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.