1285

Received 2018-07-11

Revised 2018-08-04

Accepted 2018-09-09

Useful Medicinal Plants for Vision Impairment in Traditional Iranian Medicine

Jamshid Shayanfar1, Hassan Ghasemi2, Seyed Saeed Esmaili3, Fatemeh Alijaniha4, Ali Davati5

1 Department of Iranian Traditional Medicine, School of Medicine, Shahed University, Tehran, Iran

2 Department of Ophthalmology, Shahed University, Tehran, Iran

3 Department of Traditional Medicine, School of Medicine, Shahed University, Tehran, Iran

4 Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran

5 Department of Social Medicine, School of Medicine, Shahed University, Tehran, Iran

Abstract

Vision impairment is an important general health issue that imposes many costs on governments and the health system every year. Despite the decline in infectious eye diseases, which has reduced the vision impairment and blindness over the past two decades, vision impairment is still a major health problem in some parts of the world. In traditional medicine books, visual weakness is referred to as “any disturbance in the act of seeing”. Many medicinal herbs have been mentioned in books of Traditional Iranian medicine (TIM) for the management of vision impairment. The aim of this study is to review the medicinal plants mentioned in TIM, which are considered effective for the treatment of vision impairment or its enhancement. In this library-based study, medicinal plants effective in the treatment of vision impairment were searched using 6 valid sources of traditional medicine, including Makhzan ol-Adawiya, The Canon of Medicine, Tuhfat al-Momenin, Al-Abniyah An Haqaiq al-adwiya, Al-Shamil Fi al-Sana’at al-tebiyah, and Ekhtiarate Badiee. This was done in 10 steps (finding keywords, searching for resources, preparing a single list, finding synonyms, classifying, reviewing, extracting plants from compositions, summarizing, scoring and sorting based on the obtained score). A total of 89 medicinal plants were extracted, most of which had a hot and dry temperament. Based on the obtained score, 12 plants got the highest scores (10 and above). The extracted plants can be the basis for further clinical studies to make new effective drugs for the prevention and treatment of vision impairment.[GMJ.2019;8:e1285] DOI:10.31661/gmj.v8i0.1285

Keywords: Vision Impairment; Ophthalmology; Medicinal Plants

Introduction

Visual impairment is a type of non-communicable disease that has mental and physical effects in the elderly. In 2010, 0.5% of the world population was blind, and 2.8% had severe-to-moderate vision impairment. In total, the major causes of vision impairment include, cataract, age-related macular degeneration (ARMD), uncorrected refractive errors, glaucoma, and corneal opacity [1]. Low vision refers to a condition where one is not blind, but has a less-than-normal vision. It is detected by a visual acuity of 3/60 to less than 6/18 in the healthier eye, after the best correction. Visual impairment also refers to conditions that range from low vision to blindness [2].In other words, low vision is a term for the vision impairments that cannot be corrected with standard eyeglasses or with medical or surgical treatments and may result from many eye or neurological diseases [3]. Studies have shown that vision impairment affects the quality of life by limiting social interactions and individual autonomy [4]. Visual impairment may appear with blind spots, decreased peripheral vision, decreased central vision, failure in contrast of the image, or the symptoms together. With aging and diseases such as diabetic retinopathy, the population with low vision has also increased [5]. The incidence of vision impairment also increases as the age increases among all age groups, and the risk of the disease in all regions of the world is higher in women than in men [6]. A study conducted in 2013 has estimated the financial cost of vision impairment in the United States adult persons at $51.4 billion per year [7]. In TIM references, weakness in vision has been considered as Zafe Basereh, and it has been defined as any disturbance in the act of seeing. In this disease, one cannot see the objects as they are even with effort, and an error occurs in the act of seeing [8].The approach of TIM toward health protection is based on improvement of lifestyle and emphasizes on the importance of prevention. In the area of treatment, although pharmacotherapy and manipulation are used to treat patients, lifestyle modification, especially the emphasis on nutrition, has widened the horizons for researchers in a variety of diseases, including eye illnesses [9,10]. Ancient Iranian physicians were experts in the field of diagnosis, description and treatment of eye diseases, as well as the definition of applied words. Almost all books of TIM have addressed the diagnosis and treatment of eye diseases. In addition, several specialized ophthalmological books have been written from the perspective of TIM [11]. About 25% of total prescribed drugs have been acquired from plants. Medicinal plants are famous for their little toxicity, effectiveness, and fewer side effects. A wide range of medicinal herbs has been recognized to be effective in complementary medicine schools, such as Ayurveda and Chinese medicine, in the treatment of eye diseases such as cataract and glaucoma [12]. Studies have shown that the probability of discovering a new effective drug increases up to 40% when traditional experiences are attended, in comparison to 1% in accidental researches. Thus searching in traditional textbooks may be an effective way for finding new drugs. [13]. This study aims to provide a classified and sorted list of medicinal plants mentioned in TIM references, which can be used for vision enhancement or treatment of vision weakness after conducting clinical studies.

Search Strategis

This research is a library-based study and review. In this study, 6 important references of TIM have been used. Selected references have been chosen from various historical periods, including 1. Al-Abniyah An Haqaiq al-adwiya (Abu Mansour Movafagh Heravi in the 4th century; Hijri), 2. The Canon of Medicine (Ibn Sina in the 5th century; Hijri), 3. Al-Shamil Fi al-Sana’at al-tebiyah (Ibn Nafis in the 7th century; Hijri), 4. Ekhtiarate Badiee (Haji Zeiniddin Ali ibn Hussein Ansari in the 8th century; Hijri), 5. Tuhfat al-Momenin (Momen Tonekaboni in the 11th century; Hijri), and 6. Makhzan al-Adwiya (Mohammad Hussein Aghili Khorasani in the 12th century; Hijri).Key-words including “eye” (with other synonyms in Arabic such as “ain”, and “basar”), and vision (with its synonym “basereh”), in addition to enhancement, strength, weakness, acuity, and clearing, were searched in the above-mentioned books. Subsequently, the selected plants that were effective in treating vision weakness or vision enhancement, were scored based on the model presented in the study of Mozafarpour et al. Using this model, he chose the medicinal plants effective for constipation and bloating according to TIM books [14, 15]. This scoring pattern was also used for other diseases such as palpitation [13]. In this model, scoring was done based on words indicative of the intensity and level of the effect on vision impairment or vision enhancement and sum of the scores in different books. The medicine with a stronger effect achieved a higher score, and the one with the weaker effect owned a lower score. This was done in 10 steps (finding keywords, searching for references, preparing a single list, finding synonyms, classifying, reviewing, extracting single herbs from compounds, summarizing, scoring, and sorting based on the obtained score). The plants were selected and classified if they had therapeutic properties rendering them useful for vision enhancement, acuity and clearing, or vision weakness. This pattern of defining criteria, scoring and sorting can create a categorized list of plants for researchers and provides the opportunity to choose other medicinal plants that are unavailable and, maladapted according to the patient’s situation (Table-1 and 2). Ranking of plants for clinical use has other considerations like less side effects and inexpensiveness which can change the rank of the plant in the list [16]. In addition to specific plants, the general influence on the eye health was also studied. The rout of administration and temperaments of each plant were also explained. In addition the positive effect of some medicinal plants on vision weakness (with higher score) in clinical studies, has been explained in new literature. The types of medicinal effects on vision weakness or enhancement have been evaluated.

Results

After collecting and scoring the plants, a total of 89 plants (Table-3) were found to have an effect on vision enhancement or weakness which sorted from stronger effect to weaker [17-22]. A vast majority of the plants had a dry temperament, and most of them were hot and dry (Table-4).A total of 12 plants Hasha, Hozoz, Harmal, Balsan, Farasiun, Esghil, Sodab, Razianaj, Basal, Balilaj, Heltit, and Enab-o-Salab, scored higher than other plants. Most of the plants were extracted from Makhzan al-Adwiya, and the least ones were compiled from Al-Abniyah An Haqaiq al-adwiya (Table-5). Most plants were found to be effective in vision enhancement, and a smaller number on vision impairment (Table-5).The rout of administration for most plants was similar to Kohl (Collyrium), and for a smaller number, it was oral.The results of clinical studies searched for plants with higher score (10 and above) are as follows: The aqueous extract of the seeds of Razianaj (Foeniculum vulgare) has protective and therapeutic properties against sodium selenite-induced cataract in rabbit’s eye. The possible mechanism of this extract is antioxidant activity. Different phytochemical studies have shown the presence of compounds like flavonoids, phenolic compounds, and volatile compounds, in this plant. It has several other pharmacological properties such as anti-inflammatory, oculohypotensive effects. Lens opacity scores were lower in rabbits that received aqueous extract eye drops of this plant twice daily for 5 days before cataract induction and 21 days after cataract induction[23]. Another study by Agarwal et al. showed that Foeniculum vulgare aqueous extract reduces intraocular pressure and the maximum reduction in pressure is comparable with timolol. Its mechanism of action is through an anti-cholinesterase effect [24].Sudhakar et al. showed that the oral use of Sodab (Ruta graveolens) two times a day for 2 years clearly reduced the annual progression of myopia, and even after the discontinuation of the medication, the speed of progression of myopia decreased. The mechanism of action of this plant is likely through the ciliary body, which leads to the exact focusing of the image on the retina by improving the accommodation in myopic individuals even while working near the object [25]. Javadzadeh et al. presented that the administration of 1 drop of onion extract in mice eyes for 14 days every 8 hours prevents the formation of selenite-induced cataract [26]. In 2010, a study conducted by Gupta et al. on 9-day-old rat pups showed that intraperitoneal injection of the aqueous extract of Triphala (combination of Emblica officinalis, Terminalia bellerica, and Terminalia chebula) at doses of 25mg/kg body weight prevents selenite-induced cataract formation the formation of selenite-induced cataract. In addition, it enhances the activity of antioxidant enzymes, glutathione, and decreases the extent of lipid peroxide in contradiction of selenite-induced oxidative stress [27]. Another case-control study has proved the role of oxidative stress as the main mechanism of eye damage in cataract, glaucoma, and ARMD, suggesting the role of plasma antioxidant capacity in preventing these eye diseases. Plasma antioxidant capacity increases with foods rich in antioxidants, like fruits and vegetables [28]. Despite the searches about plants with higher score, sufficient evidence of the effectiveness of all plants on vision weakness extracted from the references was not found, but the antioxidant properties of many of these plants, suggest their potency in the treatment of vision impairment or its enhancement. These include Solanum nigrum [29] , Peganum harmala [30] , Zingiber officinalis [31] , Ferula assa- foetida [32] , Rheum ribes [33] ,and Terminalia bellerica [34] .

Discussion

The causes of vision impairment in TIM include bodily causes, brain causes, causes specific to vision power, causes related to the eye layers, and causes related to the nerve that should be considered in the treatment of vision impairment Ancient Iranian physicians addressed the primary cause of the disease while paying attention to 6 essential principles of maintaining health (climatic conditions and environment, food and drink, physical activities and rest, evacuation and retention, psychiatric conditions, sleep and wakefulness), and finally, they used medications and manipulation or physical therapy (such as surgery).For example, in cataract (Nozul ol-ma), Ancient Iranian physicians believed that in the early stages of the disease, treatment is possible through nutrition and drug therapy, but when the disease progresses, surgery is the only treatment. Patients are advised to avoid eating meat, fish, and fruits, and instead, consume dry foods. In the Canon of medicine, Avicenna emphasizes that eye probing for cataract surgery should not be done quickly, and should be waited for until its completion [35]. Some inappropriate and harmful conditions and foods lead to vision weakness and should be avoided from TIM point of view.These are: dust, smoke, very hot or very cold weather, continuous gaze to objects specially very small things, too much crying, too much intercourse, exceed drinking alcohol, overeating and sleeping immediately after eating food, eating excess salt, eating foods like lentil, cabbage, garlic, sugar, long or short sleeping, and prolonged watching luculent objects. Some useful plants for eyesight are eating foods in moderate amounts, moderate sleeping, eating cinnamon, saffron, star anise and turnips [22]. The main mechanism of eye damage in cataract, glaucoma, and ARMD is oxidative stress. Antioxidants form the first layer of defense in contrast to oxidative stress and are got with diet and internal production. The most important antioxidants that perform a protective role in the eyes include ascorbic acid, superoxide dismutase catalase, and reduced glutathione. Initial studies suggest that the antioxidant capacity of the plasma can increase with diets rich in antioxidants, like fruits and vegetables, through the diet [28].In addition, there is evidence that oxidative stress leads to the activation of the molecular components contributing to the development and appearance of diseases associated with myopia [36]. A wide range of medicinal herbs is used in the management of some eye diseases, including cataract and glaucoma. Although in some health systems such as Ayurveda and Traditional Chinese Medicine, common therapeutic properties have been expressed for a plant, in the treatment or prevention of the vision impairment has been shown in a few clinical studies in modern medicine. Considering the 6 principles of maintaining health, and preventive effects of herbal medicine in early stages, TIM emphasizes on vision enhancement against vision weakness and health- maintaining principles rather than the disease treatment alone. Obviously, in advanced stages of the disease, surgery will be more important than other methods, and herbal medicines may be considered as a complementary treatments along with the surgery.

Conclusion

According to TIM and studies conducted, many medicinal herbs can be used in the treatment of vision impairment, and it is necessary to conduct more precise clinical and animal studies about the widespread use of these plants in its treatment, and this study can be the first step in this direction.

Conflict of Interest

None.

Correspondence to:

Ali Davati, Department of Social Medicine, School of Medicine, Shahed University, Tehran, Iran

Telephone Number: +98-21-51212600

Email Address: a_davati@yahoo.com

GMJ.2019;8:e1285

www.gmj.ir

Table 1. The Criteria to Score Properties Mentioned for the Plants in the Books

A strong emphasis on the vision enhancement or the effectiveness on vision impairment with terms such as seriously, strongly beneficial, experimented, ultimately, and intense.

3

The expression of the vision enhancement or effectiveness on vision weakness with terms such as usefulness for vision weakness or vision enhancement, and vision sharpening

2

Expressing the effects on eye health with terms such as usefulness or beneficial for eyes

1

The implicit expression of vision enhancement or the effectiveness on vision weakness with terms such as eliminating vision darkness, clearing vision, and increasing the light of eye.

Table 2. A Scoring Example of the Plants

Book

Plant

Makhzan al-Adwiya

the Canon of medicine

Al-Abniyah An Haqaiq al-adwiya

Al-Shamil Fi al-Sana’at al-tebiyah

Tuhfat al-Momenin

Ekhtiarate Badiee

Hasha

Suitable for vision weakness and its enhancement

Maintains the power of vision and eliminates vision darkness

Useful for vision weakness

Subtilizes the eye and enhances it strongly

Eating a small amount with food is useful for vision enhancement

It is useful for vision weakness and maintains its enhancement

Score

2

2

2

3

2

2

Total score

13

Mamiran

Using as kohl is useful for vision darkness

Sharpens the vision with its use as kohl

Sharpens the vision

Using as kohl sharpens the vision, thereby enhancing it

Using as kohl is useful for vision darkness

Increases the light of eye

Score

1

2

2

2

1

1

Total score

9

Table 3. The Effective Medicinal Plants in the Treatment of Vision Weakness

Traditional name

Scientific name

Temperament

Rout of administration

Score

Ref. No

Hasha

Thymus capitatus

Hot and dry

Oral

13

1-6

Hozoz

Lycium afrum L.

Moderate and dry

Using as kohl

12

1-6

Harmal

Peganum harmala L.

Hot and dry

Using as kohl

12

1-6

Balsan

Commiphora gileadensis

Hot and dry

Using as kohl

12

1-6

Farasiun

Marrubium vulgare L.

Hot and dry

Suppository-eye drop

12

1- 6

Esghil

Scilla maritima L.

Hot and dry

Oral

11

2-6

Sodab

Ruta graveolens L.

Hot and dry

Oral

11

1,2,4-6

Razianaj

Foeniculum vulgare L.

Hot and dry

Using as kohl

10

1-6

Basal

Allium cepa L.

Hot and dry

Oral

10

1-4,6

Balilaj

Terminalia bellerica

Cold and dry

Oral

10

2-6

Heltit

Ferula assa-foetida L.

Hot and dry

Using as kohl

10

3-6

Enab-o-Salab

Solanum nigrum L.

Cold and dry

Using as kohl

10

2-6

Oshnah

Usenea barbata Ach

Moderate

Using as kohl

9

2-6

Darsini

Cinnamomum zeylanicum

Hot and dry

Using as kohl

9

1-6

Ribas

Rheum ribes L.

Cold and dry

Using as kohl

9

2-6

Sokar-ol-Oshr

Calotropis procera dryand

Hot and dry

Using as kohl

9

2-6

Sabr

Aloe vera L.

Hot and dry

Using as kohl

9

1,3-6

Satar

Thymus vulgaris

Hot and dry

Oral

9

1,3-6

Gharanfol

Eugenia caryophyllata

Hot and dry

Using as kohl

9

2-6

Mamiran

Chelidonium majus L.

Hot and dry

Using as kohl

9

1- 6

Ostokhodus

Lavandula stoechas L.

Hot and dry

Oral

8

3,5,6

Amolaj

Phyllanthus emblica L.

Cold and dry

Oral

8

2,3,5,6

Ejas

Prunus domestica L.

Cold and wet

Using as kohl

8

2,3,5,6

Javshir

Opopanax chironium/ (L.)Koch.

Hot and dry

Using as kohl

8

2-4,6

Khelaf

Salix alba L.

Cold and dry

Using as kohl

8

2,4-6

Roman

Tunica granatum

Cold and wet

Using as kohl

8

3-6

Loz-ol-Mor

Amygdalus amara Hayne

Cold and dry

Using as kohl

8

2-4,6

Kornab

Brassica oleracea L.

Hot and dry

Oral

8

2-6

Mamitha

Glaucium corniculatum L

Cold and dry

Using as kohl

8

3-6

Mor

Commiphora

Myrrha(Nees)

Hot and dry

Using as kohl

8

3-6

Aas

Myrtus communis L.

Cold and dry

Using as kohl

7

4-6

Aghaghia

Acacia arabica

Cold and dry

Using as kohl

7

2-4,6

Athl

Tamarix gallica L.

Cold and dry

Eye drop

7

3,5,6

Badruj

Ocimum basilicum L.

Hot and dry

Eye drop

7

2-6

Bokhur-e-Maryam

Cyclamen europium L.

Hot and dry

Using as kohl

7

1,3,4

Tormes

Lupinus angustifolius L.

Hot and dry

Oral

7

3,5,6

Salikheh

Cinnamomum bejolghota (Buch. /Ham.) Sweet

Hot and dry

Using as kohl

7

1,3-6

Sakbinaj

Foeula perica

Hot and dry

Using as kohl

7

2-5

Shaljam

Brassica rapa L.

Hot and wet

Oral

7

2,3,5,6

Felfel

Piper nigrum L.

Hot and dry

Using as kohl

7

2-6

Ghasab-ol-Zarirah

Arundo phragmites L.

Hot and dry

Using as kohl

7

2,3,5,6

Ahlilaj-e-Asfar

Terminalia citrina Roxb.

Cold and dry

Using as kohl

6

2,3,5,6

Joze-Bova

Myristica fragrans L.

Hot and dry

Using as kohl

6

2,5,6

Kharbagh-e-Asvad

Helleborus niger L.

Hot and dry

Using as kohl

6

2,4,6

Dam-ol-Akhavein

Dracaena cinnabari Balf.f.

Cold and dry

Using as kohl

6

4-6

Zaferan

Crocus sativus L.

Hot and dry

Using as kohl

6

2-6

Somagh

Rhus coriaria L.

Cold and dry

Using as kohl

6

3,5,6

Sonbol

Hyacinthus orientalis

Hot and dry

Using as kohl

6

3,5,6

Shaghayegh

Anemone sp.

Hot and dry

Using as kohl

6

2-4,6

Shahtareh

Fumaria parviflora Lam.

Moderate and dry

Using as kohl

6

3,5,6

Tabashir

Bambusa arundinacea Willd

Cold and dry

Nasal snuff

6

5,6

Kondosh

Gypsophila struthium L.

Hot and dry

Nasal snuff

6

3,5,6

Marzanjush

Origanum majorana L.

Hot and dry

Using as kohl

6

3,5,6

Vaj

Acorus calamus L.

Hot and dry

Using as kohl

6

1-3,5,6

Hesrem

Vitis vinifera L.

Cold and dry

Using as kohl

6

3,6

Kharbagh-e-Abyaz

Veratrum album L.

Hot and dry

Using as kohl

5

2,4,6

Zanjebil

Zingiber officinale roscore

Hot and dry

Using as kohl

5

1-4

Gharasia

Pranus avium L.

Cold and dry

Using as kohl

5

4-6

Oqhovan

Tanacetum parthenium

Hot and dry

Using as kohl

4

5,6

Barsian

Albizzia lebbeck (L.) Bth.

Hot and dry

Oral- Smelling

4

3,6

Tashmizaj

Cassia absus

Hot and dry

Using as kohl

4

5,6

Jadvar

Curcuma zedoaria Rosc.

Hot and dry

Eye drop

4

5,6

Khardal

Brassica juncea (L.) Czern

Hot and dry

Using as kohl

4

3,6

Dardar

Ulmus campestris

Cold and dry

Using as kohl

4

2,4-6

Sous

Glycyrrhiza glabra L.

Hot and dry

Using as kohl

4

5,6

Selgh

Beta vulgaris L.

Hot and dry

Using as kohl

4

1,3

Gharab

Salix babilonica L.

Cold and dry

Using as kohl

4

2,4-6

Fotr

Funji spp

Cold and wet

Using as kohl

4

5,6

Kravia

Cuminum cyminum L.

Hot and dry

Using as kohl

4

2,6

Komon

Carum carvi L.

Hot and dry

Kohl-Eye drop

4

2,3,6

Kondor

Boswellia carterii

Hot and dry

Using as kohl

4

3,5,6

Mash

Vigna radiata R.wilczek

Cold and dry

Oral

4

5,6

Anbarbaris

Berberis vulgari L.

Cold and dry

Using as kohl

3

3

Anison

Pimpinella anisum L

Hot and dry

Using as kohl

3

3

Zaitun

Olea europaea L.

Hot and dry

Using as kohl

3

2,4

Sokkar

Saccharum officinarum L.

Hot and dry

Using as kohl

3

2,3,5

Ghatran

Pix liquida

Hot and dry

Using as kohl

3

2,4

Kafur

Laurus camphora

Cold and dry

Using as kohl

3

1,3

Asarun

Asarum europaeum L

Hot and dry

Oral

2

3

Anzarut

Astragalus sarcocolla Dym

Hot and dry

Using as kohl

2

3

Otroj

Citrus medica var.cedrata

Cold and dry

Using as kohl

2

3

Afsantin

Artemisia absinthium L.

Hot and dry

Using as kohl

2

3

Bohnkareh

Ealipta alba

Hot and dry

Oral

2

6

Hur

Populus alba

Hot and dry

Using as kohl

2

2

Zaravand

Aristolochia longa L.

Hot and dry

Oral

2

3

Faranjmeshk

Ocimum pilosum

Hot and dry

Apply on head

2

3

Ghantorion

Centaurea cyanus L.

Hot and dry

Using as kohl

2

3

Limun

Citrus aurantifolia L.

Cold and dry

Using as kohl

2

3

Kam-at

Tuber album Sow.

Cold and wet

Using as kohl

2

2,3

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Continue of Table 3. The Effective Medicinal Plants in the Treatment of Vision Weakness

Continue in next page

Continue of Table 3. The Effective Medicinal Plants in the Treatment of Vision Weakness

Continue in next page

Continue of Table 3. The Effective Medicinal Plants in the Treatment of Vision Weakness

Table 4.The frequency of plants natures

Temperament

Hot and dry

Cold and dry

Cold and wet

Moderate and dry

Hot and wet

Moderate

Number

58

23

4

2

1

1

Table 5. The Frequency of Effective Medications and Usefulness of Medicinal Plants on Vision Weakness or Enhancement

Book

No or effectiveness

Makhzan al-Adwiya

the Canon of medicine

Al-Abniyah An Haqaiq al-adwiya

Al-Shamil Fi al-Sana’at al-tebiyah

Tuhfat al-Momenin

Ekhtiarate Badiee

Number of selected plants

69

46

18

67

58

43

Effectiveness on vision enhancement

42

11

4

29

32

11

Effectiveness on vision weakness

8

4

2

2

9

4

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