Management of Cataract with Ayurveda Treatment Modality; a Comparative Clinical Study

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International Journal of Scientific and Research Publications, Volume 10, Issue 3, March 2020 473
ISSN 2250-3153
http://dx.doi.org/10.29322/IJSRP.10.03.2020.p9956 www.ijsrp.org
Management of Cataract with Ayurveda Treatment
Modality; a Comparative Clinical Study
*1 Dissanayake K. G. C., 2 Srilal U. L. N.
1Senior Lecturer Gr. I, Department of Cikitsa, Gampaha Wickramarachchi Ayurveda Institute, University of Kelaniya, Yakkala, Sri Lanka.
2Postgraduate Student, Graduate Studies Division, Gampaha Wickramarachchi Ayurveda Institute, University of Kelaniya, Yakkala, Sri Lanka.
DOI: 10.29322/IJSRP.10.03.2020.p9956
http://dx.doi.org/10.29322/IJSRP.10.03.2020.p9956
Abstract- The comparative clinical study was designed to evaluate
the effect of Anjanavarti in the management of Cataract in
comparison with Virecanakarma. Thirty patients were selected,
suffering from Cataract and randomly divided in to two groups as
group A and B. For the group A Anjanavarti was applied after the
Virecana karma for a period of thirty days. For the group B
Anjanavarti was applied for a period of thirty days. After the
Anjanavarti treatment in group A, visual acuity was tested by
using Wilcoxon Signed Ranks test. It was significant (0.001) in
0.05 levels which can be concluded that there was considerable
effect after the treatment of Anjanavarti followed by
Virecanakarma. Group B also significant (0.001) in 0.05 level.
Therefore, it was concluded that there was a therapeutic effect of
Anjanavarti in individual application. While group A and B were
compared using Mann-Whitney U test, which elaborated two
groups were not identical to each other with respect to visual
acuity at after the treatment. According to the mean rank and sum
of ranks between two groups after treatments, it can be clearly
identified that mean rank of group A is less than group B, which
means that the treatment effect of Visual Acuity in group A is
better than group B while considering the results after the
Virecana karma p value of total cholesterol (0.132), LDL
cholesterol (0.145), TGL cholesterol (0.147) and HDL cholesterol
(Based on positive ranks ) (0.176) were not significant in 0.05
level.
Index Terms- Cataract, Anjanavarti, Virechana karma,
Cholesterol
I. INTRODUCTION
Cataract, defined by the World Health Organization
(WHO) as a Visual Acuity (VA) of less than 3/60 in the
better eye, is the leading cause of blindness in the world, while
cataracts can be surgically detached, being a surgical process
patients discourage in attending treatment procedure. Globally
cataract is also a key root of low vision [1], as well a leading cause
of visual impairment, other than uncorrected refractive errors and
the greatest cause of preventable blindness globally [2]. Aging
process is a key etiological factor of cataract [3]. Additionally
cataract is much common in diabetes where superoxide in the
mitochondria is elevated as a result of hyperglycemia [4]. Opacity
over lens of eye is a direct result of oxidative stress. Global
warming and ozone depletion also increase exposure to ultraviolet
radiation which leads to a greater incidence of cataracts [5]. Some
medications likewise corticosteroids, Psoralens, Chloropromazine
and some glaucoma medications affect in cataract [6-7]. Addiction
to alcohol or substance uses while pregnancy leads to infants born
with cataract, as well as congenital cataract is common in 1:10,000
ratios [8].
In Sri Lanka, among 22 million populations around 200,000
people are believed to be blind as well 400,000 people are
suffering from low vision. Majority of them have been affected
with cataract [9]. Hence, introducing a cost effective treatment
modality in spite of surgery to manage cataract is much
advantageous in existing era.
Ancient Ayurveda literature elaborate that the cataract is
almost equal to the ‘kacha’ when premature cataract (Timira)
leads to mature cataract (kacha) due to unavailability of
treatments at the early stage. Furthermore, untreated kacha
generates ‘kapaja linganasha’ and cause blindness [10].
Instead surgical process, some treatment protocols for
cataract has been instructed in authentic Ayurveda literature
‘Susruta Samihita’. Among several modalities, application of
‘Anjana’ (collyrium) is mentioned there as an effective measure
of correction [11]. Ola leave manuscripts inherited to Indigenous
system of medicine in Sri Lanka consists with multiple time tested
recipes with effective clinical experience among practitioners.
Therefore, the current study was based on an indigenous recipe of
Anjana referred from an ola leave manuscript.
Efficacy and effect of application Anjanavarti and
application of Anjanavarti after the Virechana karma (therapeutic
purgation) in the management of Cataract were evaluated in the
study while the study prioritized in effect of Virechana karma on
visual acuity, Total Cholesterol level (TCL), Triglycerides level
(TGL), High Density Lipoprotein level (HDL) and Low Density
Lipoprotein level (LDL).
The Anjanavarti is consisted with, dried fruit of Terminalia
chebula, dried leaves of Azadirachta indica, dried legume of Piper
longum, dried seeds of Piper nigrum, central part of the dried
Terminalia belerica nut, ash from purified conch (Bhashma) of
Turbinella rapa and purified Bisulphate of arsenigrealar while
powder of all the said ingredients should be ground with goats
milk till reach to paste consistency. Thereafter the shape of the
varti should be molded and let it to be dried up in sun light.
II. METHODOLOGY
For the comparative clinical study, the study population was
comprised with the patients attending to the eye clinic at Ayurveda
CT

International Journal of Scientific and Research Publications, Volume 10, Issue 3, March 2020 474
ISSN 2250-3153
http://dx.doi.org/10.29322/IJSRP.10.03.2020.p9956 www.ijsrp.org
Central Dispensary, Kumarakanda, Dodanduwa, Sri Lanka.
Among them, thirty volunteer patients diagnosed with cataract
(VA < 3/60 in better eye) were selected after obtaining written
consent. These patients were randomly divided in to two groups
consisting of 15 patients in each group.
Inclusive Criteria
1. Both gender, age between 50 – 70 yrs
2. Visual Acuity < 3/60 in better eye
Exclusive Criteria
1. Age below 50 yrs and above 70 yrs
2. Visual Acuity > 3/60 in better eye
3. Having medicine for chronic disorders
Method of Investigation
1. Visual Acuity (VA) was determined using Snellen’s chart (in better
eye)
2. Blood glucose level was determined by FBS test followed 12 hours
fasting period (By automated chemistry analyzer)
3. WBC/DC (By automated chemistry analyzer)
4. Lipid profile followed 12 hours fasting period (By automated
chemistry analyzer)
All the investigations were done before the treatment (BT) as well
after the treatment (AT).
Method of Treatment
Group A: application of Anjanavarti for 30 days followed by
Virechana Karma
Group B: application of Anjanavarti for 30 days
Sesame seed size amount of Anjanavarti was applied over
middle part of the conjunctiva of lower eye lid once a day mixed
with water between 09.00 am to 12.00 noon daily. While the
treatment period, all the cases were instructed to continue
recommended wholesome diets and behaviors.
Table 01: Treatment Protocol of Group A
Day
Treatment
1 to 5
240 ml of Dhanyapanchaka Decoction + 2.5 g
Manibadra Choorna twice daily
6 to 12
(Ghee) Achchapana Wardhamana Snehana
13
Sarvanga Swedana
14
Pitta Virechana using Thriphala decoction
15
Resting Day
16
Day of serum investigations and Visual acuity check
up
17 to 46
Anjanavarti
Table 02: Treatment Protocol of Group B
Day
Treatment
1 to 30
Anjanavarti
Follow up: visit the clinic fortnightly up to 01 month period.
Data Analysis: IBM SPSS version 22 was used.
III. RESULTS AND DISCUSSION
Majority of the sample represents with female patients as
70% rest of 30% represented by male patients. Referring age of
participants, 53.33% of the respondents were included in 66-70
years of age while 23.33% were belongs to 61-65 years age, 6.67%
of them were belongs to age range of 56-60 years and 16.67% were
represented 50-55 years age group.
Hypothesis testing was performed to identify the effect and
the efficacy of treatments. All the tests were carried out under 5%
level of significance.
The Wilcoxon signed-rank test used when comparing two
related samples, matched samples, or repeated measurements on a
single sample to assess whether their population mean ranks differ
(i.e. it is a paired difference test). Mann-Whitney U test has used
to check whether the two groups (i.e. Group A and Group B) are
identical to each other or not with respect to Visual Acuity (Better
Eye).
Table 03: Comparative effect of treatments
Investigation
Z
Asymp. Sig.
(2-tailed)
Negative /
Positive
Rank
N
Mean Rank
Sum of Ranks
Group A
Group B
Group A
Group B
Group
A
Group
B
Group
A
Group
B
Group
A
Group
B
TCL
(AV) – (BV)
-1.507d
.132
Negative
4a
7.12
28.50
Positive
10b
7.65
76.50
Ties
1c
Total
15
TGL
-
1.45
0d
.147
Negative
5a
6.90
34.50

International Journal of Scientific and Research Publications, Volume 10, Issue 3, March 2020 475
ISSN 2250-3153
http://dx.doi.org/10.29322/IJSRP.10.03.2020.p9956 www.ijsrp.org
(AV) – (BV)
Positive
10b
8.55
85.50
Ties
0c
Total
15
HDL
(AV) – (BV)
-1.355e
.176
Negative
9a
8.22
74.00
Positive
5b
6.20
31.00
Ties
1c
Total
15
LDL
(AV) – (BV)
-1.481d
.145
Negative
2a
8.25
16.50
Positive
13b
7.96
103.50
Ties
0c
Total
15
Visual Acuity
(Better Eye)
(AV) – (BV)
-2.889e
.004
Negative
10a
5.50
55.00
Positive
0b
.00
.00
Ties
5c
Total
15
Visual Acuity
(Better Eye)
(AT) – (BT)
-3.332e
-3.416e
.001
.001
Negative
14a
14a
7.50
7.50
105.00
105.00
Positive
0b
0b
.00
.00
.00
.00
Ties
1c
1c
Total
15
15
a. After < Before
b. After > Before
c. After = Before
d. Negative Effect
e. Positive Effect
AV – After Virechana
BV – Before Virechana
Comparisons of both Groups
Table 04: Mean rank and Sum of ranks between both groups
Investigation
N
Mean Rank
Sum of Ranks
Group A
Group B
Total
Group A
Group B
Group A
Group B
Visual Acuity (Better Eye)
- BT
15
15
30
15.20
15.80
228.00
237.00
Visual Acuity (Better Eye)
- AT
15
15
30
13.03
17.97
195.50
269.50
Table 05: Significance values of Mann-Whitney U test before and after treatments
Visual Acuity (Better eye) BT
Visual Acuity (Better eye) AT
Mann-Whitney U
108.000
75.500
Wicoxon W
228.000
195.500
Z
-.206
-2.582
Asymp. Sig. (2-tailed)
.837
.014
Exact Sig. [2*(1-tailed Sig.)]
.870a
.026a
a. Not corrected for ties
b. Grouping Variable: Group

International Journal of Scientific and Research Publications, Volume 10, Issue 3, March 2020 476
ISSN 2250-3153
http://dx.doi.org/10.29322/IJSRP.10.03.2020.p9956 www.ijsrp.org
According to above statistics, since the significance value
(0.837) is greater than 0.05, the null hypothesis was accepted
under 5% level of significance; Therefore, before the treatment
two groups are identical to each other with respect to visual acuity.
Since the significance value (0.014) is lower than 0.05, the null
hypothesis was rejected under 5% level of significance; Therefore,
after the treatment two groups are not identical to each other with
respect to visual acuity.
Even though, acceptance of null hypothesis under level of
5% significance, Virechana karma was not effective in reduction
of TCL, TGL, LDL and increment of HDL, as well under level of
5% significance, Virechana Karma was effective on Visual Acuity
while under level of 5% significance, Anjanavarti also effective in
Visual Acuity referring both of group A and B.
According to the above ‘Mean rank and Sum of ranks
between two groups after treatments table which can be clearly
identified that mean rank of Group A is less than Group B. Which
means that the treatment effect of visual acuity in Group A is better
than Group B since when scaling the visual acuity variable, the
lower values have given to the better visual acuity.
Group A was treated using ghee for Achchapana, hence
TCL, TGL, LDL levels were increased, while HDL level was
decreased among them. Instead of saturated fatty substance like
ghee, replacing an unsaturated fatty substance may vary the
therapeutic effects of Group A with much efficacy.
IV. CONCLUSION
Before treatment both groups were observed with much
similar visual acuity. After the treatment of Anjanavarti for thirty
(30) days both the groups were observed with increased visual
acuity, comparatively Group A shows highest efficacy. Referring
obtained results, efficacy of Anjanavarti was comparatively high
when followed by Virecana karma. After the Virecana karma
visual acuity was increased. Therefore Virecana was effective on
Visual Acuity. As well, Anjanavarti followed by Virecana karma
is more effective than Anjanavarti alone on visual acuity.
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AUTHORS
First Author – Dissanayake K. G. C., Senior Lecturer Gr. I,
Department of Cikitsa, Gampaha Wickramarachchi Ayurveda
Institute, University of Kelaniya, Yakkala, Sri Lanka.
Second Author – Srilal U. L. N, Postgraduate Student, Graduate
Studies Division, Gampaha Wickramarachchi Ayurveda
Institute, University of Kelaniya, Yakkala, Sri Lanka.