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1.  A clinical study on Akshitarpana and combination of Akshitarpana with Nasya therapy in Timira with special reference to myopia 
Ayu  2010;31(4):473-477.
Myopia, commonly referred to as shortsightedness, is the most common eye disease in the world with substantial social, educational, and economic impact. Some of the clinical features of Timira can be correlated with myopia. An open randomized clinical trial was conducted to evaluate the role of Tarpana with and without Nasya in patients suffering from myopia. In total, 41 patients were registered in two groups, out of which 30 patients completed the treatment. In Group A, Tarpana with Mahatriphaladya Ghrita and in Group B, Nasya with Abhijita taila followed by Tarpana with Mahatriphaladya Ghrita was administered. After enrollment of the patients in the study, the cardinal signs and symptoms of Timira — myopia, that is, visual acuity, clinical refraction, were evaluated before and after the treatment. Comparatively, more relief in the signs and symptoms were found in the Nasya group followed by the Tarpana group.
PMCID: PMC3202262  PMID: 22048542
Timira; Myopia; Mahatriphaladya Ghrita; Abhijit Taila; Tarpana; Nasya
2.  OA01.36. Management of diabetic retinopathy with doorvadya ghrita tarpana and internal administration of mahavasadi kwatha- a comparative study 
Ancient Science of Life  2012;32(Suppl 1):S36.
A comparative clinical study was conducted on the management of Diabetic Retinopathy (DR) with Doorvadya Ghrita Tarpana and Mahavasadi kwatha internally. The main aim and objective of the study was to evaluate the efficacy of Doorvadya ghrita Tarpana and Mahavasadi kwatha internally, when used individually and as an adjuvant.
The patients were randomly divided in 3 groups with 15 patients in each group. Group A: Tarpana with Doorvadya Ghrita for 3 sittings, 5 days in each sitting, with a gap of 11 days after each sitting, total 48 days duration. Group B: Mahavasakadi Kwatha Pana with 50ml dose every day in the morning, empty stomach, for 48 days. Group C: Both Doorvadya Ghrita Tarpana and Mahavasakadi kwatha pana, for 48 days.
All the three groups have shown statistically significant results. Group B and C have shown better response as compared to Group A. Moreover Group B has shown slightly better response as compared to Group C.
The study showed that microaneurysms, intra retinal haemorrhages, exudates are best managed by treatment with Group-B; where as blurred vision responded better to combine treatment of Group-C. Other parameters like neovascularization did not produce any significant result in any of the groups. Hence Ayurvedic management definitely prevents further progression of the Diabetic Retinopathy and its complications.
PMCID: PMC3800914
3.  Comparative study on the effect of Saptamrita Lauha and Yoga therapy in myopia 
Ayu  2014;35(1):22-27.
Myopia is very common ophthalmic disease especially in children and adolescence. In Ayurvedic texts, only by the main feature impairment of distant vision myopia can be correlated with Drishtigata Rogas (2nd Patalgata Timira).
To compare the effect of Saptamruta Lauha and Yoga therapy in myopia.
Materials and Methods:
In present study, a total 60 patients with age group between 8 to 30 years were selected randomly from the out-patient Department of Swasthavritta and Shalakyatantra Department of Government Ayurveda College, Trivandrum, and were divided in two groups. In Group A, Saptamrita Lauha 250 mg twice daily with unequal quantity of honey and Ghrita was administered while in Group B, patients subjected to Yoga therapy (Jala Neti, Nadi Shodhana, Shitali Pranayama and point Tratak) for 3 months duration with 1 month follow-up.
Results and Conclusion:
The result obtained from the study reveals that there is no significant reduction in the visual acuity and clinical refraction, but associated changes were observed as reduced in group B when compared to group A. However, relief from headache was found to be equally effective in both the groups.
PMCID: PMC4213962  PMID: 25364195
Jala Neti; Nadi Shodhana; point Tratak; Sapthamrita Lauha; Shitali Pranayama
4.  Preliminary physico-chemical profile of Brahmi Ghrita 
Ayu  2013;34(3):294-296.
Brahmi Ghrita was processed as per the process of Snehapaka procedure described in classics. It contained Brahmi (Bacopa monneri), Vacha (Acorus calamus), Kushtha (Sassurea lappa), Shankhapushpi (Convolvulos pluricalis), and Purana Ghrita. In the preparation of Brahmi Ghrita, Brahmi Swarasa, Kalka Dravya of Brahmi, Vacha, Kushtha, and Shankhapushpi were mixed in Purana Ghrita and heated for three hours at 110°C every day for three days. On the third day Ghrita was filtered to obtain the finished product. In this manner, three samples of Brahmi Ghrita were prepared. To understand the changes that occurred during the preparation, Brahmi Ghrita and Purana Ghrita were analyzed by using modern parameters such as Acid value, Saponification value, and so on. After the analysis, it was found that the Acid values of Sample A, B, and C of Brahmi Ghrita were 4.26, 4.03, and 4.03; the Saponification values of Samples A, B, and C of Brahmi Ghrita were 227.2, 230.01, and 230.01, and the Iodine values of Samples A, B, and C were 34.75, 35.88, and 35.88, respectively, and the Acid value, Saponification value, and Iodine value of Purana Ghrita were 1.57, 199.15, and 31.04, respectively. The present study revealed that, there was no significant variation in the analytical values among all three samples of Brahmi Ghrita.
PMCID: PMC3902597  PMID: 24501526
Brahmi Ghrita; acid value; saponification value; iodine value
5.  A clinical study to evaluate the efficacy of Trataka Yoga Kriya and eye exercises (non-pharmocological methods) in the management of Timira (Ammetropia and Presbyopia) 
Ayu  2012;33(4):543-546.
Timira is a disease that can be attributed to wide range of clinical conditions starting from mild blurring of vision and having potential risk of permanent vision loss. According to the involvement of Dhatus (body elements) the condition can be grouped into two stages. The initial stage or Uttana, where the involvement of Dhatus is limited to Rasa, Rakta (blood), and Mamsa Dhatu (muscle tissue). When the Doshas are localized in the first and second Patala refractive error do happen and in presbyopia more emphasis is given to Mamsa Dhatu. In this study only Uttana stage of Timira was considered. The clinical study was done on 66 patients of Timira in two groups of four sub groups each of myopia, hypermetropia, astigmatism, and presbyopia. Group A was subjected to eye exercises (Bates method) and Group B was subjected to Trataka Yoga Kriya. After the enrolment of patients for this study, signs and symptoms were assessed both subjectively and objectively before, during, and after treatment. The study indicates that subjectively there are significant results in both the groups but objectively there is not much improvement.
PMCID: PMC3665208  PMID: 23723673
Eye exercises; refractive errors; Timira; Trataka Yoga Kriya
6.  PA01.45. An ayurvedic management of vandhyatva w.s.r. to cervical factor 
Ancient Science of Life  2012;32(Suppl 1):S95.
Vandhyatva (infertility) has been long standing problem since ancient period. Many herbal and herbo mineral formulations are mentioned as a treatment of infertility in the ancient texts, but they are not categorized according to the responsible factor like Ritu Kshetra, Ambu, Beeja. It is the need of time to evaluate the efficacy of formulations in respect to various factors of infertility. The objective was to evaluate the efficacy of Aswagandha Ghrita and Phalaghrita in the management of Vandhyatva w.s.r. to cervical factor.
In this study, total 14 patients were treated in two groups viz. Group A; Ashwagandha ghrita (Intra cervical Uttarbasti 6days for 2 cycles and Ghritapana 15ml bid for 2 months) and Group B; Phalaghrita (Intra cervical Uttarbasti 6days for 2 cycles and Ghritapana 15 ml bid for 2 months) to assess the role of Ghrita in the management of Vandhytva. Sim's hunter and Moghissi cervical mucus Test and Post coital test were selected for the diagnosis and for evaluation of efficacy of therapy on cervical factor.
The overall effects of both the therapies on properties of cervical mucus showed that the administration of Ashwagandha ghrita (group A) was more effective to increase the amount and tradability as compared to Phalaghrita whereas Phalaghrita was more effective in comparison to Ashwagandha ghrita to decrease the cellularity and viscosity of cervical mucus.
Significant results were found in both the groups, but Ashwagandha ghrita provided better results in comparison to Phalaghrita.
PMCID: PMC3800978
7.  A comparative study on chronic administration of Go Ghrita (cow ghee) and Avika Ghrita (ewe ghee) in albino rats 
Ayu  2012;33(3):435-440.
Ghrita (ghee) is the foremost substance of Indian cuisine from centuries. Ayurvedic classics described eight kinds of ghee from eight different animal milk, among them ghee made from cow milk is said to be the superior and ghee of ewe milk is said to be the inferior and also detrimental to heart. The present study was undertaken to evaluate chronic administration of cow ghee (Go Ghrita) and ghee of ewe milk (Avika Ghrita) to experimental animals. Experiment was carried out on Wistar strain albino rats and study was done at two dose levels. The test drugs were administered orally for 45 consecutive days. Parameters, such as gross behavior, body weight, weight of important organs, total fecal fat content, electrocardiogram, serum biochemical parameters, and histopathology of different organs were studied. Both the test drugs did not alter the gross behavior, body weight, weight of organs, and cytoarchitecture of different organs to significant extent. Avika Ghrita at a low dose significantly decreased triglyceride content, significantly prolonged QTc and at both dose levels it significantly shortened the PR interval. This study shows chronic administration of Avika Ghrita and Go Ghrita has no marked differences between them except the QTc prolongation in Avika Ghrita. This may be the basis for the classics to categorize Avika Ghrita as Ahridya.
PMCID: PMC3665096  PMID: 23723655
Ahridya; albino rats; Avika Ghrita; cholesterol; ghee; Go Ghrita
8.  Myopia Stabilization and Associated Factors Among Participants in the Correction of Myopia Evaluation Trial (COMET) 
To use the Gompertz function to estimate the age and the amount of myopia at stabilization and to evaluate associated factors in the Correction of Myopia Evaluation Trial (COMET) cohort, a large ethnically diverse group of myopic children.
The COMET enrolled 469 ethnically diverse children aged 6 to younger than 12 years with spherical equivalent refraction between −1.25 and −4.50 diopters (D). Noncycloplegic refraction was measured semiannually for 4 years and annually thereafter. Right eye data were fit to individual Gompertz functions in participants with at least 6 years of follow-up and at least seven refraction measurements over 11 years. Function parameters were estimated using a nonlinear least squares procedure. Associated factors were evaluated using linear regression.
In total, 426 participants (91%) had valid Gompertz curve fits. The mean (SD) age at myopia stabilization was 15.61 (4.17) years, and the mean (SD) amount of myopia at stabilization was −4.87 (2.01) D. Ethnicity (P < 0.0001) but not sex or the number of myopic parents was associated with the age at stabilization. Ethnicity (P = 0.02) and the number of myopic parents (P = 0.01) but not sex were associated with myopia magnitude at stabilization. At stabilization, African Americans were youngest (mean age, 13.82 years) and had the least myopia (mean, −4.36 D). Participants with two versus no myopic parents had approximately 1.00 D more myopia at stabilization. The age and the amount of myopia at stabilization were correlated (r = −0.60, P < 0.0001).
The Gompertz function provides estimates of the age and the amount of myopia at stabilization in an ethnically diverse cohort. These findings should provide guidance on the time course of myopia and on decisions regarding the type and timing of interventions.
The Gompertz function was used to describe the latter stage of myopia progression and estimate age and amount of myopia at stabilization in an ethnicially diverse cohort with juvenile onset myopia. These findings should provide guidance on the time-course of myopia and type and timing of interventions.
PMCID: PMC3850666  PMID: 24159085
myopia; myopia stabilization; Gompertz function; associated factors; myopia progression
9.  Hepatocyte growth factor and myopia: Genetic association analyses in a caucasian population 
Molecular Vision  2009;15:1028-1035.
Hepatocyte growth factor (HGF) and hepatocyte growth factor receptor (C-MET) genes have previously been reported to be associated with myopia in Asian family-based and case-control association studies, respectively. We examined whether these genes were associated with myopia in a Caucasian family dataset biased towards high myopia.
Participating families had at least one offspring with high myopia (≤-5.00 diopters [D]). Genotyping was performed with tagging single nucleotide polymorphisms (SNPs) for each candidate gene using Taqman™ allelic discrimination assays. The data were analyzed with two family-based association methods, the pedigree disequilibrium test (PDT) and the association in the presence of linkage (APL) test. Analyses compared 1) high myopia (<-5.00 D), 2) mild to moderate myopia (-0.50 to -5.00 D), 3) any myopia (<-0.50 D) and 4) extreme high myopia (≤-10.00 D) versus emmetropia using refractive error as either sphere (SPH) or spherical equivalent (SE=sphere + [cylinder/2]). Bonferroni correction was applied to adjust for multiple testing leading to significance levels of 0.0125 for HGF and 0.008 for C-MET. Two and three-marker sliding window haplotype association tests using APL were also performed for HGF markers. Significance levels for haplotype association testing were set at 0.01 for the global tests, and 0.007 for the three marker haplotype specific tests and 0.0125 for the two marker haplotype specific tests.
A total of 146 multiplex families consisting of 649 Caucasian subjects were included. The HGF SNP, rs3735520 (APL p=0.002768 for SPH and 0.005609 for SE), and the haplotypes, rs2286194-rs3735520-rs17501108 (APL p=0.007403 for SPH and 0.062685 for SE) and rs12536657-rs2286194 (APL p=0.004219 for SPH and 0.00518 for SE), showed significant association with mild to moderate myopia versus emmetropia. A promising association between extreme high myopia and the HGF SNP, rs2286194, was also found (APL p=0.005763 for SPH and 0.004103 for SE). No evidence of association was found in the SNPs tested for C-MET.
This study supports a strong association between the mild to moderate myopia group and the HGF SNP rs3735520 and the HGF haplotypes rs2286194-rs3735520-rs17501108 and rs12536657-rs2286194, and a moderate association of the extreme high myopia with rs2286194. C-MET polymorphism statistical associations with myopia in an Asian study were not replicated in our Caucasian cohort. HGF may be a potential myopia candidate gene for further investigation.
PMCID: PMC2684748  PMID: 19471602
10.  Visual Activity before and after the Onset of Juvenile Myopia 
Before the onset of myopia, children's near work activities did not differ from those of emmetropes. Those who became myopic had fewer sports and outdoor activity hours than emmetropes had, before, at, and after myopia onset.
To investigate visual activities before and after the onset of juvenile myopia.
The subjects were 731 incident myopes (−0.75 D or more myopia on cycloplegic autorefraction in both meridians) and 587 emmetropes (between −0.25 and +1.00 D) in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study. Parents supplied visual activity data annually. Data from myopic children 5 years before through 5 years after myopia onset were compared to data from age-, sex-, and ethnicity-matched models of children who remained emmetropic.
Hours per week spent reading or using a computer/playing video games did not differ between the groups before myopia onset; however, hours per week for both activities were significantly greater in myopes than in emmetropes at onset and in 4 of the 5 years after onset by 0.7 to 1.6 hours per week. Hours per week spent in outdoor/sports activities were significantly fewer for children who became myopic 3 years before onset through 4 years after onset by 1.1 to 1.8 hours per week. Studying and TV watching were not significantly different before myopia onset.
Before myopia onset, near work activities of future myopic children did not differ from those of emmetropes. Those who became myopic had fewer outdoor/sports activity hours than the emmetropes before, at, and after myopia onset. Myopia onset may influence children's near work behavior, but the lack of difference before onset argues against a major causative role for near work. Less outdoor/sports activity before myopia onset may exert a stronger influence on development than near work.
PMCID: PMC3101696  PMID: 20926821
11.  Clinical efficacy of Ayurvedic management in computer vision syndrome: A pilot study 
Ayu  2012;33(3):391-395.
Improper use of sense organs, violating the moral code of conduct, and the effect of the time are the three basic causative factors behind all the health problems. Computer, the knowledge bank of modern life, has emerged as a profession causing vision-related discomfort, ocular fatigue, and systemic effects. Computer Vision Syndrome (CVS) is the new nomenclature to the visual, ocular, and systemic symptoms arising due to the long time and improper working on the computer and is emerging as a pandemic in the 21st century. On critical analysis of the symptoms of CVS on Tridoshika theory of Ayurveda, as per the road map given by Acharya Charaka, it seems to be a Vata–Pittaja ocular cum systemic disease which needs systemic as well as topical treatment approach. Shatavaryaadi Churna (orally), Go-Ghrita Netra Tarpana (topically), and counseling regarding proper working conditions on computer were tried in 30 patients of CVS. In group I, where oral and local treatment was given, significant improvement in all the symptoms of CVS was observed, whereas in groups II and III, local treatment and counseling regarding proper working conditions, respectively, were given and showed insignificant results. The study verified the hypothesis that CVS in Ayurvedic perspective is a Vata–Pittaja disease affecting mainly eyes and body as a whole and needs a systemic intervention rather than topical ocular medication only.
PMCID: PMC3665100  PMID: 23723647
Computer vision syndrome; Shatavaryaadi Churna; Tarpana
12.  Analysis of the keratocyte apoptosis, keratocyte proliferation, and myofibroblast transformation responses after photorefractive keratectomy and laser in situ keratomileusis. 
PURPOSE: To test the hypothesis that (1) there are quantitative differences in the cellular responses in the corneal stroma after photorefractive keratectomy (PRK) for low myopia compared to high myopia and (2) there are both qualitative and quantitative differences in the cellular responses in the corneal stroma after PRK for high myopia and laser in situ keratomileusis (LASIK) for high myopia. METHODS: PRK for low myopia (-4.5 diopters [D]), PRK for high myopia (-9.0 D), and LASIK for high myopia (-9.0 D) were performed in rabbit eyes, and corneas were obtained for examination at 4, 24, and 72 hours, 1 and 4 weeks, and 3 months after surgery. A total of 144 rabbits were included in the study. Stromal apoptosis, necrosis, mitosis, myofibroblast generation, and inflammatory cell infiltration were evaluated by immunohistochemical methods and electron microscopy. RESULTS: Keratocyte apoptosis/necrosis and the subsequent proliferation and density of myofibroblasts were qualitatively and quantitatively different in PRK for high myopia compared to either PRK for low myopia or LASIK for high myopia. Significant inflammatory cell infiltration was noted in both PRK and LASIK but appeared to be greater in PRK for high myopia. CONCLUSIONS: The qualitative and quantitative differences in the cellular wound healing response after PRK for high and low myopia and LASIK for high myopia are likely determinants of the clinical differences in refractive outcome and some of the complications, such as regression and haze, seen after these procedures.
PMCID: PMC1358972  PMID: 12545703
13.  Association of vitamin D receptor gene start codon (Fok1) polymorphism with high myopia 
Oman Journal of Ophthalmology  2011;4(2):57-62.
High myopia caused primarily due to abnormal emmetropization and excessive axial ocular elongation is associated with sight-threatening ocular pathology. Muscular dysfunction of ocular ciliary muscles due to altered intracellular calcium levels can result in defective mechanotransduction of the eye and retinal defocus. The vitamin D3 receptor (VDR; a intracellular hormone receptor) is known to mediate calcium homeostasis, influencing the development of myopia.
Materials and Methods:
In the present study, a total of 206 high myopia, 98 low myopia and 250 control samples were analyzed for VDR gene Fok1 (exon 2 start codon) polymorphism using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique.
High myopia patients revealed decrease in the frequency of ff homozygotes (8.3%) as compared to control group (14.0%), with a corresponding increase in frequency of FF homozygotes (68.9% in high myopia vs. 62.8% in controls). The frequency of f allele carriers (Ff and ff) was increased in females of high myopia (35.6%) and low myopia cases (45.4%). Elevated frequency of f allele was found only in early age at onset cases of high myopia (0.227) and later age at onset (10–20 years) cases of low myopia (0.273) as well as in low myopia cases with parental consanguinity (0.458) (P 0.035; χ2 = 6.692*).
The results suggest that VDR gene might not be playing a direct role in the development of myopia, but might contribute indirectly to the risk conferred by mechanical stress factors or growth/development related factors through its role in calcium homeostasis and regulation of ciliary muscle function.
PMCID: PMC3160070  PMID: 21897619
Axial elongation; calcium homeostasis; high myopia; myopia development; polymorphism; VDR gene; vitreo-retinal degeneration
14.  Visual Quality after Wavefront-Guided LASIK for Myopia 
Journal of Korean Medical Science  2005;20(5):860-865.
This study evaluated the visual quality after wavefront-guided laser in situ keratomileusis (LASIK) for treating myopia. Thirty-two eyes with moderate myopia (-5.78~-2.17D) and 25 eyes with high myopia (-7.78~-6.17D) were prospectively reviewed. The contrast sensitivity (CS), glare and the total higher order aberrations (HOA) were measured before and 1 week, 1 month and 2 months after LASIK. The pupil diameter was measured at day- and night-time illumination. The CS and glare at all spatial frequencies were not reduced after wavefront-guided LASIK (p<0.05) and the difference between the moderate and high myopia group was not significant. No significant correlation was found between the amounts of myopia and the postoperative CS (p>0.05). The area under the log contrast sensitivity function (AULCSF) showed no correlation with the total HOA (r2=-0.071, p=0.612, between the daytime AULCSF and the total HOA with a 4 mm entrance pupil, r2=-0.176, p=0.260, between the nighttime AULCSF and the total HOA with a 6 mm entrance pupil). There was no decrease in CS and glare after wavefront-guided LASIK for myopia. In conclusion, wavefront-guided LASIK based on the individual ablation patterns is a good option for refractive surgery to improve the visual quality in both moderate and high myopia cases.
PMCID: PMC2779286  PMID: 16224163
Contrast Sensitivity; High Order Aberration; Glare; Keratomileusis, Laser In Situ; Myopia; Wavefront
15.  Interventions to slow progression of myopia in children 
Nearsightedness (myopia) causes blurry vision when looking at distant objects. Highly nearsighted people are at greater risk of several vision-threatening problems such as retinal detachments, choroidal atrophy, cataracts and glaucoma. Interventions that have been explored to slow the progression of myopia include bifocal spectacles, cycloplegic drops, intraocular pressure-lowering drugs, muscarinic receptor antagonists and contact lenses. The purpose of this review was to systematically assess the effectiveness of strategies to control progression of myopia in children.
To assess the effects of several types of interventions, including eye drops, undercorrection of nearsightedness, multifocal spectacles and contact lenses, on the progression of nearsightedness in myopic children younger than 18 years. We compared the interventions of interest with each other, to single vision lenses (SVLs) (spectacles), placebo or no treatment.
Search methods
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 10), MEDLINE (January 1950 to October 2011), EMBASE (January 1980 to October 2011), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to October 2011), the metaRegister of Controlled Trials (mRCT) ( and ( There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 11 October 2011. We also searched the reference lists and Science Citation Index for additional, potentially relevant studies.
Selection criteria
We included randomized controlled trials (RCTs) in which participants were treated with spectacles, contact lenses or pharmaceutical agents for the purpose of controlling progression of myopia. We excluded trials where participants were older than 18 years at baseline or participants had less than −0.25 diopters (D) spherical equivalent myopia.
Data collection and analysis
Two review authors independently extracted data and assessed the risk of bias for each included study. When possible, we analyzed data with the inverse variance method using a fixed-effect or random-effects model, depending on the number of studies and amount of heterogeneity detected.
Main results
We included 23 studies (4696 total participants) in this review, with 17 of these studies included in quantitative analysis. Since we only included RCTs in the review, the studies were generally at low risk of bias for selection bias. Undercorrection of myopia was found to increase myopia progression slightly in two studies; children who were undercorrected progressed on average 0.15 D (95% confidence interval (CI) −0.29 to 0.00) more than the fully corrected SVLs wearers at one year. Rigid gas permeable contact lenses (RGPCLs) were found to have no evidence of effect on myopic eye growth in two studies (no meta-analysis due to heterogeneity between studies). Progressive addition lenses (PALs), reported in four studies, and bifocal spectacles, reported in four studies, were found to yield a small slowing of myopia progression. For seven studies with quantitative data at one year, children wearing multifocal lenses, either PALs or bifocals, progressed on average 0.16 D (95% CI 0.07 to 0.25) less than children wearing SVLs. The largest positive effects for slowing myopia progression were exhibited by anti-muscarinic medications. At one year, children receiving pirenzepine gel (two studies), cyclopentolate eye drops (one study), or atropine eye drops (two studies) showed significantly less myopic progression compared with children receiving placebo (mean differences (MD) 0.31 (95% CI 0.17 to 0.44), 0.34 (95% CI 0.08 to 0.60), and 0.80 (95% CI 0.70 to 0.90), respectively).
Authors’ conclusions
The most likely effective treatment to slow myopia progression thus far is anti-muscarinic topical medication. However, side effects of these medications include light sensitivity and near blur. Also, they are not yet commercially available, so their use is limited and not practical. Further information is required for other methods of myopia control, such as the use of corneal reshaping contact lenses or bifocal soft contact lenses (BSCLs) with a distance center are promising, but currently no published randomized clinical trials exist.
PMCID: PMC4270373  PMID: 22161388
16.  Spectral- and time-domain optical coherence tomography measurements of macular thickness in young myopic eyes 
Diagnostic Pathology  2014;9:38.
To evaluate the variation in macular retinal thickness and volume in young Chinese myopic patients using time-domain optical coherence tomography (Stratus TD-OCT) and spectral-domain optical coherence tomography (Cirrus HD-OCT).
Ninety-two eyes of 92 myopic subjects were recruited in this study. Based upon spherical equivalence (SE), subjects were divided into two groups: the low to moderate myopia group (-0.5 D ≤ SE < -6.0 D), and the high myopia group (SE ≥ -6.0 D). Stratus TD-OCT and Cirrus HD-OCT were used to compare macular retinal thickness and volume between the two groups. Bland–Altman analysis and Pearson correlation were used to measure agreement between the two OCT systems.
Average macular retinal thickness and total macular volume measured by Cirrus HD-OCT and Stratus TD-OCT of the low to moderate myopia group were 283.52 ± 12.14 μm and 245.38 ± 8.55 μm, respectively, and 10.08 ± 0.37 mm3 and 6.85 ± 0.26 mm3, respectively, and the high myopia groups were 269.58 ± 10.72 μm and 235.65 ± 7.54 μm, respectively, and 9.71 ± 0.36 mm3 and 6.52 ± 0.25 mm3, respectively. The measurements of the two OCTs showed that macular retinal thickness of the parafovea was significantly lower in the high myopia group compared with the low to moderate myopia group, except at the fovea (all P-values less than 0.001, except at the fovea). Using the Bland–Altman method and Pearson correlation, measurements of macular thickness in nine macular retinal subfields and total macular volumes showed good agreement between the two OCTs in myopic eyes (all P-values less than 0.001), with better agreement in the low to moderate myopia group than in the high myopia group.
The average macular retinal thickness of the fovea did not vary with myopia, while the total volume and retinal thickness of the parafovea were thinner with increasing myopia. There was good agreement between the two OCTs in myopic eyes in all macular subfields, and the Cirrus HD-OCT system provided thicker macular retinal thickness measurements than the Stratus TD-OCT system.
Virtual slides
The virtual slides for this article can be found here:
PMCID: PMC3996088  PMID: 24555908
Myopia; Macular retinal thickness; Optical coherence tomography; Time-domain; Spectral-domain
17.  Antipyretic activity of Guduchi Ghrita formulations in albino rats 
Ayu  2010;31(3):367-370.
The present pharmacological investigation was undertaken to study the anti-pyretic activity of Guduchi ghrita formulations in albino rats against yeast induced pyrexia. Seven groups of six animals were used for the experiment. The yeast induced pyrexia method was standardized first by injecting 12.5% yeast suspension (s.c) followed by recording the rectal temperature at regular intervals. Then the evaluation of anti-pyretic activity of Guduchi ghrita formulations was carried out by using this standard procedure. Both the Guduchi ghrita samples including vehicle significantly attenuated the raise in temperature after three hours of yeast injection. After 6 and 9 hours of yeast injection also both the Guduchi ghrita samples attenuated the raise in temperature in a highly significant manner in comparison to both yeast control and vehicle control groups. The data generated during study shows that both the Guduchi ghrita formulations having significant anti-pyretic activity.
PMCID: PMC3221073  PMID: 22131741
Guduchi Ghrita; pyrexia; Brewer's yeast; paracetamol; Tinospora cordifolia (Willd.) Miers. medicated ghee
18.  Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial 
To determine if ‘Defocus Incorporated Soft Contact’ (DISC) lens wear slows childhood myopia progression.
A 2-year double-blind randomised controlled trial was carried out in 221 children aged 8–13 years, with myopia between −1.00 and −5.00 Dioptres (D) and astigmatism ≤1.00 D. Subjects were randomly assigned to the DISC (n=111) or single vision (SV; n=110) contact lens group. DISC lenses incorporated concentric rings, which provided an addition of +2.50 D, alternating with the normal distance correction. Refractive error (cycloplegic autorefraction) and axial length were measured at 6-month intervals. Differences between groups were analysed using unpaired t test.
In total, 128 children completed the study, n=65 in the DISC group and n=63 in the SV group. Myopia progressed 25% more slowly for children in the DISC group compared with those in the control group (0.30 D/year; 95% CI −0.71 to −0.47 vs 0.4 D/year; 95% CI −0.93 to −0.65, p=0.031). Likewise, there was less axial elongation for children in the DISC versus SV groups (0.13 mm/year; 95% CI 0.20 to 0.31 vs 0.18 mm/year; 95% CI 0.30 to 0.43, p=0.009). Treatment effect correlated positively with DISC lens wearing time (r=0.342; p=0.005). Indeed, myopia in children who wore the DISC lenses for five or more hours/day progressed 46% (mean difference=−0.382 D, p=0.001; 95% CI −0.59 to −0.17) less than those in the SV group.
The daily wearing of DISC lens significantly slowed myopia progression and axial elongation in Hong Kong schoolchildren. The findings demonstrated that simultaneous clear vision with constant myopic defocus can retard myopia progression.
PMCID: PMC3888618  PMID: 24169657
Clinical Trial; Child Health (Paediatrics); Contact Lens; Optics and Refraction
19.  Wnt Signaling in Form Deprivation Myopia of the Mice Retina 
PLoS ONE  2014;9(4):e91086.
The canonical Wnt signaling pathway plays important roles in cellular proliferation and differentiation, axonal outgrowth, cellular maintenance in retinas. Here we test the hypothesis that elements of the Wnt signaling pathway are involved in the regulation of eye growth and prevention of myopia, in the mouse form-deprivation myopia model.
Methodology/Principal Findings
(1) One hundred twenty-five C57BL/6 mice were randomly distributed into form-deprivation myopia and control groups. Form-deprivation myopia (FDM) was induced by suturing the right eyelid, while the control group received no treatment. After 1, 2, and 4 weeks of treatment, eyes were assessed in vivo by cycloplegic retinoscopic refraction and axial length measurement by photography or A-scan ultrasonography. Levels of retinal Wnt2b, Fzd5 and β-catenin mRNA and protein were evaluated using RT-PCR and western blotting, respectively. (2) Another 96 mice were divided into three groups: control, drugs-only, and drugs+FDM (by diffuser). Experimentally treated eyes in the last two groups received intravitreal injections of vehicle or the proteins, DKK-1 (Wnt-pathway antagonist) or Norrin (Wnt-pathway agonist), once every three days, for 4 injections total. Axial length and retinoscopic refraction were measured on the 14th day of form deprivation.
Following form-deprivation for 1, 2, and 4 weeks, FDM eyes had a relatively myopic refractive error, compared with contralateral eyes. There were no significant differences in refractive error between right and left eye in control group. The amounts of Wnt2b, Fzd5 and β-catenin mRNA and protein were significantly greater in form-deprived myopia eyes than in control eyes.DKK-1 (antagonist) reduced the myopic shift in refractive error and increase in axial elongation, whereas Norrin had the opposite effect in FDM eyes.
Our studies provide the first evidence that the Wnt2b signaling pathway may play a role in the development and progression of form-deprivation myopia, in a mammalian model.
PMCID: PMC3995642  PMID: 24755605
20.  PA03.17. A clinical evaluation of Punarnavadi Mandura and Dadimadi Ghritha in management of pandu (Iron defeciency anaemia) 
Ancient Science of Life  2013;32(Suppl 2):S86.
Iron deficiency anaemia is currently the most micronutrient deficiency affecting 1.5 billion people globally. in our country 50% of children are Anemic. the features of iron deficiency anaemia are almost similar with that of Panduroga mentioned in Ayurvedic classics. Punarnavadi mandura and Dadimadi Ghrita are mentioned in the management of Pandu. Mandura (Fe2O3) directly increases serum ferritin,Punarnava decreases gastric irritation produced by Mandura,while Dadimadi Ghrita helps for better digestion and absorption. Hence,the study was planned to find the efficacy of these drugs in Pandu.
The present study was conducted on 50 children fulfilling inclusion criteria in between the age group of 10 to 14 years. The patients were selected from S.D.M.C.A & Hospital, Hassan. Punarnavadi Mandura 500 mg B.D and dadimadi Ghritha 10 ml B.D with luke warm water for a period of 84 days (3 lunar months) The cases were recorded according to the case proforma prepared for the study and observations were recorded.
Symptoms were statistically analyzed before and after treatment, their was statistically significant changes (P < 0.001) were observed in the signs and symptoms of Pandu rogi(IDA). There was a statistically significant response in hemoglobin and other hematological investigation like MCHC, MCV, PCV, Reticulocyte Count, peripheral Blood smear, serum iron, serum Ferritin and Total Iron Bindinig Capacity in the Group (P < 0.001).
Punarnavadi Mandura and Dadimadi Ghrita are effective in the management of Pandu roga (Iron Deficiency Anemia).
PMCID: PMC4147561
21.  Astigmatism and Myopia in Tohono O'odham Native American Children 
To describe change in spherical equivalent (M) in a longitudinal sample of Tohono O'odham students ages 3 to 18 years and to test the hypothesis that astigmatism creates complex cues to emmetropization, resulting in increased change in M in the direction of increasing myopia and increased occurrence of myopia.
Subjects were 777 Tohono O'odham Native American children on whom cycloplegic right eye autorefraction was measured on at least two study encounters between ages 3 and 18 years (first encounter prior to age 5.5 years, final encounter ≥ 3 years later). Regression lines were fit to individual subjects’ longitudinal M data to estimate rate of change in M (regression slope, D/year). Regression was also used to predict if a subject would be myopic (≤−0.75D M) by age 18 years. ANCOVA was used to assess the relation between M slope and magnitude of baseline M and astigmatism. Chi-square analyses were used to assess the relation between predicted myopia onset and magnitude of baseline M and astigmatism.
Mean M slope was significantly more negative for hyperopes (M ≥ +2.00) than for myopes (M ≤ −0.75) or for subjects neither hyperopic nor myopic (NHM, M > −0.75 and < +2.00), but there was no significant difference between the myopic and NHM groups. Chi-square analysis indicated that final myopia status varied across level of baseline astigmatism. Subjects with high astigmatism were more likely to be predicted to have significant myopia by age 18 years.
The association between greater shift in M towards myopia with age in subjects who were hyperopic at baseline is consistent with continued emmetropization in the school years. Results regarding predicted myopia development imply that degradation of image quality due to refractive astigmatism creates complex cues to emmetropization, resulting in increased occurrence of myopia.
PMCID: PMC4068822  PMID: 24100480
astigmatism; myopia; refractive development; emmetropization
22.  Self-reported myopia in Taiwan: 2005 Taiwan National Health Interview Survey 
Eye  2012;26(5):684-689.
To determine the prevalence of self-reported myopia nationwide in Taiwan and its association with degrees of urbanization and education levels.
Data were obtained from the 2005 Taiwan National Health Interview Survey, a nationwide survey using multistage stratified systematic sampling. The presence of myopia, current residential areas, and education levels were ascertained by a structured questionnaire in participants ≥12 years of age.
A total of 20 609 eligible persons were included in this study. The overall weighted prevalence of myopia in Taiwan was 46.7% (95% confidence interval: 45.9, 47.5%). The prevalence of myopia for persons aged 12–19, 20–39, 40–64, and ≥65 years was 70.3%, 65.4%, 30.4%, and 5.6%, respectively. Women had significantly higher rates of myopia than men for persons younger than 40 years of age (P<0.001). Myopia was significantly associated with both higher degrees of urbanization of current residential areas and higher education levels (both P<0.001). In young adult and adult groups, the effect of education levels on myopia was stronger than that of degrees of urbanization.
The study provides a nation-wide prevalence data on myopia in Taiwan. Both degrees of urbanization and education levels are risk factors for myopia.
PMCID: PMC3351071  PMID: 22344187
myopia; self-reported; 2005 Taiwan National Health Interview Survey; epidemiology; prevalence
23.  Alterations in Protein Expression in Tree Shrew Sclera during Development of Lens-Induced Myopia and Recovery 
During myopia development and recovery, remodeling of the scleral extracellular matrix (ECM) alters the axial elongation rate. Proteins involved in cell-ECM adhesions and the cytoskeleton change in abundance, possibly altering slippage of scleral layers across each other.
During the development of, and recovery from, negative lens-induced myopia there is regulated remodeling of the scleral extracellular matrix (ECM) that controls the extensibility of the sclera. Difference gel electrophoresis (DIGE) was used to identify and categorize proteins whose levels are altered in this process.
Two groups of five tree shrews started monocular lens wear 24 days after eye opening (days of visual experience [VE]). The lens-induced myopia (LIM) group wore a −5 D lens for 4 days. The recovery (REC) group wore a −5 D lens for 11 days and then recovered for 4 days. Two normal groups (28 and 39 days of VE; n = 5 each) were also examined, age-matched to each of the treatment groups. Refractive and A-scan measures confirmed the effect of the treatments. Scleral proteins were isolated and resolved by DIGE. Proteins that differed in abundance were identified by mass spectrometry. Ingenuity pathway analysis was used to investigate potential biological pathway interactions.
During normal development (28–39 days of VE), eight proteins decreased and one protein increased in relative abundance. LIM-treated eyes were myopic and longer than control eyes; LIM-control eyes were slightly myopic compared with 28N eyes, indicating a yoking effect. In both the LIM-treated and the LIM-control eyes, there was a general downregulation from normal of proteins involved in transcription, cell adhesion, and protein synthesis. Additional proteins involved in cell adhesion, actin cytoskeleton, transcriptional regulation, and ECM structural proteins differed in the LIM-treated eyes versus normal but did not differ in the control eyes versus normal. REC-treated eyes were recovering from the induced myopia. REC-control eye refractions were not significantly different from the 39N eyes, and few proteins differed from age-matched normal eyes. The balance of protein expression in the REC-treated eyes, compared with normal eyes and REC-control eyes, shifted toward upregulation or a return to normal levels of proteins involved in cell adhesion, cell division, cytoskeleton, and ECM structural proteins, including upregulation of several cytoskeleton-related proteins not affected during myopia development.
The DIGE procedure revealed new proteins whose abundance is altered during myopia development and recovery. Many of these are involved in cell-matrix adhesions, cytoskeleton, and transcriptional regulation and extend our understanding of the remodeling that controls the extensibility of the sclera. Reductions in these proteins during minus lens wear may produce the increased scleral viscoelasticity that results in faster axial elongation. Recovery is not a mirror image of lens-induced myopia—many protein levels, decreased during LIM, returned to normal, or slightly above normal, and additional cytoskeleton proteins were upregulated. However, no single protein or pathway appeared to be responsible for the scleral changes during myopia development or recovery.
PMCID: PMC3292368  PMID: 22039233
24.  Progression of myopia. 
BACKGROUND: Myopia is an important public health problem because it is common and is associated with increased risk for chorioretinal degeneration, retinal detachment, and other vision-threatening abnormalities. In animals, ocular elongation and myopia progression can be lessened with atropine treatment. This study provides information about progression of myopia and atropine therapy for myopia in humans. METHODS: A total of 214 residents of Olmsted County, Minnesota (118 girls and 96 boys; median age, 11 years; range, 6 to 15 years) received atropine for myopia from 1967 through 1974. Control subjects were matched by age, sex, refractive error, and date of baseline examination to 194 of those receiving atropine. Duration of treatment with atropine ranged from 18 weeks to 11.5 years (median 3.5 years). RESULTS: Median follow-up from initial to last refraction in the atropine group (11.7 years) was similar to that in the control group (12.4 years). Photophobia and blurred vision were frequently reported, but no serious adverse effects were associated with atropine therapy. Mean myopia progression during atropine treatment adjusted for age and refractive error (0.05 diopters per year) was significantly less than that among control subjects (0.36 diopters per year) (P < .001). Final refractions standardized to the age of 20 years showed a greater mean level of myopia in the control group (3.78 diopters) than in the atropine group (2.79 diopters) (P < .001). CONCLUSIONS: The data support the view that atropine therapy is associated with decreased progression of myopia and that beneficial effects remain after treatment has been discontinued.
PMCID: PMC1312077  PMID: 8719698
25.  Genome-Wide Analysis Points to Roles for Extracellular Matrix Remodeling, the Visual Cycle, and Neuronal Development in Myopia 
PLoS Genetics  2013;9(2):e1003299.
Myopia, or nearsightedness, is the most common eye disorder, resulting primarily from excess elongation of the eye. The etiology of myopia, although known to be complex, is poorly understood. Here we report the largest ever genome-wide association study (45,771 participants) on myopia in Europeans. We performed a survival analysis on age of myopia onset and identified 22 significant associations (), two of which are replications of earlier associations with refractive error. Ten of the 20 novel associations identified replicate in a separate cohort of 8,323 participants who reported if they had developed myopia before age 10. These 22 associations in total explain 2.9% of the variance in myopia age of onset and point toward a number of different mechanisms behind the development of myopia. One association is in the gene PRSS56, which has previously been linked to abnormally small eyes; one is in a gene that forms part of the extracellular matrix (LAMA2); two are in or near genes involved in the regeneration of 11-cis-retinal (RGR and RDH5); two are near genes known to be involved in the growth and guidance of retinal ganglion cells (ZIC2, SFRP1); and five are in or near genes involved in neuronal signaling or development. These novel findings point toward multiple genetic factors involved in the development of myopia and suggest that complex interactions between extracellular matrix remodeling, neuronal development, and visual signals from the retina may underlie the development of myopia in humans.
Author Summary
The genetic basis of myopia, or nearsightedness, is believed to be complex and affected by multiple genes. Two genetic association studies have each identified a single genetic region associated with myopia in European populations. Here we report the results of the largest ever genetic association study on myopia in over 45,000 people of European ancestry. We identified 22 genetic regions significantly associated with myopia age of onset. Two are replications of the previously identified associations, and 20 are novel. Ten of the novel associations replicate in a small separate cohort. Sixteen of the novel associations are in or near genes implicated in eye development, neuronal development and signaling, the visual cycle of the retina, and general morphology: BMP3, BMP4, DLG2, DLX1, KCNMA1, KCNQ5, LAMA2, LRRC4C, PRSS56, RBFOX1, RDH5, RGR, SFRP1, TJP2, ZBTB38, and ZIC2. These findings point to numerous biological pathways involved in the development of myopia and, in particular, suggest that early eye and neuronal development may lead to the eventual development of myopia in humans.
PMCID: PMC3585144  PMID: 23468642

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