Cataracts

Overview: Cataracts

• The lens is one of the body's most solid tissues, being approximately 36% solid. It is composed of mostly proteins (crystalline fibers and enzymes) and some carbohydrate and polyunsaturated fatty acids.

• The lens curvature and the align-ment of the fibers are designed for the bending of light rays in the visual spectrum and the absorption of radiation above and below that spectrum. A cataract is any opacification of the normally clear crystalline lens of the eye.

• Oxidation of lens fibers, catalyzed by short, phototoxic ultraviolet (UV) wavelengths of light, destroys the sulfhydryl protein bonds. Breaking of these bonds leads to a denaturation and clumping of the protein, with consequent loss of lens clarity.

• The eye is a remote outpost that relies on good nutrition, liver function, circulation, and breathing. The lens, in particular, has no direct vascular or neurologic innervations and therefore must rely on the circulation of the small amount of aqueous humor, going from the ciliary body out through the trabecular meshwork, for delivery of nutrition and removal of toxins.

Important points to consider

• Cataracts are the leading cause of vision impairment in both developed and developing countries and are the major cause of blindness worldwide.

• Patients may not volunteer information about decreasing vision because they do not notice the gradual decrement, may fear losing a driver's license, or are anxious about having their eyes examined.

• Every year in the United States, cataract surgery is performed in more than 3 million people, engendering more than $2 billion in Medicare costs. Delay of cataracts for 10 years would lead to tremendous cost savings.

Major Stressors and Lens

• Ultraviolet and blue light sunlight

• Inadequate nutrition

• Lifestyle habits

• Stress

• Chronic disease

Tips for Prevention of Dry Eyes

• Adequate hydration can be promoted by drinking six to eight glasses of water daily.

• It is important to remember to blink, especially during work with computers and other tasks requiring visual concentration.

• The beneficial fats in the tear film can be reinforced with supplementation of docosahexaenoic acid (DHA) and fat-soluble nutrients such as vitamin A and lutein.

• DHA produces significant improvement in comfort within a week. Recommend 800 to 1000mg/day (or 2g/day of fish oil).

• Use of eye drops and ointments as moisturizers is recommended. For example, Tears Again (Cynacon/OCuSOFT, Inc., Rosenberg, Tex), a liposomal vitamin A and E spray, can be applied externally on the lid and appears to penetrate the eye quickly, providing relief, Mechanical problems with the lower lids should be ruled out, especially in patients who may be sleeping with their eyes open.

• When observing the patient, the clinician should check to see whether the lower lid moves during routine blinking.

• A humidifier should be kept in the bedroom.

• Periodic evaluation of the patient's medication profile is recommended.

Prevention Prescription

• Recommended eye examination annually for people older than 50 years and for people at risk. Use of preventive measures is appropriate even in patients with early cataracts.

• Advise use of sunglasses, with side shields as necessary, as well as hats or visors and sunblock in persons whose occupation or interests dictate spending time outdoors.

• Recommend a balanced diet with five or six servings of fruits and vegetables as well as grains, nuts, berries, and organic eggs for amino acids, with consumption of cold-water fish two or more times per week.

• Recommend lutein-rich foods, such as spinach, three times a week; these foods are especially important for ocular protection.

• Promote adequate hydration with intake of six to eight glasses of filtered water daily, with reduction in intake of soft drinks and artificial sweeteners.

• Recommend a daily multivitamin including taurine, zinc, lutein, an additional 1000 to 2000 mg of vitamin C, 400 units of vitamin E, and 5000 units of vitamin A palmitate.

• Advise the patient to maintain an appropriate body weight and to avoid animal fat in the diet.

• Encourage the healthful lifestyle habits of stretching, exercise, moderate alcohol intake, and a regular sleep pattern, with cessation of smoking.

• Advise the patient to maintain a positive attitude and optimism.

• Periodically review prescription and other medications for ophthalmologic effects. Encourage regular physical examination and vision testing.

Integrative therapeutics review

• Abundant evidence suggests that we can develop new strategies to maintain our health now instead of waiting for cataracts to form.

• Here is a summary of therapeutic and preventive options for cataracts. If a patient presents with severe symptoms, such as profound visual obstruction, it would be to his or her benefit for the clinician to immediately begin a more aggressive therapy, such as referral for elective surgery. For the patient who has mild to moderate symptoms, however, this ladder approach is appropriate.

Remove Exacerbating Factors

• The patient should be encouraged to

• Stop taking steroid-containing and photosensitizing medications for prolonged use.

• Stop smoking, have moderate alcohol intake; try to lose weight, if needed, through diet and exercise, and substitute good fats in place of bad fats in the diet.

• Wear sunglasses while outside and a hat or visor with at least a 3-inch brim.

Nutrition

• Encourage a low-fat, low-cholesterol diet.

• Encourage foods rich in omega-3 fatty acids (wild salmon, nuts, flaxseed) or supplementation with DHA 800 to 1000 mg/day.

Supplements

• Multivitamins: daily multivitamin including taurine, zinc, lutein, an additional 1000 to 2000 mg of vitamin C, 400 units of vitamin E, and 5000 IU of vitamin A palmitate

• Docosahexaenoic acid (DHA): 500-800 mg/day Lutein: 6 mg/day for 1 month, then 2 mg/day

Botanicals

• Turmeric is a major antiinflammatory agent used throughout Asia; there are many data in the Chinese literature of its effectiveness in reducing the risk of cataracts.

Surgical Therapy

• If the patient's symptoms persist or worsen despite the preceding measures, referral for ophthalmic evaluation and treatment is warranted:

• Cataract extraction by phacoemulsification with intraocular lens insertion (one-step)

Key Web Sources

• http://eyeadvisory.com/

• http://www.ageingeye.net/