A Case Study to Evaluate the Combined Effect of Shatavari Ghrita Tarpana and Eye Exercises in Pratama Patalagata Timira with Special Reference to Simple Myopia

Introduction

Myopia, commonly known as nearsightedness, is a prevalent ocular condition characterized by difficulty in focusing on distant objects.¹ Despite its widespread occurrence, the mechanisms underlying its development remain complex and multifaceted. It is a widespread ocular condition with significant implications for public health. As the prevalence of myopia continues to surge globally, understanding its etiology, progression, and potential interventions has become paramount. Globally, myopia is the leading cause of distance refractive error, affecting 1.45 billion or 27% of the world population in 2010.² According to the Sight-saving review (1979), myopia is the 4th major cause of visual loss after cataract, glaucoma, and senile macular degeneration. Recent surveys and predictive models indicate a concerning trend in its prevalence and impact. The number of people with myopia is expected to continue to rise both in absolute numbers and as a percentage of the population. Furthermore, myopia is not merely a matter of refractive error; it is also associated with an increased risk of various ocular complications, including retinal detachment, glaucoma, and myopic maculopathy. Exploring the pathophysiological pathways linking myopia to these complications is essential for early detection and management.

As such there is no effective treatment for myopia; only optical correction using spectacles or contact lenses to restore distant vision is advised. Surgical intervention is advised only in condition of stabilized myopia and complications such as dry eye and night glare are common. Moreover, the cost of surgery makes it fearful and less opted procedure. Hence an alternative treatment which is safe, devoid of complications, cost effective, is the need of the hour. Among many efficient formulations mentioned in the classics, this study on Shatavari Ghrita Tarpana and eye exercises was taken up to evaluate its efficacy in the management of simple myopia.

Case Presentation

A 21-year-old female patient visited OPD of Shalakya Tantra, C/O blurred distant vision in both the eyes since one year, which was disturbing her daily activities. This was not associated with watering of eyes or headaches. No history of usage of spectacles was given. No other abnormalities were noted on local and systemic examination.

Family history: Nothing significant

Clinical Findings

Ocular structures- Normal

Fundus examination -  No abnormalities detected

Visual acuity -  Distant vision -  Right eye - 6/12

                          Left eye - 6/12

                          Near vision -Right and left eye - N6

Autorefraction- Right eye - Spherical:  -0.75 D

                          Left eye - Spherical:  -0.75 D

Timeline- The total duration of treatment was 70 days.

Two sittings of Tarpana with Shatavari Ghrita for five days (at an interval of 15 days), with sufficient quantities of Ghritha in the morning before food. Eye exercises were practiced every day, preferably in the morning for 15 days after each sitting of Tarpana (a total of 30 days).³ Two follow-up visits were scheduled in a month. The total study period was 70 days.⁴

Diagnostic Assessment

Subjective parameter assessment was done using a self-formulated grading scale based on perceived improvement (Table 1).

Objective parameters were evaluated using Snellen chart readings and autorefraction measurements (Table 2).

Therapeutic Intervention The details of the therapeutic intervention along with treatment protocol adopted are given in Table 3.

Follow-up

A significant improvement was observed in both subjective and objective parameters. Marked improvement was observed at 1st follow-up visit and the same result was observed after 2nd follow-up. The results of before and after the intervention are given below.

On the first follow-up:

The blurriness of vision in both the eyes reduced from moderate to mild.

Visual acuity changes

                    Rt eye - Improved from 6/12 to 6/9

                    Lt eye - Improved from 6/12 to 6/9

Autorefraction - Rt eye - 0.75 D to -0.50 D

                            Lt eye - 0.75 to -0.50 D

On the second follow-up:

The blurriness of vision in both the eyes remained same as noted at the first follow-up.

Visual acuity changes -

                            Rt eye - Improved from 6/12 to 6/9

                            Lt eye - Improved from 6/12 to 6/9

Autorefraction -Rt eye -0.75 D to -0.50 D

                            Lt eye - -0.75 to -0.50 D

Discussion

Shatavari is one among the Chakshushya dravyas,possessing Madhura thikta rasa, Sheeta veerya, Madhira vipaka, Guru and Snigda gunatmaka guna.⁵ It has Vata pitta hara properties.

Its actions such as, Snehana, Balya, Agnivardhana, Chakshushya and Rasayana gives strength to eyes and stops degenerative process.

Shatavari can be a good and effective option for the treatment of simple myopia. Goghrita has similar properties like Madhura Rasa, Madhura Vipaka, Sheeta Virya and Guru, Snigdha, Yogvahi, Mriduguna. Thus it is Vaatapitta Shamaka. Eye is developed from Majja Dhatu and Ghrita is Meda, Majja, Shukra Dhatu Vardhaka and acts as an eye tonic. Goghrita is also rich in Vitamin A, D, E, K. Vitamin A and E are well known for their antioxidant properties and are useful in preventing tissue damage.

The prepared Shatavari Siddha Ghrita possesses all the above properties. Tarpana means nourishment of eye. It also helps relieve tiredness of eyes, and improves eye sight by providing gentle exercises to the eyes through regular, relaxed closing and opening.

Eye Exercises

Eye exercises have been in practice since ancient times. References to vision-protecting regimens, such as Surya namaskara, can be found as far back as the Vedic period, and these practices continue to be followed today.

Trataka (candle light concentration), explained in yoga shastra is another reference for netra vyayama. Chakshushya regimen like eye wash and palming has been explained in Ayurvedic classics.

In the early 1900s, William Bates controversially asserted that myopia, as with all refractive errors, occurs from a particular type of ‘eye strain’ that was itself a result of ‘mental strain’. He stated that the shape of the eyeball responded instantaneously to the action of extraocular muscles and that myopia was produced due to the contraction of the inferior oblique and superior oblique muscles which lengthened the eye. According to him, myopia is associated with the ‘strain’ in seeing distant objects rather than near ones.

According to Bates, the objective of all methods used in the treatment of imperfect sight without glasses is to achieve rest or relaxation, first of the mind and then of the eyes. He stated that rest always improves vision, while effort tends to impair it. These relaxation exercises have a significant effect on improving visual efficacy.

Eyes require exercises, just like any other part of the body. These exercises strengthen and tones the eye muscles and regularizes blood circulation. Eye exercises help to achieve uniform movements of eyeball, with proper light perception and accommodation of lens, thus providing greater support towards the maintenance of health of eyeball.

Procedure of Tarpana

The eyes are cleaned with sterile cotton dipped in lukewarm water and a concentric boundary is made along the outer orbital margin with the paste of Masha Choorna. Approximately 20 mL (till it covers the tip of eyelashes) of luke warm Shatavari Ghrita is filled in both eyes and allowed to retain in the eyes approximately for 25 minutes (1000 Matrakala) and the patient is allowed to close and open eyes frequently. After the prescribed time, Ghrita is removed by making a hole in the boundary at the lateral canthus of the eye, followed by the removal of boundary. The eyes are then cleansed and Akshibandhana with Malathi pushpa is performed for 30 minutes.

Eye Exercises

Sunning: Sunning involves simply bathing the eyes in sunlight. The right way to do this exercise is to sit or stand facing the sun with the eyes closed, then swing the body gently from side to side like a pendulum for two minutes. This treatment becomes more effective if honey is applied with a glass rod. It relieves strain more quickly. Sunning stimulates retina, abolishes photophobia, clears blood shot eyes, prevents granulation of the lids, and eliminates itching.

Eye wash: The eye cups are filled with a weak solution of Triphala kashaya near to the brim and kept against the eyes gently. The eyes are moved downwards and continuously blinked for two minutes. Eye bath is very effective in toning up the eyes and the surrounding tissues. It helps in relaxation and in improving the eye sight.

Palming: Palming is done by covering the closed eyes with palm (the fingers being crossed over the forehead) without applying pressure on the eye ball. Palming is one of the easy and best methods for relieving strain and securing relaxation.

Shifting and swinging: The patient is instructed to stand in front of a board with a bar-like structure, in a relaxed position, with feet about one foot apart and arms hanging freely. The patient then moves the body from right to left and vice versa, while raising the heel of right foot and vice versa, alternatively, for 30 times. The eyes and the sight are kept following the movements of the head and the patient should blink at each end of the bar. The patient will observe the bars moving in the opposite direction.

Candle flame concentration: The patient is made to sit facing the candle flame about one foot away and gently move the body forward and backward with the rhythm of respiration. While keeping the sight focused on the flame, the patient is asked to count 25 to 100 respirations. The flame stimulates the retinal cells, improves blood circulation and gives feeling of comfort, rest and relaxation.

Game of  ball: This exercise improves the accommodating ability of the eyes. It is done by throwing the ball from one hand to the other. One should follow the ball movements and blink after each catch. This should be done for 10 minutes.

Cold pad: Dip two cotton pieces in cold water and place them over the closed eyes for 10 minutes. This gives relaxation to the eyes.

Conclusion

In conclusion, the treatment of simple myopia with Shatavari Ghrita Tarpana and eye exercises was successful in improving the visual acuity and providing symptomatic relief for the patient in this case study. Continued monitoring and research are essential to optimize treatment strategies for myopia management. A key limitation of this case study is the relatively short duration of follow-up. Long-term monitoring of the patient's myopia progression would offer valuable insights into the stability of the condition and the sustained effectiveness of the treatment approach.

Patient Perspective

The patient was happy and satisfied with the results of the treatment.

Conflict of Interest

NIL