Chinese Medical Ophthalmology

Andy Rosenfarb, ND LAc

Dr. Rosenfarb’s Published Books

Coming Soon!

Retinitis Pigmentosa Research

► Johns Hopkins University, Maryland - 2012

► NOVA Southeastern University - 2014

Appearance on

The Dr.Oz Show

Clinical Objective

To IMPROVE and RECOVER lost vision.

&

PRESERVE vision LONG TERM!

Vision & The Eye

► The Eye contains more than 50% of the total sensory receptors in the body.

► The Eye - 2.5 cm diameter

► Anterior eye is only 1/6 of the eye

► Vision is the Interplay of Matter & Energy Material/Structure (Eye Structure-Yin)

Immaterial/Function (Vision-Yang)

Anatomy of the Eye

Three coats or tunics

Fibrous: Consists of sclera and cornea

Vascular: Consists of choroid, ciliary body, iris

Nervous: Consists of retina 15-9

How the Eye Works

The eye functions like a camera

Iris allows light into eye

Lens, cornea, humors focus light onto retina

Light striking retina is converted into action potentials (images) relayed to brain for interpretation.

15-10

How We See

15-12

What Causes of Failing Vision?

Genetic Predisposition Trauma/ Injury/ Illness Drugs/Medications Metabolic Imbalances Poor Nutrition Eye Strain Epigenetic Stress Factors Poor Circulation Systemic Disease

Conventional Medicine

The eye is diagnosed and treated as an

isolated organ pathology.

Decline of vision is said to be

a “natural process,” that can

either stabilize or get worse.

Conventional Approaches for

Eye Disease

“Corrective” Glasses & Contacts Lenses

Medications

Surgical Procedures

“Wait and See What Happens…”

Chinese Medicine Approach

Deals with the body as a whole, rather than in individual “parts.”

Everything is “connected,” and vision can be influenced by all organs in the body.

According to Chinese Medicine, most eye disease is related to Liver (functional) and/or Kidney (structural) dysfunction.

Holistic-Integrative approach producesthe best outcomes for our patients.

How Acupuncture Helps Vision

Increases Blood Flow the eye (O2 + food)

Stimulates Nerve Cells

Charges Dormant Retinal Cells

Regulates the Autonomic Nervous System

Promotes a Parasympathetic Response

Treats BOTH eye condition & underlying cause

Primary Objectives for

Preserving Vision Improve Circulation

Stimulate Photoreceptors, Optic

Nerve & Visual Cortex

Decrease Inflammation

Reduce Oxidative Stress

Identify & Manage Causative Factors

Long term Neuro-Protection

CHINESE MEDICINE &

DEGENERATIVE VISION LOSS

TCM 5-Wheel Theory

Element Yin Organ Yang Organ Structure

Fire Heart Sm. Intestine Inner/Outer canthus

Earth Spleen Stomach Eyelids aqueous

Metal Lung Lg. Intestine Sclera cornea, conjunctiva

Water Kidney Urinary Bladder

Pupil, macula, & retina, choroid

Wood Liver Gall Bladder Iris & eye muscles

Eyes & The Liver

Liver Opens into the Eyes, eyes reflect

the function of the liver.

Liver Qi is connected to the Eye & the

Harmony of the Liver Qi allows the Eyes

to see.

Liver stores the blood; the storage of

blood allows the eyes to see.

The Liver governs the tears; the tears

luster the eyes.

Eyes & The Heart

The Heart Governs the Blood, the blood

nourishes the eyes.

The Heart s connected with the blood

vessels, and all the vessels are related

to the eyes.

The Heart houses the spirit and

liveliness; the eyes command the Heart.

Eyes & The Spleen

The Spleen Transports Essence upward

to the eyes.

The Spring brings clear yang upwards to

the eyes.

The Spleen Qi controls the blood to

circulate within the blood vessels of the

eyes.

Eyes & The Lung

The Lung Dominates Qi; the harmony of

Qi ensures the brightness of the eyes.

The Lung governs dispersing and

descending; the smooth flow of Wei Qi

to the collaterals of the eye.

Lungs Govern the exterior, protecting

the eyes so as to be nourished and

warmed without damage by external

pathogen

Eyes & The Kidney

Kidney Governs the storage of Essence;

sufficiency of Essence ensures the brightness

of the eyes.

Kidney engenders the cerebral marrow; the

eyes are connected with the brain.

The kidney governs fluids & moisten the eye.

The Kidney supplies True Yin and True Yang; it

nourishes and supports the function of the

retina, pupil, chorroid, aqueous & vitreous.

Relationship with the Six Fu

Zang moves Qi to the Fu; Fu Transports

Essence to the Zang.

Six Fu: govern reception, control digestion,

separate clear and turbid, move waste

through the bowels, transport essence in

the form of “Sensory Jing” to the eyes.

In short, Fu delivers Ying-Nourishment

the eyes to maintain healthy vision.

TCM Pathogens & Eye Diseases

PATHOGEN ORGAN EFFECT ON EYES

Fire/Heat Heart Swelling, redness, inflammation

Cold Kidney Slow onset degenerative eye diseases

Wind Liver Sudden onset eye diseases

Dampness Spleen Mucus, edema, secretions – slow onset

Dryness Lung Dryness, itching, redness

Summer Heat All Organs Inflammation w/ mucus

EYE CONTITIONS

Macular Degeneration

AGE RELATED MACULAR DEGENERATION

Insufficient oxygen and nutrients damages photoreceptor molecules

With ageing, the ability of RPE cells to digest these molecules decreases

Excessive accumulation of residual bodies (drusen)

RPE membrane and cells degenerate and atrophy sets in and central vision is lost

BMJ 326, 2003; 485-488

AGE RELATED MACULAR DEGENERATION

Alternatively the photoreceptors and pigment epithelium send a distress signal to choroid capillaries to make new vessels

New vessels grow behind the macula

Breakdown in the Bruch’s membrane

Blood vessels are fragile

Leak blood and fluid

Scarring of macula

Potential for rapid severe damage

BMJ 326; 2003: 485-488

DRY MACULAR DEGENERATION

1. Accounts for about 90% of all cases

1. Also called atrophic, non exudative or

drusenoid macular degeneration

DRY MACULAR DEGENERATION

Drusen

Drusen is an aggregation of hyaline material located between Bruch’s membrane and RPE.

Drusen are composed of waste products from photoreceptors.

Drusen > 63 microns in diameter are statistically associated with visual pathology and are termed early ARMD.

Hypo/hyper pigmentation of RPE may be present

NEJM, Vol 342 (7): 483-492

DRY MACULAR DEGENERATION: VISUAL

WET MACULAR DEGENERATION

Accounts for about 10%

Also called choroidal neovascularization, subretinal neovascularization or disciform degeneration

Abnormal blood vessels grow beneath the macula

These vessels leak blood and fluid into the macula damaging photo receptors

Progresses rapidly and can cause severe damage to central vision

http://www.blindness.org

Treatment Guidelines for AMD

Acupoints: Sp-3, Ht-8 Qihou, GB-20, Yuyao, St-2, UB-2,

Sp-6, St-36, GB-37, Lv-2

Bleeding – Moxa Sp-1

TC Herb Rx: San Ren Tang Phlegm-Damp

Xiao Yao San – Qi Stagnation

Zhu Jung Wan – Lv/Ki Deficient

Ming Mu Di Huang Wan – Lv/Ki deficient

Retinitis Pigmentosa

What is Retinitis Pigmentosa?

Retinitis Pigmentosa, also known as RP, is a group of diseases that usually run in families which causes slow, but progressive and permanent loss of vision.

The retina is a tissue which lines the inside of the eye, and sends images to the brain. RP causes a gradual destruction of the light sensing cells, dark and peripheral vision cells, straight ahead and fine details, and cells responsible for seeing color.

Currently there is no cure for Retinitis Pigmentosa, however there are developments progressing.

Causes

Retinitis Pigmentosa (RP) is a group of inherited diseases that

damage the light-sensitive rods and cones located in the retina,

the back part of our eyes.

Rods, which provide peripheral and night vision are affected

more than the cones that provide color and clear central vision.

Left: Normal Eye Right: RP Eye

The RP Eye:

Healthy Retina vs. Affected Retina

Through the Eyes of RP

Tunnel Vision

Frequency

✓ Internationally: The incidence of primary RP is

approximately 1 in 4000.

✓ Gender: Because of X-linked varieties, men may be affected

slightly more than women.

✓ Age: The age of onset varies depending on the disorder. RP

usually is diagnosed in young adulthood, although it can

occur anywhere from infancy to mid 30s to 50s.

Treatment Guidelines for RP

Main TCM DX: Liver Blood Stasis with lung Deficiency

Acupoints: Lv-8, Ki-10, Ki-7, Sp-3, Ht-8, Lu-10, Taiyang, Yuyao, UB-2, St-1

Herbs: Xue Fu Zhu Yu Tang – blood stasis

Qi Ju Di Huang Tang – Li/Ki Yin

Shi Hu Ye Guang Wan – Night Vision/ Yin Def

Glaucoma

Types of Glaucoma

Congenital, Trauma, Steroid Induced Normal Tension Glaucoma Open Angle Glaucoma (Chronic) Closed Angle Glaucoma (Acute) Headaches

No Symptoms

Eye Pain

Nausea

Severely Blurred Vision

Glaucoma Diagnosis

These are four things Ophthalmologist’s

look for:

The eye’s fluid pressure

The shape and color of the optic nerve

The complete field of vision

The angle where the iris meets the cornea

Eye’s Drainage System

Focus Tx on The Optic Nerve

TCM Pattern Differentiation for

Glaucoma

Open Angle (Chronic)

Kidney Deficiency Liver Deficiency

Liver Qi & Blood Stagnation

Stagnation of Fluids

Closed Angle (Acute)

Liver Wind Stirring/ Liver Yang Rising

Treatment Principles

1. Warm & Strengthen the Yang (and Qi)1. Jin Qui Shen Qi Wan

2. Wen Dan Tang

3. You Gui Wan

2. Move the Qi & Blood (and fluids)1. Dai Di Dang Wan – stagnation of essence

2. Xue Fu Zhu Yu Tang

3. Xiao Yao San

TCM Acupuncture

Focus on the GB Xu & UB to being Ying to Eyes to enable Yang

Stagnation of Qi, Blood, fluids & Deficiency of Jing

Locate ah-shi points on these meridians. Common points used: SJ-3, LI-4, GB-4,20, 43, 37 Taiyang, UB-1,2, 62, SI-3, K-7

DO NOT USE LOCAL E-STIM FOR GLAUCOMA PATTIENS AS IT CAN RAISE Inter-Ocular Pressure!

Andy’s Acupuncture Glaucoma

Guidelines

Treatment:

GB-1 (local), GB- 20 (move Qi to the eyes), GB-30 (move Qi in GB), GB-37 (special eye point), GB-43 (tonification), UB-2 (local), St-2 (local), St-36 (horray), Lv-8 (move blood), Ki-7 (tonify yang qi)

Extra Glaucoma points:

Extra Glaucoma #1 – 1 cun superior to SJ-23; and one finger-width lateral. In the tender spot, needle posterior until a strong “de-Qi” sensation is obtained.

Extra Glaucoma #2 – ½ cun anterior to St-5; needle superior in tender area as to obtain a strong “de-Qi” sensation.

Eye Exercises to Reduce IOP – Press & Hold St-1 3x for 10 seconds

Direct Moxa: Knuckle of second joint of thumb & middle finger

Supplements for Glaucoma

Cod Liver Oil

Vitamin C

Taurine

Coleus Forskohlii (Steaming)

Ginko Biloba

Turmeric & Circumen

Cataracts

What is a cataract?

A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging. Cataracts are very common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery.

A cataract can occur in either or both eyes. It cannot spread from one eye to the other.

Cataracts

TCM Diagnosis &

Treatment of Cataracts

TCM Herbs for Cataracts

Kidney & Lung Yin Def. Qi Ju Di Huang Wan

Sha Shen Mai men Dong Tang (Glehnia & Ophiopogon)

Internal Heat/ Fluid Deficiency Qi ju Do Haung Wan

Gou Qi Zi & Ju Hua

Qi & Blood Yu Xue Fu Zhu Yu Tang

TCM Acupuncture for Cataracts

Focus on LI, St and UB to bring Ying to the Eyes.

Taiyang, St-1 UB-2, Lu-10, Lu-7, K-3 & 6, LI-1

Use herbs, diet, fluids, & supplements to hydrate & nourish Yin. Need to cool, moisten, & hydrate.

NOTE: Looks for possible infections or chronic GI inflammation other than cardio stress.

Supplements for Cataracts

Vitamin C & Bioflavonoid

Glutathione (antioxidant)

Alpha Lipoic Acid

NAC Eye Drops, “CAN-C”

Smoking is the WORST thing for cataracts!

What Can Effect the Outcome?

How advanced the condition is

Degree of emotional stress

Other co-existing conditions

Willingness to receive treatment

Compliance with treatment and supplements

Sleep and Adequate Rest during recovery

Smoking, Alcohol, Drugs (Rx and Non-Rx)

Poor Diet & Malnutrition

THANK YOU!