AGE RELATED MACULAR DEGENERATION

• A degenerative disease of the retina typically leading to central vision impairment caused by deposits under the retinal pigment epithelium( in dry AMD) or neurovascularization in the subretinal space (in wet AMD) and in rare cases leads to complete blindness 
• Age-related macular degeneration (ARMD), also called senile macular degeneration, is a bilateral disease of persons over 50 years of age. It is a leading cause of blindness in developed countries, in population above the age of 65 years. It is of two types non exudative and exudative

Multi factorial – Various molecular consequences of ageing

Risk factors

• Advanced age
• Family history and genetic predisposition
• Cardiovascular disease
• Smoking
• Obesity

• Gradual loss of ability to see objects clearly
• Shape of objects appears distorted (Metamorphosia)
• Straight lines look wavy or crooked
• Loss of clear colour vision
• A dark or empty area in the centre of vision usually affects both eyes in adults over age 50 might be a case of macular degeneration

 Non-exudative or atrophic ARMD

• It is also called dry or geographic ARMD and is responsible for 90% cases

Symptoms

• Mild to a moderate, gradual loss of vision
• Visual impairment is slow and progressive (usually over decades) with unilateral or bilateral onset

Signs

• Early-stage- The occurrence of macular drusens , Focal hyper pigmentation and pale area of Retinal pigment atrophy (RPE atrophy)
• Intermediate stage - Sharply circumscribed circular areas of RPE atrophy with variable loss of choriocapillaries along with drusens
• Advanced stage - Enlargement of atrophic Areas

Exudative ARMD

• It is also called wet or neovascular ARMD, acute or insidious onset(over weeks to months) and usually manifests in one eye first
• Drusens with retinal pigment epithelial detachment
• Choroidal neovascularization
• The haemorrhagic detachment of the neurosensory retina

• Fundus Fluorescein Angiography- Choroidal Neovascularization
• Amsler grid - Detection of metamorphosias and scotomas
• Optical Coherence Tomography (OCT) - retinal pigment atrophy (RPE atrophy), helps confirm diagnosis of wet AMD

Non-exudative ARMD

• Currently, there is no effective treatment that stops the progression of dry ARMD
• Dietary supplements and antioxidants
• Smoking cessation

Exudative (neovascular) ARMD

• Intravitreal anti-VEGF therapy
• Photodynamic therapy (PDT)
• Surgical treatment

Ayurvedic Treatment

• ARMD – krichasadya roga as it is an age-related degenerative disease
• Wet ARMD – since there is bleeding, Retinopathic measures can be adopted
• Dry ARMD – Dietary supplements, Cataract treatment

Internal medicines

• Triphala gritha + Triphala choorna+ honey
• Indukantha gritha
• Chyavanaprasa
• Chandraprabha gutika

Procedures

• Jaloukavacharana – on forehead
• Bidalaka – Mukkadi ( in wet type)
• Sirodhara – ksheerabala, Dhanwantara taila
• Nasya - Ksheerabala 101 avarthi
• Tarpana - Jeevaneeya gritha