Myopic Macular Degeneration

What Is Myopic Macular Degeneration?

As I stated in the beginning, one of the ways I wanted to use this blog was to educate people about pathological myopia and myopic macular degeneration, and giving a general overview of the basics seems like a good place to start.

Note: I am not a doctor, nor do I have any medical training outside some very basic biology classes in high school and college, and they were never my strong points. Please do not use this website to diagnose yourself, it is strictly me speaking about my personal experiences with the addition of a bit of research.  This article published in November 2017 by the American Academy of Ophthalmology was the primary resource I used for some of the more medical information in this post and if you are interested in reading in more detail, I strongly recommend it: Myopic Choroidal Neovascularization.

What is Myopic Macular Degeneration?

Myopic Macular Degeneration is a retinal disease that impacts the macula, the part of the eye which controls detailed and central vision.  It is really a shortened way of describing the condition, which medically is known as myopic choroidal neovascularization, secondary to pathological myopia.  That is a quite a mouthful though, so MMD it is. Myopic macular degeneration shares a lot of similarities with age-related macular degeneration (AMD) in terms of symptoms and treatment, but rather than being a result of getting older, it’s caused by the strain put on the retina in those who have an extreme form of near-sightedness. If you’ve never heard of MMD, you’re not alone – I did not know what it was until I was diagnosed. It only impacts about .035% of the US popular, and is slightly more common in women.

If you don’t have much time and want the simplified version, this video from the pharmaceutical company Novartis does a good job at providing a succinct overview of myopic choroidal neovascularization (CNV).

 

Cause of Myopic Macular Degeneration

As the name indicates, this condition affects people who suffer from a severe form of myopia,  or near-sightedness, which is caused by the elongation of the eye.  For those of you who may be wondering if your vision puts you in the category or someone who may be at risk of developing MMD, let’s take a look at the numbers.

If you have received a glasses or contact prescription from an optometrist or ophthalmologist in the past, the power of the lens needed to correct your visual acuity to 20/20 will be measured in a unit called diopters. The larger the number, the higher the strength of your prescription.

  • Mild myopia includes powers up to -3.00 diopters (D)
  • Moderate myopia, values of -3.00 to -6.00D
  • High myopia is myopia over -6.00D
  • Severe myopia is is myopia exceeding -10.00D

When a person reaches the point of having severe myopia, they are then at risk of developing what is known as degenerative myopia or pathological myopia (leading me to sometimes refer to myself as a pathological degenerate, but I also have an odd sense of humor).  When I was diagnosed, my prescription was around -18 in my right eye, -22 in my left eye.

Glasses of someone with myopic macular degeneration on a black table next to a quarter with the lenses width almost the same as the coin.
My glasses are heavy, y’all

In pathological myopia, the retina and other layers at the back for the eye become so thin that the cells in the retina can die slowly. This leads to atrophy and a slow decline in central vision and increases the likelihood of cracks or tears in the retina.  About 5% of people with pathological myopia will start to develop abnormal new blood vessels underneath the macula, and if those blood vessels begin to leak, a person will be diagnosed with  myopic choroidal neovascularization/myopic macular degeneration.

Symptoms of Myopic Macular Degeneration

Three grids side by side showing potential symptoms of someone with myopic macular degeneration, including dark holes or spots, blurring, and curvy lines.

While age-related macular degeneration and myopic macular degeneration share a lot of similarities, the one of the differences I’ve learned about with regards to symptoms is that myopes (as my doctor calls us) experience two different types of bleeds.

Benign Bleeds

The strain on the retina caused by severe myopia can cause cracks in the retina, referred to as lacquer cracks due to their shape, and occur in approximately 5% of highly myopic individuals.

Scan of the inside of Theresa's eye, with white lines showing myopic macular degeneration symptoms.
The white lines in this image of my retina are the lacquer cracks in my right eye

Occasionally small amounts of blood can get through these cracks, causing what appears in the vision to be a small shadowy area. Visually, it appears as the holes or blurring on the grids in the image at the top of this section, but rather than being in the most central part of my vision, they are typically slightly off-center.  My doctor refers to these blood spots as benign or innocent bleeds because although they cause temporary disruption to my vision, they will eventually resolve themselves on their own without treatment and do not leave any lasting damage.  They’re more annoying than anything, and occur in my vision quite frequently. I almost always have at least one benign bleed in my eye at a time. The farther away these shadows are from my central vision, the more confident I feel going into an appointment that it will be determined to be a benign bleed.

Active Bleeds

Myopic Macular Degeneration OCT Scan comparing the current and previous appointment.
Top scan shows previous month with no bleeds, bottom was following month with myopic CNV

My doctor has termed the occurrence of choroidal neovascularization as an “active” bleed, since it occurs when the abnormal blood vessels growing under the macula have started to hemorrhage fluid into the eye. This causes large areas of distortion in my central vision, causing everything to look warped, as seen in the “curvy lines” grid in the image at the top of this section.  This area of distortion will continue to grow and worsen until treatment is received, and as the fluid grows more dense, it can create a blind spot in the vision.  Left untreated, the leakage from these blood vessels will continue to grow and increase the likelihood and size of scarring on the macula, leaving permanent damage to the vision.  

Both active and benign bleeds are unpredictable; there are no indicators that one is oncoming until you start to notice changes in your vision, so as soon as something seems out of the ordinary, CALL YOUR DOCTOR. I have monthly appointments scheduled, and I’ll still call to have someone see me, even if I was just there a few days earlier.  

Permanent Distortion

The scar tissue the develops on the macula both as a result of the retinal atrophy and growth of blood vessels caused by myopic CNV is the cause of the permanent distortion in central vision that significantly deteriorates vision in those with MMD.  It decreases an individual’s visual acuity, which makes things such as reading, identifying faces and anything that requires seeing in detail more difficult.  As the scarring and atrophy become more and more severe, that is when a person is at risk of becoming legally blind.

Light Sensitivity

One of more mild, but still impactful, symptoms of pathological myopia is photophobia, or an increased sensitivity to light.  This both takes the form of being uncomfortable when confronted with bright lights and having difficulty adapting to changing light levels.  Although it may not seem as significant as retinal bleeds or macular scarring, photophobia can still cause people to have to make drastic changes to their day-to-day living; in my case, I had to make the choice to no longer drive at night because of the difficulty I have with the headlights of other vehicles.

Treatment for Myopic Macular Degeneration

If you are squeamish, skip right on down to the next section, Long Term Prognosis.

A pair of yellow rubber gloves next to long cotton swabs, and a bottle of Betadine.
Treatment Preparation

Currently, the most common form of treatment for myopic macular degeneration is injecting one of three drugs directly into the eye: Lucentis, Eylea or Avastin.  These drugs bind to the proteins that are responsible for the growth of abnormal blood vessels to slow and stop their growth.  Depending on the severity of the bleed, injections may need to be administered several months in a row, but frequently for myopic CNV they can be cleared up after one injection.  Prior to treatment, your doctor will numb your eye (mine uses a combination of drops and gels) so you will not feel anything aside from a slight amount of pressure. My doctor also uses a lot of betadine to help prevent any potential infection. In my personal experience, the stinging from the betadine is wayyy more unpleasant than the actual injection.

There is not currently any way to prevent the growth of these abnormal blood vessels or to reverse the scarring on the macula that they cause, which is why it so important to CALL YOUR DOCTOR if you notice any changes to your vision so they can treat you immediately, if necessary.

If you made it through reading about the treatment for MMD (and for anyone who made it to the end of this massively long post), congratulations! Here’s a pup-rito!

Gif of a small dog grabbing a blanket in its mouth and rolling itself up like a burrito.

 

Long Term Prognosis

Unfortunately, this is the part of the post where I shrug a little bit. The injections used to treat CNV were only approved by the FDA 10-years ago.  Combined with the limited number of people diagnosed with MMD and how unpredictable this condition can be, there’s no real timeline to determine “your visual acuity declines at a rate of X per year, and Y years after a diagnosis is when you may be considered legally blind.”  Approximately 35% of individuals diagnosed with MMD in one eye will develop it in their other eye within an 8-year period; it took about 3.5 years for that to happen to me.  I happen to have a fairly active form of myopic macular degeneration and will have an active bleed every couple months; I’ve spoken with some people who go years between occurrences. It’s true about all things in life, but this is definitely a condition where everyone is different and why I consider it to be so important to find a retina specialist that you trust is giving you the best care possible and continually informing you about the prognosis of your condition and any new forms of treatment that may be available along the way.

Currently, there are a number of clinical trials in progress to find a way to reverse the visual distortion caused by scarring on the macula, and several of them have had encouraging results. I remain hopeful that during my lifetime treatment will be available to either reverse the vision loss caused by macular scarring or to prevent active bleeds before they happen.

Leave me a note in the comments or send me an email and let me know any aspects of myopic macular degeneration or how I live with it you’d like to know more about! I have a few things in mind for future posts relating to it, but I’d love to know if there is anything specifically you want to know!

Theresa is a Maryland native who is grateful to only be a 2-hour flight from Walt Disney World. She loves exploring new locations & cuisines, and can beat anybody in a game of “Oh! You know what else that actor was in?” Although myopic macular degeneration is deteriorating her eyesight, it hasn’t dampened her spirit or sense of humor; she likes to tell people this simply makes her a “temporary visionary.” Visit About Theresa to learn more or send an email to insightfulllife@gmail.com!

17 Comments

  1. Hey Theresa! You are adorable. I think we will be very good friends.
    My mom had thick glasses her whole life and only until she had a surgery or two was she able to see better. She did have macular degeneration too but technology wasn’t available yet. We actually thought she looked great with glasses.
    I cannot wait to play the movie game of “Kevin Bacon” with you. Though I’m better at movies made before 1950.

    • Theresa Reply

      Thanks for commenting! Whenever I get frustrated, I do try to keep reminding myself that I am fortunate to have been diagnosed after a treatment had been developed, since I know the condition progressed so much more quickly before then.

      And I’ve watched my fair share of early movies, although typically for the black and white ones I’m not as sharp with remembering actors names, just recognizing what other characters they’ve played.

      So happy to have you here reading along and chatting with me!

    • Hi! I was diagnosed about 5 years ago with pathological myopia around age 30. It was initially just the atrophy and lacquer cracks, which made my vision less correctable. Then about 3 years ago I experienced bilateral CNV about 1 week apart. Did the suggested 3 shot course and CNV reoccurred about 4 months after my last shot. Since then they set me on a course extending 2-4 weeks at a time. This January I had very significant bilateral CNV recurrence 10 weeks post injections. I had had small ones here and there.

      Now my new schedule is 2 months indefinitely because the medication doesn’t work as well as they hoped. However, I’ve been switched from Avastin to Eylea because it had better long term outcomes. They were the same at one year, but Eylea had a lesser rate of recurrence 2 years out. It’s a relatively new published study. But I’m kind of hopeful.

      My myopia is continuing to worsen rather rapidly though, and it just makes it all worse.

      I do find it interesting that most people I’ve read about or talked to have prescriptions quite a bit stronger than mine. I think my worse eye was at about -12 when I got CNV the first time. It just shows how variable it is in each person I think!

      Its always nice to read about others experiences because it’s rare to come across. My doctor is in a major metro area, and it’s a large eye clinic, but I’m the only person with this they are treating(they have AMD patients though). My ophthalmologist hadn’t even seen it before in person. I don’t think my retina doctor had eyether! 😉

      Well it’s been a few years since this article, and I hope things have been good for you. Or at least as good as they can be.

  2. Thanks for sharing your blog on Facebook! You and P have completely different retinal diseases…but the similarities in your journeys are comforting. Thank you for sharing yours. 💚💚

    • This is really a very helpful article for me. i am 25 and was diagnosed with myopic macular degeneration about 3 years ago. At first, it affected my right eye but now I have MMD in both the eyes. It’s really very frustrating because of the dearth of information on the topic and also because of the uncertainty that any time bleeding may occur. Hopefully there will be a better treatment available in near future. Thankyoh very much for the article. Please keep up updated.

  3. Hi Theresa. Thank you for creating this blog. I’m another fellow degenerative “myope”. I’m 45, -21 both eyes plus a little astigmatism in the right one. I’ve recently been told I have posterior staphylomas and lacquer cracks in both eyes with significant choroidal thinning in the right eye. I haven’t had any CNV yet in either eye but with these recent findings I know it’s only a matter of time…:(

    I see you mention what your eyes are currently correctable to but I’m wondering what your eyes were correctable to before your first CNV episode? Do you feel the anti-VEGF shots are helping to stabilize your vision?

  4. Naveed ul haq Reply

    I am hiigh myopic with – 17 in my right eye & – 15 in my left eye.I had an retinal detachment in my right eye & had surgery & been left with submacular scaring which makes everything look distorted & my right eye was my independent eye.Which I had myopic Cnv & was assaulted & which lead to submacular hamrioge.I had 3 injections & I had 2 retinal tears which I had laser surgery.But now I have submacular scaring in both eyes & been registered partially blind.Whicj I have lost my driving independence & I have lost my employment as I was driving for a living.I have done a lot of research for submacular scaring remedy.Bit there is no cure in the world.I hope during my life time they find a cure.As I have little children who have lost father who was full of life & independent.

  5. Naveed ul haq Reply

    My name is Naveed ul haq I live in the uk.I was diognosed with myopia from the age of 8 as I couldn’t take the sun light & my father notified my teacher & my I teacher referred me for an eye test & I started wearing glasses.During my teenage days my prescription got worse every year.By the time I was 17 I was -17 in my right eye & – 15 in my left eye which was very worrying & embracing with coke bottle glasses.So when I started college I started wearing control lenses which gave me a lot of confidence.As I got to my twenties my eye sight deteriorated.So from soft lenses i started wearing gas permeable lenses which improved my eyesight
    & I passed my driving I gave me a lot of freedom & independents.By the time I was 25 yeas of age I had an retinal detachment .I went to spec savers & the opticians advised it was an allergic reaction & gave me some eye drops & told me to come back after 4 weeks.When I went back after 4 weeks they told me it was a retinal detachment and referred me to the eye hospital.Which I had to go through an eye surgery and was left with submacular scaring & was advised that I have lost my central vision.After that I had one independent eye which gave me my freedom.As I got older to my age of 43 my left eye became cloudy & was diognosed with a catract.So me and my Opthamolist decided to have an AOL implant.Whilst waiting for surgery my Good eye became blood shot red I thought it was my contact lenses After 2 days I was assaulted & thrown down some stairs which caused a submacular hamrioge and Opthamolist advised me that you had myopic macular degeneration & the assault made it worst.So he said you have an retinal tear which we will laser together & you need to have 3 lucentis injections but you a submacular scar right in the middle of my macular and registered me partially blind.So I lost my job and my driving independence.Which lead me with severe PTSD and clinical depression.The reason being as I was advised that there is no cure for submacular scaring in the world so I lost all hope.As I was the father to 3 children and a bother to 2 disabled brothers & an old vulnerable mother who all were dependent on me.So my children lost the independent father full of life.Is there any one out there In the sane position as me please and will they ever find a cure for submacular scaring ?

  6. Hi, theresa, i was recently diagnosed with mmd, if this worsens, can it leave you with total blindness?

  7. Naveed ul haq Reply

    Iliza I have read your blog that you have been diognosed with MMD.Sorry to hear about you been diognosed with MMD.I have had a lot of experience on severe myopia and retinal changes.As long as your MMD has been diognosed at an early stage with out it leading to a submacular hamrioge .One lucentis injection will stop the bleed which shouldn’t lead to submacular scaring.Which causes distorted vision with a submacular scar.I shouldn’t really worry a bout it to much,Visit a Opthamolist straight away for treatment.

  8. Hi Theresa I have a 23 year old daughter with special needs that’s as recently been diagnosed with degenerative myopia in her left eye. Very myopic -25 in right eye -27.5 in left eye. Right now the dr is taking a “wait and see” attitude; visits every six months. Have you and others here gotten that response?. I read about injections to slow things down much like you have
    Are we being put off because the inevitability is blindness..

  9. Hi Theresa, I’ve been dealing with myopic degeneration for several years now, had many injections etc., but a week ago I experienced what I thought was a blind spot. I never had one of these before so I did go to my retina doctor and started the injections again. I came across this page of yours and, based on your pictures, I’m hoping I have blurring and not a blind spot. What I’m seeing is definitely a gray spot and not a black spot. Sometimes I think I can see through it, but I’m not sure if I can or if it’s my mind playing gestalt tricks on me. Your blog has cheered me up a little hoping that this blur spot, if that’s truly what it is, may go away so thank you for that.

  10. CHRIS MAYHER Reply

    Hello Theresa. I have high myopia in both eyes. I have had benign bleeding in the left eye infrequently (Thank God) over the past 30 years. Probably about 5 total. I see my ophthalmologist once a year for a checkup. My question is…How do you stay so upbeat and positive. You obviously have had much more issues than I and yet you can stay so upbeat. You are my hero. I have become very depressed and fearful over my condition. I have had to be on Paxil to help me cope with my constant terror of going blind. The myopia has finally affected me so psychologically that I have become reclusive. What do you do to stay so positive and do you take any special vitamins that may help stave off any new damage ? Thank you for reading my lengthy text. Take care and thanks for sharing your story !!

    Chris Mayher

  11. Eric Newmark Reply

    One night I sneezed and blew blood vessels which I guess distorts my vision similarly to you folks . I hope a cure comes quickly for all of us. The injections have helped but very little . GOOD LUCK TO ALL

  12. best ayurvedic eye treatment hospital |
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    Virechana– purgation therapy
    Niruha vasti- enema with decoction
    Anuvasana vasti– enema with oil
    Nasya– nasal instillation.
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    SADHYO VAMANA
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    PURVAKARMAYUKTA VAMANA/ VAMANA
    Classical Vamana is a collaborative effort where a patient must go through various procedure phases. Like snehapanam, svedanam, samsarjana karma etc.,
    So, this procedure takes around 15 to 18 days to complete. The days depend on the disease’s condition and the patient’s digestive fire.
    Generally, it takes around 15 to 18 days to complete the procedure.
    Now let’s see the phases a patient undergoes while Vamana;
    PURVA KARMA
    PRADHANA KARMA
    PASCHATH KARMA
    PURVA KARMA (Pre Operative procedure)
    This phase is the preparatory phase of the patient before the main procedure.
    DEEPANA- PACHANA
    First, the patient is introduced to some appetizers and carminatives to enhance the
    Digestive fire. This is done by taking medications internally, if it’s necessary for one.
    SNEHANAM
    It means oleation therapy, where the oiliness (snigdhata) is attained to the body.
    Bahya and Abyantara Snehana karma ( both external and internal oleation therapies) are done, and both are related to Purvakarma ( preparatory procedure).
    After the Deepana-Pachana procedure, a physician can introduce ghee or oil when the patient attains enough digestive fire to digest the medicine. This phase is called the Snehapanam procedure. During the Snehapanam phase, the fat content- tailam/ ghrutha/ vasa ( oil/ ghee/ bonemarrow fat respectively) is taken without mixing in food items called Achasnehapanam. Sometimes, the administration of Sneha dravya, orally mixed with food items such as gruel, milk, etc., is also done, and that procedure is known as Pravicharana Snehapanam. The Sneha dravya and mode of administration of sneha dravya may differ from patient to patient and is chosen by the physician by analysing a patient’s digestive fire and on the basis of Doshadikya (predominance of Dosha).
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    Bahya Snehanam
    After internal oleation, when the patient attains samyak snigdha lakshanam bahya snehana, i.e., external oleation therapies like Abhyangam ( body massage with oil), etc., is done and then advise svedana ( sudation) procedure is done, before the main procedure.
    SVEDANA
    This is the procedure which induces sweating for therapeutic purposes. It is usually done after Snehanam (oleation therapy).
    PRADHANA KARMA (Main Procedure)
    Here comes the main procedure where all Utklishta doshas ( therapeutically aggravated doshas after Snehana Svedana karma ( oleation and sudation) phases will be forcefully expelled out through the therapeutic emesis (Vamana).
    Here, the patient is advised to take medicines to his/her neck level. For this, milk and decoctions made of certain medicines are given. After that, Vamanaushada dravya is given in Kapha kala ( early morning), and then the patient starts to vomit – expelling out Utklishta doshas and toxins from the body.
    Virechana – Purgation Treatment
    Here, in this treatment, the accumulated toxins are removed by means of Virechana (purgation).The person is made to have loose motions for a short while by administering medicines. Virechana treatment is usually indicated in Pitta dosha vikaras ( diseases that occur by pitta dosha).
    Again, Virechana is of many types, which are classified usually on the basis of mode of medication, duration, purpose, Doshadhikya ( predominance of dosha along with Pitta dosha) etc., for example, in Sukha Virechana ( mild effortless laxatives) are used, in teekshana Virechanam( strong laxatives ) are used, in Ruksha Virechanam (is usually done when Kapha dosha associates with Pitta dosha), Snigdha Virechanam ( is usually done when Vata dosha associates with Pitta Dosha), Sadhyo Virechanam is done where elimination of toxins and Pitta is needed instantly, Nitya Virechanam is done where purgation is needed on daily basis. Like this, various types of Virechana karma ( purgation therapies) are there, which are planned and chosen by the physician after analysing a patient’s body, Doshadhikya ( predominance of doshas) condition of disease and patient.
    Usually, in Virechanam (purgation procedure), the patient needs to go through the same Purvakarma ( preoperative procedures) and Paschath karma (post-operative procedure), almost the same as Vamana( emesis therapy).
    Here also;
    PURVAKARMA
    Deepana- Pachana ( intaking of appetisers and carminatives)
    Snehanam ( oleation treatments)
    Svedanam ( sudation treatment)
    These three steps are almost the same as in Vamana ( emesis therapy). Maybe the number of days may differ. This Vamanam and Virechanam for removing Kapha And Pitta, respectively, are like brothers as far as treatment is concerned because the deepana- pachana karma ( appetisers), the oleation phase ( snehana karma), the sudation phase and the medicine administering phase are more or less the same.
    PRADHANA KARMA
    After snehana and svedana karma, on the day of Virechanam, the patient is administered Virechanoushada ( purgative medicine), which helps to expel the doshas and toxins through the anal route as loose motions.
    How do Vamana And Virechana Work?
    During the Snehapanam phase, what happens is;
    The fat contents (oil/ ghee) that the patient takes percolate inside the body and reach every tissue across the body. This ghee/ oil ( fat contents usually have the quality to stick to things which come into contact with.
    So when this ghee/ oil ( fat contents) enters the body, it gets stuck with these doshas and toxins.
    So next comes the Snehana karma with Svedana ( external oleation therapy with sudation) is done. Here, the body gets oleated again externally by doing abhyanga ( body massages) and later exposed to warm temperatures to make the patient sweat.
    Thus it helps to bring Shakhasrita doshas (Dosha accumulated in different part of body ) into Koshta, as we all know that ghee or oil will get melted easily by excess heat and liquefy and start to flow. Our body is designed in such a way that whatever flows will automatically come and be collected in the Koshta (Amashahaya and Pakwashaya) region.
    This is taken as an advantage, one medicine is given in the next phase, which helps to expel out doshas easily.
    The procedure of Purvakarmayukta Vamana and Virechana is almost the same, and one difference is in Vamana Kapha dosha toxins come out with the medicine as vomiting, while in Virechana the medicine gets digested and flushed out with Pitta and toxins as loose motions
    PASCHATKARMA
    In Paschatkarma, Acharyas have given more focus to diet that to follow after the main procedures which are known as Samsarjana karma. After Vamana and Virechana , digestive fire becomes very low, especially in patients who underwent through the Snehapanam phase in the Snehanam procedure, where the patient is only supposed to take the fat contents- ghee/ oil for 5 to 7 days and later undergoing the main procedure. So, what Samsarjana Karma does is to re-establish the digestive fire after these procedures. This phase will extend up to 5- 7 days. Here before planning the Samsarjana karma physician analyses the patient and plans how the diet should be. And its done according to the number of vegas by patients during the procedure( Vama and Virechana) and the strength of purification therapy.
    Vegas means the number of how many times the patient passes the motion in Virechana karma and how many times the patient vomits during Vamana karma. A patient with maximum Purification is termed as Avara Shudhi. When 8 bouts of vomiting in Vamana and 30 bowel movements during purgation in Virechana occur is said to be
    Avara Shudhi.
    DAY
    FIRST MEAL
    SECOND MEAL
    1
    PEYA
    PEYA
    2
    PEYA
    VILEPI
    3
    VILEPI
    VILEPI
    4
    AKRUTHA YUSHA
    AKRUTA YUSHA
    5
    AKRUTA YUSHA
    KRUTHA YUSHA
    6
    KRUTA YUSHA
    KRUTA YUSHA
    7
    RASA
    RASA
    8
    RASA
    NORMAL DIET

    Here
    PEYA – Thin gruel.
    VILEPI- Thick gruel
    AKRUTA YUSHA- unseasoned vegetable soup
    KRUTA YUSHA- seasoned vegetable soup
    RASANNA- rice along with meat soup or protein-content food.
    Normal Food- get back to normal diet
    A patient with Medium Purification is termed a Madhyama Shudhi. When a person is having 6 bouts of vomiting in Vamana and 20 purgations, Virechana is meant to be Madhyama Shudhi.
    DAYS
    FIRST MEAL
    SECOND MEAL
    1
    PEYA
    PEYA
    2
    VILEPI
    VILEPI
    3
    AKRUTA YUSHA
    AKRUTA YUSHA
    4
    KRUTA YUSHA
    KRUTA YUSHA
    5
    RASA
    RASA
    6
    NORMAL DIET
    NORMAL DIET

    A patient with minimum purification is termed Avara Shudhi. When a person has four bouts of vomiting in Vamana and 10 purgations in Virechana, it is meant to be Avara Shudhi.
    DAYS
    FIRST MEAL
    SECOND MEAL
    1
    PEYA
    VILEPI
    2
    AKRUTA YUSHA
    KRUTA YUSHA
    3
    RASA
    NORMAL DIET

    By observing Peyadikramas in Samsarjana karma after purification therapies, the digestive power which has been lowered by the therapies will gradually enhance, becomes steady and capable of digesting everything.
    Basti – Enema
    Two types of rectal enemas exist in Ayurveda.
    Niruha Vasti, Kashaya, or Ruksha Vasti ( enema with decoctions) and
    Anuvasana Vasti or Sneha Vasti (oil enema).
    The Ayurvedic enema is quite different from the regular enema given to relieve constipation. Even though Basti treatment is adopted predominantly for Vata imbalance, it is used in a wide range of diseases because of its action. Thus, Basti plays a very important role in Panchakarma.
    Basti– medicated decoctions or oil enemas given through the anal, urethral or vaginal route are the best treatment to combat vitiated vata and help to pacify it.
    Vata dosha is believed to have its predominant seat in the colon, but it can affect other areas of the body as well, including the pelvis, ears, bones, and skin. Balancing Vata is essential for maintaining overall health and well-being in Ayurveda.
    Basti has much importance in Ayurveda and also Panchakarma because of its benefits.
    Vasti / Basti is said to be Agroushada for Vata, and it says a physician can treat any disease with Basti by using his Yukti ( logic) along with it. That’s why Basti itself is mentioned as Ardha Chikitsa – half treatment. Since its having its action from the head to the tip of the toes, it plays an important role.
    As with other Pashatkarma, Basti also has Purvakarma, Pradhana karma and Paschatkarma.
    ASTHAPANA BASTI/ VASTI
    This vasti is also known as Ruksha vasti because if it is Ruksha guna (dry nature), also known as Kashaya Vasti because unlike Anuvasana vasti here Kashaya ( decoction) is used as the key ingredient. Other than the Kashaya, other ingredients like honey, saindava ( rock salt) etc is added to it. The Decoction will be differ from person to person and is choosed by physician according to the condition of patient.
    In Purvakarma ( preparatory procedure)– usually, Snehana is done with Bahyasnehana and then svedanakarma.
    In Pradhanakarma– the enema is given through the anal route, and the patient suddenly has the urge to pass the bowel after Basti.
    In Paschat Karma- it is are somewhat different two types of enemas;
    In Asthapana / Kashaya Vasti the patient suddenly needs to take a bath and have food after the motion passes.
    ANUVASANA BASTI
    This enema is different from the Asthapana Basti; here, oil is used instead of decoction thus, its also known as Sneha Basti because of its snigdhatha (unctuousness).
    In Purvakarma ( preparatory procedure)-
    The patient is supposed to have the food only after taking the food Anuvasana basti is done.
    and Snehana is done with Bahyasnehana ( here abdominal massage) and later Svedanam ( sudation) is given to the patient.
    In Pashchatkarma (post-operative procedure),
    In Anuvasana vasti (oil enema ), unlike Asthapana basti, the patient is supposed to stay for a while, and the motion doesn’t pass immediately after the procedure.
    There are a variety of enemas, and on the basis of the chronicity of disease and patient after analysing the doshadhikya (predominance of doshas) and strength of the patient a physician can plan it.
    Nasya – Nasal Instillation
    Instillation of powders or Ayurvedic liquids through the nose is called Nasya treatment. It is usually prescribed for Urdhwajatrugata Vikara (a disease that manifests above the clavicular region, Thus, it is usually prescribed for diseases of the ear, nose, throat, and head- and hence, Nasya ensure the healthy parts above the neck and enhances the healthy functioning of Indriyas.
    Mainly, Nasya is of two types on the basis of dosage:
    Marsa Nasya (higher dosage)- is to be done under medical supervision.
    Pratimarsha Nasya (lower dosage) – which can be done on a daily basis) without much precautions as in Marsha Nasya.
    While Pratimarsha Nasya can be done on a daily basis without any preparation, while Marsha Nasya can only be practised under the supervision of a physician. Here, the preparatory phase and post-operative phase are there.
    Purvakarma ( Preparatory Procedures)
    Pradhanakarma ( Main Procedure)
    Pashchatkarma (Post-operative Procedures)
    Purvakarma
    Bahyasnehana is given by Mukha Abhyanga ( face massage with medicated oil) and later Svedanam is given usually, Nadi Svedanam is preferred.
    Pradhanakarma
    Here, a prescribed amount of nasal medicine is instilled into the nasal cavity through the nostrils.The patient is asked to spit out the phlegm, whatever toxins are draining into the mouth.
    Pashchatkarma
    Here, after instilling the medicine, the patient’s soles, neck, palms, ears, etc., should give a mild massage administered with svedana and Dhoomapanam ( smoke inhalation- prepared with medicine), then advised to take Kavalam ( gargle) with medicated lukewarm water.
    Patients who underwent the Nasya are not supposed to wash their heads and can’t use cold water to wash their bodies. Patients are not supposed to go to wind exposure or heat exposure, are not supposed to sweat and heavy exercises are contraindicated. And Nasya procedure can’t be done soon after the food, and a patient can’t intake food soon after Nasya.
    Right Time For Nasya
    Nasal medication should be administered in;
    Morning – if Kapha is increased
    Mid day – if Pitta is increased.
    Evening – if Vata is increased.
    It should be given in the forenoon during the Sharath ( autumn) and Vasanta ( spring) seasons. During Winter, Nasya can be done at midday if it’s too cold.
    And in the summer in the evening. However, the time of medicine installation and type and dosage of medicine for Nasya will differ from person to person and is chosen by the physician after analysing the condition of the disease.
    Read More
    Is Panchakarma Suitable for Everyone
    Ayurvedic Post Panchakarma Care
    Who Needs Panchakarma Treatment?
    Panchakarma is a therapeutic procedure aiming to cleanse and rejuvenate the body. While it can benefit many people, its suitability should be assessed individually, taking into account factors like one’s health, age, and specific conditions.
    Benefits of Panchakarma Treatments
    Ayurveda is a traditional system of medicine that emphasises a balanced body’s doshas, which are Vata, Pitta, and Kapha. When these doshas become imbalanced, it can lead to various health issues. Ayurvedic treatment aims to restore the equilibrium of these doshas.
    Panchakarma, as mentioned, is a key component of Ayurvedic Therapy. It involves a series of five therapeutic procedures which give benefits of:
    Detoxifying – toxins are eliminated from the body.
    Regain the balance of Tridoshas– These procedures help remove accumulated toxins and restore the body to a state of balance.
    Rejuvenation of the body– slows the ageing process and increases the lifespan.
    Relaxation for the body– stress is reduced, and the body gets relaxed.
    Energy level increases- helps to boost the immunity and body energy level.
    Increases mental power– enhances strength, energy, vitality and mental clarity.
    Enhances skin glow– Increases the glow and lustre of skin.
    Helps to implement a healthy diet and lifestyle.
    Thus, Panchakarma can be used to manage various health conditions for preventive, curative and promotive purposes.

    Lifestyle And Diet Changes During Panchakarma Treatments
    One must follow the Diet and lifestyle while undergoing the Panchakarma procedures.
    Here are some important common rules to be followed during Panchakarma procedures:
    One must use only warm water for drinking, baths (except the head) and other activities.
    A person who is undergoing Panchakarma therapy can not indulge in sex.
    Sleeping in the daytime is contraindicated.
    Natural urges should not be controlled.
    Exposures to extreme temperatures or weather conditions have to be avoided.
    Ratri jagaranam (keeping awake at night) is not advisable.
    Foods that cause Amam (indigestion) can not be consumed.
    Mental stress and heavy exercise have to be avoided.
    Even though these are the common regimens to follow while undergoing the Panchakarma procedure, each procedure of Panchakarma has its own Purva karma (preparational procedures) and Paschat karma (post-procedure), diets and regimens to follow and avoid while undergoing Panchakarma procedures.
    Steps and Procedures In Panchakarma
    Usually, Panchakarma is performed in three steps:
    Purvakarma– Preparatory procedures
    Pradhanakarma– Main procedures
    Paschathkarma– Post-operative procedures.
    for every procedure, a patient needs to go through these phases, which will be different for each procedure. Why are these Purvakarma (pre-operative measures) so important to follow before Panchakarma? Can any Panchakarma procedures be done without Purvakarma? is the same way of steps and procedures to be followed before every Panchakarma. Is it necessary for everyone to undergo Purvakarma before Panchakarmas?
    Most often, many people have these questions and doubts about procedures, and When we step into the description of these questions, we should know about some basic concepts that we follow in Ayurvedic treatments, like concepts about doshas, bahudoshavastha, Leena dosha avastha, upasthita doshas etc;
    Bahudoshavasta – is the phase in which vitiated Doshas are in excess quantity and where Shodhana can be indicated.
    Leena Doshavastha– is the dosha that is stick on to a specific area. In this stage usually one doesn’t prefer Shodhana directly because it will be like the extraction of juice from unriped fruit. So it will be very difficult for the doshas in this phase.
    Upasthitha Doshas– here, the accumulated dosha from shakha (extremities) to koshta ( can be correlated with stomach/ intestine) and have changed from their fors from Leenavastha to Utklishta avasta ( aggravated) can be said as Upasthitha Doshavastha.
    Purvakarma Pre-operative Procedures
    Purvakarma gives the body a gentle introduction to more intensive treatments that follow in Panchkarma. Without preparatory measures, the body may react adversely to the abrupt detoxification process in Panchakarma. By doing Purvakarma procedures, if doshas are Bahudoshavastha, by Snehana and svedana by making it Utkleshavastha, which helps to expel the doshas easily. And if the doshas are in leena avastha, then by Purvakarma, we bring the leena dosha to Upasthitha dosha and then expel it through shodhana karma (purification process).
    Pradhanakarma
    Pradhana karma expels toxins and Utklishta doshas (aggravated doshas) from the body through any of Panchakarma.
    Pashchatkarma
    Pashchatkarma helps the body regain normalcy, like digestive fire, appetite, etc., by following Samsarjanakarma ( diet and regimens) as mentioned according to the Panchakarma practised .
    What Happens to Your Body After Panchakarma?
    Panchakarma improves health and promotes the body’s self-healing power. After the five purification procedures of Panchakarma, once the dosha gets back to normalcy, a healthy body with a healthy mind will be regained. The whole body is cleansed in the Panchakarma treatment. During the Panchakarma itself, after one or two phases, you will notice both mental and emotional changes to your body. For some, it’s common to experience a healing crisis in the initial phases, which is usually seen as a beneficial step.
    A healing crisis is- when toxins are expelled through purification procedures; expelling of unwanted toxins may cause insomnia, a feverish-like feel, tiredness, general discomfort, heaviness and achy feel. Up to an extent, it’s necessary and is experienced as a part of the natural process of tissue cleaning. Thus after Panchakarma therapies as aggravated doshas get expelled and thus by regaining the normalcy of Tridoshas and digestive fire, both body and mind get healthy and calm, feel fresh and get rid of Disease condition
    Panchakarma Treatment at Dheemahi Ayurveda
    Dheemahi Ayurveda is an authentic ayurvedic hospital having a team of expert doctors for patient care with the knowledge of the past five generations and thus we follows the traditional way of healing methods as per Ayurveda. Thus we ensure the quality of treatments that we provide for healing too.Dheemahi Ayurveda village provides a calm and peaceful atmosphere which also has a major role in curing the disease. Mind serves equal importance as the body in attaining a healthy life. The spacious Garden and living rooms support your peaceful stay and healing process.
    While privileged resorts give calm and beautiful surroundings for your stay. Dheemahi facilitates the same with a professional approach of doctors and treatments. We have our own pharmacy and medicine manufacturing unit – through this, we can provide you with authentic medicines and assure you to get cures. Our team of professionals help you achieve a complete state of health and vitality by giving you a daily food and lifestyle routine.
    Conclusion
    Panchakarma treatments are a very important part Of Ayurveda. But often, people who are new to Ayurvedic treatments always mislead or confuse Panchakarma treatments with other treatments like Massages, kizhi, etc., and sadly, some people often misuse it too. Always remember you are supposed to undergo any Panchakarma treatments only under a certified physician and in a place where authentic treatments are provided. The mode of steps or procedures followed during the Panchakarma procedures may have slight changes, as planned by the physician by analysing the dosha avastha, stage of disease and condition of the patient.

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