rarely leads to total blindness. Instead, worsening symptoms including a loss of central vision and a diminished ability to see things straight ahead. People with ARMD will rely more on peripheral vision. Sometimes, in the early stages, there are holes in the vision, called scotoma. Most people with ARMD become unable to drive and are eventually declared legally blind.

Types of macular degeneration

• Dry Stage of Macular Degeneration
• Development of Drusen
• Degeneration of Retinal Pigment Epithelial Cells
• Wet stage of Macular Degeneration
• Breaks in Bruch’s Membrane Leading to Growth and Leakage of Blood Vessels
• Absorption of Blood with the Development of Scar Tissue

MANAGEMENT
Many studies have shown that the antioxidants, Vitamins A, C, E, Zinc and Selenium can retard the progression of this disorder. One of the treatments for wet ARMD uses laser surgery to cauterize the leaky blood vessels. This measure may preserve more vision in the long run, but usually results in worse vision in the short run because healthy tissue is almost always destroyed along with the diseased vessels. Laser treatments are only indicated for the wet type of degeneration and in fact only a small percentage of patients with the wet type will actually qualify for laser treatment.

HOMOEOPATHIC MANAGEMENT
The constitutional approach works best, the goal being to find the remedy for the totality of the case. When the remedy is not clear or the patient is not willing to undergo constitutional treatment, sector remedies can be used.

Rubrics for Macular degeneration:

• INFLAMMATION – Choroid
• EYE – INFLAMMATION – Chorio-retinitis
• EYE – ATROPHY – CHORIOD, Atrophic spots
• EYE – INFLAMMATION – Retina – pigmented
• EYE – INFLAMMATION – Retina – punctata albescens
• EYE – INFLAMMATION – Retina – syphilitic
• EYE – INFLAMMATION – Retina
• VISION – DIM VISION – FOGGY
• VISION – LOSS OF VISION – vanishing of sight
• VISION – LOSS OF VISION – colors, for
• VISION – SCOTOMA
• VISION – SCOTOMA – central

Constitutional approach along with the evolved miasm works tremendously. The exudative type of degeneration represents sycotic miasm. The dry or atrophic type of macular degeneration represents the syphilitic miasm. The earliest presentation with minimal pigmentary changes and a loss of the foveal light reflex represents psoric miasm. Pre disposition, disposition and diathesis should be considered while working out with miasm and consititution. This can lead us to proper similimum in a right manner.

In last stages we can go palliative mode of treatment which can give slight relief from the symptoms.

THERAPEUTICS

• BENZENUM DINITRICUM

The most obvious result of poisioning by skin absorbtion are changes in RBC and liver degeneration in amblyopia, colour blindness, retinitis. Field of vission contracted. Black urine.

• IODOFORMIUM

Pupils dilated ; Contract unequally, react poorly. Diplopia. Failing sight due to retrobulbar neuritis, central scotoma-partial atrophy of optic disc.

• CARBONEUM SULPHURATUM

Myopia, asthenopia, and dis-chromotopsia, cloudiness and atrophy of optic disc and central scotoma for light and for red and green and not for white. Optic neuritis advancing towards atrophy. Arteries and veins congested. Retinal congestion ; Optic disc pale. Everything seems in a fog. Vision greatly impaired. Color-blindness.

• BRYONIA

Pressing, crushing, aching pain. Glaucoma. Sore to touch and when moving them. Mucous membranes are all dry.

• GELSEMIUM

Ptosis; Eyelids heavy, double vision , vision blurred and smoky. Dim sighted , orbital neuralgia, with contraction and twitching of muscles. Serous inflammations. Detached retina, glaucoma and descemetitis. 

CONCLUSION
Homoeopathy can effectively work in eye affections. But most of the physicians refer the patients to specialists without even analysing the case. If we are well aware with pathology, we can analyze the prognosis and manage the case ourselves without complications. Constitutional remedy selected inconsideration with miasm can work well in managing ARMD. 

Reference

1. Comprehensive ophthalmology. A.K Khurana,6th edition
2. Essentials of Opthalmology. Neil J Friedman, Peter K Kaiser
3. Sythesis repertory. Frederik Schroyens, 9th edition
4. Sathye, Sandeep. (2017). Effect of Homoeopathic Rutagraveolens followed by an Individualised treatment on progression of Simple Myopia. Advancements in Homoeopathic Research. 2. 27-35.

Dr Ananthakrishnan VA
PG Scholar
Father Muller homoeopathic medical college, Mangalore