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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 11  |  Issue : 1  |  Page : 46-50

A clinical study on Triphaladi compound and Shunthyadi eye drop in the management of computer vision syndrome


Department of Shalakya Tantra, IPGT and RA, Gujarat Ayurved University, Jamnagar, Gujarat, India

Date of Web Publication17-Jan-2018

Correspondence Address:
Dr. Shashi Prakash Gupta
Department of Shalakya Tantra, Room No. 201, P. G. Girls Hostel, IPGT and RA, Gujarat Ayurved University, Jamnagar, Gujarat - 361 008
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_119_17

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  Abstract 


BACKGROUND: Computer vision syndrome (CVS) is a group of symptoms which crop up from the extended viewing of the visual display terminals, when the demands of the task exceed the abilities of the viewer. The symptoms of CVS include eyestrain, dry eyes, burning sensation, headache, focusing difficulties, and neck and shoulder pain.
AIM: This study aims to evaluate the efficacy of Triphaladi compound and Shunthyadi eye drops in the management of CVS.
MATERIALS AND METHODS: In this trial, forty patients were registered, of which 37 completed the treatment. In Group A, 18 patients had been prescribed Triphaladi compound internally and Shunthyadi eye drops, and in Group B, 19 patients had been prescribed the carboxymethylcellulose eye drops along with ergonomics adopted in both the groups. Assessment was done on the basis of eyestrain, redness, headache, blurring of vision, burning sensation, slow refocusing, irritation, fatigue, tear film breakup time, and Schirmer's I- test.
RESULTS: In total, marked improvement was observed in 61% and 53% of patients in Group A and Group B, respectively.
CONCLUSION: The study shows that Triphaladi compound and Shunthyadi eye drops provide better relief in breaking down the pathology of CVS topically and systematically.

Keywords: Computer, computer vision syndrome, Shunthyadi eye drop, Triphaladi compound


How to cite this article:
Gupta SP, Vaghela D B. A clinical study on Triphaladi compound and Shunthyadi eye drop in the management of computer vision syndrome. Indian J Health Sci Biomed Res 2018;11:46-50

How to cite this URL:
Gupta SP, Vaghela D B. A clinical study on Triphaladi compound and Shunthyadi eye drop in the management of computer vision syndrome. Indian J Health Sci Biomed Res [serial online] 2018 [cited 2019 Aug 24];11:46-50. Available from: http://www.ijournalhs.org/text.asp?2018/11/1/46/223417




  Introduction Top


Computer is one of the most developed technologies, which is used in present time by the children, the young, and the old. More and more, humans are sitting in front of computer for longer and longer hours. Computers have increased the work efficiency and communications and have opened access to information like never before. Despite these contributions to the society, prolonged exposure to computer has been the cause of a visual and ergonomic disorder called “computer vision syndrome” (CVS). Although computer is such a highly visually demanding task, the eyes are still structured according to old hunting days and are unable to adjust themselves, which lead to discomfort coined as CVS - an emerging pandemic of the 21st century. The prevalence of CVS ranges from 64% to 90% among computer users. Nearly 60 million people suffer from CVS globally.[1] No remedy for the prevention and cure of this pathology prevails in the modern medicine, except using ocular surface lubricants, computer glasses, and counseling for judicious computer use. CVS according to our Ayurvedic point of view is a group of Vata–Pitta dominant ocular and systemic disorder which is in contemporary to the modern concept of CVS, who takes CVS as ocular problem only. There why giving rise to the complex of this proble m. Hence, it cannot be considered only ocular problem. Hence, here, in the present clinical study, an attempt has been made to treat the basic pathology of the disease using local drug, i.e., Shunthyadi eye drops and systemic administration of Triphaladi compound. Triphaladi compound (Anubhoota Yoga) is a combination of 11 dried herbs, i.e., Haritaki, Bibhitaki, Amalaki, Yashtimadhu, Gokshura, Guduchi, Haridra, Daruharidra, Shunthi, Tulsi, and Punarnava in capsule form, which is administered as a Rasayana therapy in patients of CVS. Kriyakalpas or topical ocular therapeutics is the uniqueness of Ayurvedic ophthalmology which includes Parisheka/Seka, Aschyotana, and Tarpana. Many people are not in a position to follow these treatments due to overwork in office, especially with computer users. Hence, in the present study, Sneha Aschyotana was taken in the form of eye drop (topical), i.e., Shunthyadi eye drop (Anubhoota Yoga). Both the drugs were authenticated through pharmacognostical and pharmaceutical approach.

Aims and objectives

  1. To evaluate the efficacy of Triphaladi compound and Shunthyadi eye drops in the management of CVS
  2. 2. To compare the efficacy of Ayurvedic management and modern management in CVS.



  Materials and Methods Top


Study design

In this clinical study, forty patients from the Outpatient Department of Shalakya Tantra of IPGT and RA, Gujarat Ayurved University, Jamnagar, who were suffering from CVS and fulfilling the criteria of inclusion for the present study, were registered, of which 37 completed the treatment. An elaborative research pro forma was specially designed for the purpose of incorporating all aspects of the disease on Ayurvedic and modern aspect. Clinical study was started after getting clearance from the Institutional Ethics Committee (No. PGT/7/-A/Ethics/2015–2016/1490), and the study was also registered under the Clinical Trial Registry of India (CTRI/2016/04/006891). Informed consent was taken from the patients. Selected patients were randomly divided into two groups with the following drug schedule in a particular group:

  1. Group A – A total of 18 patients were administered with Triphaladi compound orally in a dose of three capsule/day(1 cap = 500 mg) for 6 weeks and Shunthyadi eye drops topically four times a day, one drop in each eye for 6 weeks along with counseling for changing the working style and standard
  2. Group B - A total of 19 patients were administered with carboxymethylcellulose eye drops topically four times a day, one drop in each eye for 6 weeks along with counseling for changing the working style and standard.


Follow-up

Follow-up was done fortnightly to assess the changes in the patients.

Inclusion criteria

  1. Computer users complaining of eyestrain, irritation, blurred vision, redness, burning eyes, headache, etc., Patients having minimum three symptoms of CVS
  2. Patients in the age group 18–50 years irrespective of sex
  3. Continuous 3 h/day and more than that exposure to any type of video display terminals such as desktop, laptop, and similar devices.


Exclusion criteria

  1. Patients not willing for registration
  2. Patients suffering from systemic and metabolic disorders such as polyarthritis, rheumatoid arthritis, and autoimmune diseases
  3. Use of nonspecific beta-blockers for longer time by glaucoma patients
  4. Patients using contact lenses
  5. Case complicated with acute/chronic infections and/or inflammation of lid, conjunctiva, cornea, and sclera.


Criteria of assessment

Grading and scoring system was adopted for assessing subjective and objective parameters before the commencement of trial and after the completion of trial.

Subjective criteria

  • Eyestrain
  • Blurred vision
  • Headache
  • Redness
  • Burning sensation
  • Irritation
  • Slow refocusing
  • Excessive fatigue (neck, shoulder, and back pain).


Objective criteria

  • Schirmer's test
  • Tear film breakup test (TBUT).


Statistical analysis

Student's paired t-test was applied to access the results for individual groups, and unpaired t-test was used to calculate the comparison of results between the groups. The results were interpreted at the level of P < 0.001 as highly significant, P < 0.05 as significant, and P > 0.05 as insignificant.


  Results and Observations Top


Demographic data have been presented for 40 patients, while clinical data and observations were made on 37 patients who completed the trial, and similarly, the results were analyzed and are presented in [Table 1], [Table 2], [Table 3], [Table 4].
Table 1: Effect of therapy on chief complaints in Group A

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Table 2: Effect of therapy on objective parameters in Group A

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Table 3: Effect of therapy on chief complaints in Group B

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Table 4: Effect of therapy on objective parameters in Group B

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Demographic profile

It was observed that majority of the patients, i.e., 25 (62.5%) were reported in the age group of 18–30 years, maximum, i.e. 80% of patients were male, maximum, i.e., 95% of patients were Hindus, maximum, i.e., 75% of patients were serviceperson, maximum, i.e., 65% of patients were graduates, majority of the patients registered, i.e., 65% belonged to middle class, majority of the patients, i.e., 52.5% were married, maximum number of patients, i.e., 95% belonged to urban area, maximum number of patients, i.e., 72.5% were vegetarian, maximum, i.e., 52.5% of patients were addicted to tea, maximum number of patients, i.e., 82.5% had sound sleep, majority of the patients, i.e., 77.5% were using computer for 6–10 h/day, and majority of the patients, i.e., 52.5% were using laptop.

Clinical profile

Maximum number of patients, i.e.,100% had irritation/dry eyes, 97.5% of patients had eyestrain, 87.5% of patients had burning sensation in eyes, 82.5% of patients had slow refocusing, 82.5% of patients suffered from headache, 75% had blurred vision, 75% had symptom of fatigue, and 52.5% of patients had redness in eyes. Maximum eyes, i.e., 61 (76.25%) had TBUT between 6 and 10 s, 10 (12.5%) of eyes had TBUT between 11 and15 s, and 9 (11.25%) of eyes had TBUT <5 s. Maximum eyes, i.e., 71 (88.75%) had Schirmer's I-test reading >15 mm/5 min, 5 (6.25%) of eyes had 6–10 mm/5 min, whereas 4 (5%) of eyes had 11–15 mm/5 min.

Effect of therapy in Group A

In slow refocusing, 100% relief was found followed by relief in eyestrain 97.92%; 97.83% relief in irritation; 97.53% in burning sensation; 97.37% in neck, shoulder, and back ache; 97.26% in blurred vision; 95.35% in redness; and 84.37% in headache, which were highly significant (P< 0.001) [Table 1].

73.41% improvement was found in TBUT which was highly statistically significant (P< 0.001). 7.48% improvement was found in Schirmer's I-test which was statistically significant (P< 0.05) [Table 2].

Effect of therapy in Group B

In burning sensation, 88.46% relief was found followed by 84.21% in headache, 83.33% in redness, 82.29% in irritation, 81.91% in eyestrain, 81.43% in slow refocusing, 80.30% in blurred vision, and 77% in fatigue (neck and shoulder pain), which were highly significant (P< 0.001) [Table 3].

57.56% improvement was found in TBUT which was statistically significant (P< 0.001). 0.85% improvement was found in Schirmer's I-test which was statistically insignificant (P > 0.05) [Table 4].

Comparison between Group A and Group B

Statistically significant change was assessed on symptoms such as burning sensation and irritation, whereas statistically highly significant change was found on symptoms such as eyestrain, blurred vision, and slow refocusing [Table 5].
Table 5: Comparison of difference of symptoms between Group A and Group B

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Statistically insignificant change was assessed on Schirmer's I-test between Group A and Group B, whereas statistically significant change was observed for TBUT [Table 6].
Table 6: Comparison of difference between Group A and Group B on objective findings

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Overall effect of therapy

In Group A, of 18 patients, 2 (11%) patients got moderate improvement, 11 (61%) patients got marked improvement, and 5 (28%) patients got cured after the completion of treatment.

In Group B, of 19 patients, 2 (10%) patients got mild improvement, 2 (10%) patients got moderate improvement, 10 (53%) patients got marked improvement, and 3 (16%) patients got completely cured. Two (10%) patients remained unchanged after the completion of treatment [Figure 1].
Figure 1: Overall effect of therapy

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  Discussion Top


Findings of both the groups suggest that highly significant relief was seen on subjective parameters in both the groups, but better results were observed in Group A in percentage relief. It clarifies that CVS is Vata–Pitta vitiation pathology and needs to be managed by lubricating (Snigdha) and rejuvenating (Rasayana) measures, both locally and systemically.

In CVS, there is Atiyoga and Mithyayoga of Chakshurendriya, which lead to Vata–Pitta vitiation, i.e., Vata–Pitta Vridhi. They ultimately lead to Kshaya of Kaphashrayi Dhatu, i.e., Rasa, Meda, Majja, etc. Therefore, Triphaladi compound, which is mainly Vata–Pitta Shamka, pacifies the vitiated Vata–Pitta Dosha and Rasayana property performs the function of Dhatuvardhana and giving Chakshurendriya strength. Maximum drugs in Triphaladi compound have Sheeta Veerya, Madhura Vipaka, Vata–Pitta Shamaka, Chakshusya Balya, and Rasayana properties with Tridoshshamaka property. We can say that Triphaladi compound acts systemically by improving general health and thereby increasing the functional integrity of the visual apparatus by pacifying the vitiated Vata and Pitta.

Shunthyadi eye drop is an Anubhoot Yoga comprising of Shunthi, Saindhava, and Go ghrita-manda was used for Snehana Aschyotana (lubricating eye drops) in Amavastha (early stage of disease). Shunthyadi eye drop has Rasayana, Chakshushya, Vata–Pitta Shamaka properties, which is helpful in strengthening the first Patala (cornea and conjunctiva) and reconstruct the Ashru (tear film) to provide tear film stability. It also works on Dvitiya Patala (second) to give nourishment and strengthens the ciliary muscle. Hence, this formulation was used which can save the time and cost of medicine. Thus, both the drugs help increase the ocular strength which in turn increases the organ's capacity to overcome its pathological condition.


  Conclusion Top


It can be concluded from the present clinical study that Triphaladi compound and Shunthyadi eye drop (Group A) were effective in relieving ocular as well as nonocular symptoms of CVS. However, both the groups were equally effective on symptoms such as headache, redness, and fatigue (neck/shoulder pain). During the study, no significant adverse effects were observed. Further studies can be done at large sample size and for long duration to establish the curative effect of both the drugs.

Financial support and sponsorship

The study was supported by IPGT and RA, Gujarat Ayurved University, Jamnagar.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3991936/#. [Last accessed on 2017 Apr 05].  Back to cited text no. 1
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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