A Clinical Consensus study for developing the practice guidelines and Standardization of Tarpana & Putapaka with a Feasibility study in Myopia

Netra Kriyakalpa is a topical therapeutics performed in Ayurvedic ophthalmology. It involves a specific procedure using a prescribed formulation for proper application to the eyes. They comprise procedures such as Tarpana (retention of medicated ghee), Putapaka (retention of extracts of medicinal plants), Seka (medicated solution poured as stream), Aschyotana (eye drops), Anjana (ointments), Pindi and Bidalaka (external application on the eyelids and adnexa). Ayurveda certainly recommends a number of methodological guidelines that are specifically designed in accordance with the stage, site and severity of the disease in order to avoid any untoward effects and to obtain the optimum outcome. The Ocular therapeutics such as Tarpanaand Putapaka mentioned in Ayurveda Samhita’s differs in factors such as dosage form, consistency of medicine temperature, retention time of medicines, the height of administration, safety instructions, quality indicators, and therapeutic benefit evaluation. Standardization is required to ensure uniformity in the quality and integrity of the procedures. Hence there is need of hour for development of critical guidelines for kriyakalpa procedures like Tarpana and Putapaka in terms of dosage form, temperature, time, height, quality, and feasibility in order to promote consistent practice.

This study is done in 2 stages,

Stage 1 is Clinical consensus study to to develop standard operative procedure and practice guidelines for Tarpana & Putapaka kriyakalpa procedure using the RAND/UCLA Appropriateness Method (RAM) which is indeed a widely recognized technique used to assess the appropriateness of medical and surgical interventions. It involves gathering expert opinions through a structured process to evaluate the appropriateness of specific healthcare procedures or treatments. The method involves a panel of experts who independently review and rate the appropriateness of specific medical procedures. Their opinions are then aggregated and analyzed to provide insights into the appropriateness of those interventions. This information can be used to develop standardized practice guidelines, improve healthcare quality, and inform decision-making in clinical settings. In RAM, panellists rate the scenarios in a two-round “Modified Delphi” process. This method is a structured communication technique that involves a group of experts providing feedback in a series of rounds, with the goal of reaching a consensus. The "Modified" Delphi method usually involves iterative rounds of feedback and may include face-to-face interactions. The two-Round Rating Process includes, in the first round, panellists individually rate the appropriateness of medical procedures. There is no interaction among panellists during this phase. and in the second round, panel members come together for 1-2 days under the guidance of a moderator experienced in using the method. This face-to-face interaction allows for discussions and further clarification.

     Stage 2 is the Feasibility study where Feasibility of Tarpana and Putapaka procedure with standardized dose, duration and procedure at OPD level, CARI, Bengaluru, CARI, New Delhi, RARI, Lucknow and NARIP, Cheruthuruthy (4 centres of CCRAS) is done with the objective to assess the feasibility and acceptability of the standardized procedure of Tarpana and Putapaka in in Myopia with Mahatriphaladya Ghrita.