Many homeopaths are reluctant to treat age related macular degeneration for several reasons. First, there is a poor understanding of the pathology and its affect on the visual system. Second is the belief that only a specialist should treat this serious disorder, and lastly is the belief this condition will not respond to homeopathy-it is an incurable state.
Since there is no effective allopathic treatment, why not try homeopathy? The homeopathic treatment of macular degeneration is a unique opportunity for homeopaths. I would like to share my experiences using homeopathy in the treatment of this disorder.
Definition of Age Related Macular Degeneration (ARMD)
Macular degeneration is a pathological condition that occurs in the macular area of the retina. The macula is the area of the retina responsible for central vision or that which gives us the greatest detail in our sight. The pathological changes primarily occur in the choroid (the vascular layer of the eye which lies between the sclera and the retina) and pigmented retinal epithelium (PRE – the layer separates the choroid from the retina). These changes may lead to fluid accumulation, hemorrhage and scar tissue. Loss of central vision occurs, but this rarely produces total blindness because the peripheral vision is preserved. Macular degeneration affects thirteen million Americans. Most of them are over the age of sixty-five, but certain hereditary conditions may cause it to develop in younger individuals. Persons over the age of seventy-five have a thirty percent chance of developing it.
ARMD; it rarely affects anyone younger than fifty-five years old. Caucasians tend to develop it more than persons of pigmented skin, due to the fact they have less pigment in the retina, especially if they have blue, gray, or green eyes. It affects men and women equally. People who are nearsighted (myopic) have a greater chance of developing the condition as do people who work or spend a lot of time out of doors and are exposed to ultraviolet radiation from sunlight.
Symptoms of ARMD
When a patient has ARMD, vision in the center of the visual field gets fainter and fainter until finally there is hardly any way to see objects in the center of the visual field. The first thing most people will notice is a lessening of their sight as they look straight ahead at things, like the printed word, faces or clocks. This may 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, for example, the ability to find a seat in a movie theater, is also apt to be very slow.
Macular degeneration rarely leads to total blindness. Instead, worsening symptoms include a loss of central vision and a diminished ability to see things straight ahead. People with ARMD will rely more and more on peripheral vision. Sometimes, in the early stages, there are holes in the vision, called scotoma. These are areas where you cannot see anything. Most people with ARMD become unable to drive and are eventually declared legally blind.
Types of ARMD
There are two main types of macular degeneration, wet and dry.
The dry or areolar type consists of degeneration of the retinal pigment cells resulting in drusen (described below) and hyper and hypopigmented areas in the retina with loss of rods and cones and generalized atrophy. Dry ARMD, which affects ninety percent of persons with ARMD, results from a buildup of cellular waste product called drusen, in the back part of the inner eyeball where the retina and macula are. Drusen is from the German word druse meaning bump or gland. It refers to the earliest changes that are observed in ARMD. A drusen or bump develops on Bruch’s membrane. This occurs when the retinal pigment epithelium becomes overloaded with undigested discs from the cones. This material collects on Bruch’s membrane producing thickened areas.
The wet type or exudative type presents as vascular leakage with exudates and a detachment of the retina with loss of vision. In addition when the retinal pigment epithelium becomes overloaded, the RPE cells begin to degenerate. Debris begins to accumulate at the base of these cells. These cells lose their attachment to Bruch’s membrane and fluid begins to accumulate under the cells. Soon there are breaks in Bruch’s membrane leading to growth and leakage of blood vessels from the choroid. This leakage and new blood vessel growth into the retina lead to the wet stage of macular degeneration. A small percentage of these cases can be treated successfully with the argon laser. There is another type of wet macular degeneration that occurs in people who are diabetic. This results from leakage of small blood vessels, which leads to fluid accumulation under the retina and loss of central vision.
Summary of the 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
There have been many studies that 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.
Macular degeneration can be treated homeopathically just like any other disease state of the body. 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, a more lesional approach 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
I first try to uncover the miasm stages in these cases to limit the remedies under consideration. The exudative type of degeneration represents the sycotic miasma. The dry or atrophic type of macular degeneration more commonly represents the syphilitic miasm. Psoric Stage – This is the earliest presentation with minimal pigmentary changes and a loss of the foveal light reflex. The foveal light reflex is produced when healthy cones reflect the light, which enters the eye. As the cells become weakened with age and disease, they loose this ability to reflect light. Sycotic Stage -There is a hyperproliferation of tissue in the macular area. This can manifest as excessive pigment which has the appearance of dark pepper like specks in the macular area. Another presentation can be that of drusen. These drusen cause a weakening of the retina and can lead to death of the photoreceptive cells. This weakness can also cause tiny blood vessels to grow into the retina. These vessels can leak fluid or bleed and cause a sudden loss of vision (wet macular degeneration). Syphilitic Stage – There is more destruction of tissue with atrophy and destruction of the retina.
Description of lesion
Characteristics of the macula can be very useful in remedy differentiation. Is the lesion wet or dry? Is there hyperpigmentation or hypopigmentation? What color is the exudate? Yellow, white, or orange? Is there blood present? What color is the blood? As an ophthalmologist I have the unique ability to observe the changes inside the eye and to use these physical findings to help select the remedy, but you can ask the patient to bring in retinal photos of the macular degeneration so you can study these characteristic features. I often will look at the Skin and Generalities sections as well. Some rubrics that I have found to be helpful in treating macular degeneration are:
SKIN – CICATRICES
SKIN – DISCOLORATION
SKIN – EXCRESCENCES
SKIN – ERUPTIONS
SKIN – FRECKLES
SKIN – INFLAMMATION
SKIN – WARTS
GENERALS – ARTERIOSCLEROSIS
GENERALS – ATROPHY
GENERALS – HEMORRHAGE
GENERALS – INDURATIONS
GENERALS – INFLAMMATION
GENERALS – STASIS of the venous system
GENERALS – TUMORS
Remedies that have an affinity to the eye
Some prescribers have had experience with a more lesional approach to this disease. I use this approach when the patient is not interested in undergoing constitutional treatment.
Tissue salts can also be useful in the treatment of macular degeneration. The following salts have been helpful in the treatment of ARMD:
Calc flourica 8X – The tissue strengthener.
Calc phosphorica 6X – The cell builder.
Kali phosphorica 6X – Nerve nutrient.
Natrum muriaticum 6X – The fluid distributor. Dryness or excessive moisture in any parts of the body. Can be helpful in cases of wet macular degeneration.
Carboneum sulphuratum – Andrew Lange, ND, has reported success in early macular degeneration using Carboneum sulphuratum. He uses 30C everyday and has seen resolution of drusen and pigmentary changes.
Secale – Dr. Johann A. Miller has had good success with Secale in the treatment of macular degeneration. Secale is used in low potency when the patients have some general signs compatible with Secale such as, being worse from heat and better from cold.
Sanicula and Vanadium – Dr. A. U. Ramakrishnan has used Sanicula in cases of macular degeneration with the symptom of wavy vision. He has also used Vanadium 200C every month for the treatment of macular degeneration.
Sarcode – Human retina 5C: Max Tetau has reported the affects of 5C, 7C and 9C sarcodes on the tissue that was prepared. 5C Stimulates activity of the tissue from which it was derived. 7C normalizes tissue activity and 9C suppresses tissue activity.
Human retina 5C has been used with some success in stimulating the activity of the failing macula.
DS 76 year old female
Prominent look of suffering on her face during the interview.
Recent episode of a hypertensive crisis with a reading of 220/146, she is very anxious about getting her vision back and has had over ten laser treatments in both eyes. She is worried about the future and what will happen. She needs more information. She needs the information so she can do whatever will help her. She has to be sold on this approach; she is a skeptical person.
She sleeps with the light on all night. She was robbed as a child and has a fear of robbers. She is afraid that a man will come up through a trap door. Her parents’ home was large with fourteen rooms. She and her sister would take turns staying up at night. She has a fear that someone is in the room. She is on guard all the time. She sleeps facing the door on her left side. She also has a gun; a small ladies gun which is loaded. She will sleep for a couple of hours and then wake at 2:00 to 3:00 AM. The fears are worse when she is alone. She stayed up all night when her husband was in the hospital. She could solve this problem if she had a dog. The dog would be on guard instead of her.
Physical exam 5/100 right eye, 5/10 left eye Cataracts Central scarring in right eye from laser treatment Retinal pigmentary changes with large drusen (Tumors/Warts) in left eye
Diagnosis: ARMD Cataracts Hypertension Anxiety
FACE – EXPRESSION – suffering
MIND – FEAR – alone, of being
MIND – ANXIETY – health; about – own health; her/his
MIND – ANXIETY – night
GENERALS – TUMORS
She escapes by reading books about the simple life. Small town, a quite place, the neighbors visiting each other. She likes the feel of soft clothes. Desires creature comforts. She wants a simple dog, a dog to stay on guard at night. There are many aspects of Calcarea carbonica in her story with issues of security in the home, enjoying the simple pleasures of life. There is also the fear and anxiety element of Arsenicum album.
Plan: Calcarea arsenicosum LM1
Follow up one year later: It took her 2 months before she started the remedy because she had a strong fears of an aggravation. She feels good. Lots of energy. She can relax easily. She has a lot more energy in her business. She is getting a lot of compliments on her skin since taking the medication. Her fears are greatly improved. She does not have the fear of being robbed. Her fears at night have greatly improved. Happier and more relaxed. Her vision has improved two lines on the chart. Physical Exam: 5/100 in the right eye, 5/10 in the left eye.
RR 78 year old female
Chief complaint is macular degeneration, cataracts and a balance problem.
She has noticed her vision decreasing since her last eye exam when she was told that she had macular degeneration and cataracts. Vision is very dim and she has trouble reading. The vertigo comes on suddenly and she then goes down like a rock. Room spins from left to right. She is debilitated. She is like a quivering old lady. She is so weak that her arms and legs shake. Twice it happened at 7:00AM when she woke up from bed. She pulled herself up with great effort. She lives in fear that this attack will come back again when she is under stress. She works as a real estate broker. When she is in a stressful conversation she can feel her balance leave her. She feels that the bottom is dropping out of her stomach and she experiences light-headedness. She has also developed ringing in her ears associated with the vertigo.
An important aspect of her life was ballroom dancing which she did with great dedication. She is very depressed because now she can’t compete. She feels hopeless and withdrawn. Her sexual drive was never very high and she is not in a relationship. She states there is a lot of sexuality in dancing. She enjoys the provocative aspects of the Latin dancing.
Physical exam: 20/300 right eye, 3/100 left eye. Advanced cataracts in both eyes. Myopic degeneration with atrophic changes in her retina.
Diagnosis: ARMD, Vertigo, Cataracts.
EYE – CATARACT
VERTIGO – ACCOMPANIED by – staggering
VERTIGO – SUDDEN
EAR – NOISES in – ringing
MIND – DANCING
FEMALE GENITALIA/SEX – SEXUAL DESIRE – diminished
According to A. B. Norton in his article “The Homeopathic Treatment of Incipient Senile Cataract, with Tabulated Results of One Hundred Cases“, Sepia is the number one remedy to think of in females with advanced cataracts.
Plan: Sepia LM1
Eight month follow up: She can read the menu. She’s had a seventy percent improvement in her vision. Street signs are becoming clearer – colors are vivid. No more dizziness – stronger and confident walking. No more ringing in her ears. PE – vision is now 20/200 OU.
EA 78 year old female
Two years ago, she developed cloudy vision in the left eye where her vision became very dim and letters began to run together while she was reading. One of the biggest difficulties in her life has been her relationship with her daughter. “She has cut me off from the family. She will not return my letters and she will hang up the phone when I call. It is such a big disappointment in my life.” “She has told lies about my husband and I. You know mother, you are a slob. I wanted to cry but I could not cry. How could she be so hurtful? We could go for hours not talking to each other.
My daughter would not appreciate anything that I did. I wanted to tell them to ‘go to hell’ but I did not because I did not want to exacerbate it.” “I blow and get angry very quickly. Sometimes a silly little thing will irritate me. I was eating my salad and they brought out the main course. It was cold and I became extremely upset.”
Physical exam: Retinal pigment atrophy in the left eye. Vision 10/10 right, 1/70 left eye
Diagnosis: ARMD Hypertension
MIND – CONTRADICTION – intolerant of contradiction
MIND – ANGER – trifles; at
MIND – ANGER – violent
CHEST – PALPITATION of heart – anger
VISION – RUN together – letters
Plan: Staphysagria LM1
Seven month follow up: Peripheral vision is better on left eye – the right she has noticed an overall improvement. Colors are much brighter, she has a dress that she thought was gray and now it looks lavender! She is not getting angry as easily or as often. She called her daughter and asked her if she wanted to meet her-she said yes. It was a good meeting, at the end she said that they had wasted three years. Vision has improved three lines in the left eye: 10/10 in the right eye 1/40 in the left eye Homeopaths should not view macular degeneration as an incurable disease. I hope that all homeopaths will welcome the opportunity to help people who are suffering from the effects of macular degeneration. Do not tell them what so many eye doctors have told them: “Nothing can be done.” Homeopathy can help, so begin to look for the simillimum that will improve their vision and their life.
Dr. Edward Kondrot, MD(H),CCH, a board certified opthalmologist, is recognized as a pioneer in the use of homeopathy for eye conditions and is director of the Healing the Eye and Wellness Center in Arizona. He is author of “Healing the Eye the Natural Way: Alternative Medicine and Macular Degneration” , “Microcurrent Stimulation: Miracle Eye Cure”, and Homeopathy and Eye Disease (Audio Tape).
Visit him at his website at http://www. homeopathiceye.com