Cataracts

cataracts2

Do You Have Cataracts?

Cataracts are the leading cause of blindness in the world today, and are the leading cause of impaired vision in New Zealand, with a large percentage of the elderly population exhibiting some signs of this eye lesion. In 2005, the Government in this country pledged to spend an extra $17 million over the next three years in providing a total of up to 7500 more cataracts operations. The NZ Ministry of Health said that by 2007-08 they hoped to be performing more than 12,000 operations a year, a 50 percent increase on 2005. I am not sure of the prevalence of cataracts with the different age groups in NZ, but in America, age-related lens changes have been reported in 42% of those between the ages of 52 to 64, 60% of those between the ages 65 and 74, and an amazing 91% of those between the ages of 75 and 85. My guess is that these figures are similar to here. Are quite elderly, and reading this article? Chances are they you may well have one cataract. Please get your eyes checked out if you are unsure. Too many elderly citizens fall, and some of these falls may well have been prevented – just by seeing better!

What Are Cataracts?

The word cataract comes from the Latin word cataracta which basically means “waterfall”. As rapidly running water turns white, the term may later have been used to describe the similar whitish appearance of the mature opacities. Opacity means that the lens of your eye becomes clouded, a bit like you are looking at the mirror in your bathroom when you step out of the shower, and you can’t quite clearly see yourself until you wipe the surface. The lens in your eye is situated immediately behind the coloured part of your eye, the iris, and this lens is held in position by tiny ligaments, which conveniently alter its shape for near or far vision.Cataracts are developmental or degenerative opacities of the lens of the eye, generally characterised by a gradual painless loss of vision. The extent of the vision loss depends on the size and location of the cataract. Cataracts may be located in the center in the superficial layers, in the middle, or in the rear of the lens area. Cataracts are also classified according to their colour, which is consistent with their location and density. Pale yellow cataracts are typically slight opacities; yellow to light brown are consistent with moderate to intense opacities; and by the time they reach a brown colouring, cataracts are very dense opacities – causing quite significant vision loss and even complete blindness.

Cataracts Are Easy To Spot

I have found that when I look into an older patient’s eyes, cataracts can be readily spotted by looking into the pupil with a light shining on it, under some degree of magnification. The pupil has changed appearance somewhat, it is not a nice deep black colour, there appears to be a fogginess or haziness overlaying the pupil. Because cataracts tend to develop slowly over time, you don’t even know your vision has deteriorated that much, until one day somebody literally “cleans your windows”. My mother had the lenses in her eyes replaced in a cataract surgical procedure when she was in her late 60’s. I can still remember her telling me that it was like somebody had “wiped the windows clean”, and that she could see so much more clearly. I’ll bet many readers who have had cataract surgery can relate to this one. Remember when they took that patch off your eye – and you went, wow! How amazing!

Sun Damage To Eyes – Were Suitable Protection

When you go out at times, isn’t it interesting how many people squint, and hold their hand up to their forehead whilst they are out in the sun? Do you wear sunglasses, particularly when you are at the beach, or near any water or snow? It is my belief that you really should, the reflective glare can be incredible – and you will causing damage to your vision, as well as your skin (if you still don’t get the “cover up” message) to some degree. Although cataracts have no 100% scientifically proven prevention, many scientists do say that wearing ultraviolet-protecting sunglasses may slow the development of cataracts, in some cases significantly. Exposure to the sunlight with particular reference to the ultraviolet-B radiation spectrum is thought to be one of the leading causes of cataract, particularly in tropical countries. So – shading your eyes throughout your life from ultraviolet light is one of the best measures one can take to prevent cataracts. Brimmed hats are also recommended. Now that you have read this article so far, when did you have your eyes checked last? I am constantly amazed at how many patients we see in the clinic, who have not had an eye exam in years for some reason or other, no reading test, no pressure test for glaucoma, no peripheral vision test for macular degeneration. No test at all. You don’t know what you have got….until it’s all gone, as the saying goes. What price do you put on your vision? I think you will have to agree – good vision is absolutely priceless, at any age.

Causes of Cataracts

Most cataracts develop due to aging, but there are potentially many factors which may contribute to cataract formation. What most experts do agree on, is that the actual biochemical cause of cataracts is the inability to maintain a normal concentration of calcium, potassium and sodium ions within the protein cells of the actual lens. Free radical production (some of the causes below, like sunlight, heavy metals, drugs, stress, dietary factors, etc.) has a devastating effect on this incredibly high-metabolically active area. How do we know this? Well simple, high levels of anti-oxidants in the eye can have a most amazing effect in reducing the risk of cataract development, but more on this later.

Some of the most plausible causes include:

  • Radiation. A study among pilots in Iceland showed commercial airline pilots are three times more likely to develop cataracts than people with non-flying jobs. Cataracts are also    unusually common in persons who spend a great deal of time outdoors (the sun), and those exposed to infrared radiation, such as glassblowers.
  • Smoking: But of course you don’t smoke, Healthy Options readers don’t smoke !
  • Following trauma: eye injuries, penetrating injuries
  • Oxidative stress – free radical production.
  • Dietary factors – e.g.; the consumption of large quantities of milk by people who do not efficiently utilise the milk sugar called galactose. This in turn causes a deficiency of the B Vitamin riboflavin (B2). B2 has been found to important in recycling glutathione, which has been found to be very important in keeping cataracts at bay by exerting antioxidant effects in the lens of the eye.
  • Obesity. There is much evidence which shows that obese people have a 200% greater likelihood of developing cataracts compared to normal, healthy humans.
  • Diabetics (Type 2) are more prone to cataracts due to the inherent inability of a diabetic to properly metabolise carbohydrates. Excessive levels of a sugar (galactose – a component of lactose, the milk sugar) can accumulate within the eye, resulting in an increased water uptake – which may proceed to form cataracts via complex biochemical mechanisms.
  • Pharmaceutical drugs: You may be quite surprised to know that certain drugs may be the cause of cataracts; these include corticosteroids (asthma, and many immune conditions like allergies, eczema, etc), various gout medications, phenothiazines (for certain psychiatric disorders) amiodorone (for treatment of heart ailments like irregular heart beating). And Ezetrol (ezetimibe – used to lower cholesterol) has also been implicated.
  • Environmental toxins: environmental exposure to heavy metals may contribute to cataract formation. Cadmium, copper, lead, iron, and nickel have all been found in lenses which have developed cataracts. A high level of cadmium in the lens is associated with smoking and can contribute to accumulation of other heavy metals.

Conventional Cataract Treatment

Cataract surgery: According to orthodox Western medicine, the most effective and common treatment simply is to surgically remove the cloudy lens. This surgical procedure generally consists of removing the lens but leaving the majority of the lens capsule intact. The cataractous lens is removed and replaced with a plastic lens (an intraocular lens implant) which remains permanently in the eye. Cataract operations are usually performed using a local anaesthetic and the patient will often be allowed to go home the same day. Although quite rare, complications after cataract surgery may include retinal detachment.
Aspirin is being recommended by some practitioners to help prevent cataracts. I’ve heard it all before, Aspirin has been recommended for stroke and cancer prevention, and just about everything else. Aspirin may inhibit glycosylation (a process whereby proteins are cross linked) in the lens of the eye that is a causative factor in the development of cataracts. Although evidence shows that people who have used Aspirin on a daily basis for four months or longer may have a statistical reduction, the disadvantages of what Aspirin can do to the digestive system, in my opinion, far outweigh the benefits one would derive from this drug. Aspirin also depletes the body’s reserves of glutathione, and impairs absorption of calcium, potassium, and Vitamin C. These are the very nutrients which you need to prevent cataracts long term! Like all pharmaceutical drugs – short term gain, long term misery, and the only people who profit here are the drug companies’ shareholders.

Cataract Dietary Recommendations

Several studies in Europe and America have shown dietary links to an increased and a decreased risk of cataract. An Italian study found an increased risk in those with the highest intakes of butter (heated up), total fat (animal), salt (refined, not sea salt) and oil (except olive oil). The Nurses Health Study in the States revealed that regular consumption of spinach and kale was quite protective for cataracts in women. Another study found that spinach and broccoli decreased the risk in men. Consuming foods rich in carotenoids can decease the risk by a huge 40%, and three and a half daily servings of fruits and colourful vegetables can slash your risk by a whopping 50% !Spinach, kale and eggs – Spinach would rate as the No. 1 food in the world for cataract prevention. Popeye may have smoked a pipe, but I’m certain he had no cataracts. Increasing frequency of intakes of both spinach and kale, foods both rich in lutein and zeaxanthin and any foods rich in these carotenoids may well significantly decrease the risk of cataract formation severe enough to require extraction. So now you know, eat spinach whilst you are wearing sunglasses. Lutein derived from egg yolks is claimed to be absorbed 2 – 3 times more effectively than lutein from plant sources. Do you still believe that eggs are bad for your health? Popeye probably loved them too.
  • Avocado, asparagus, tomatoes, watermelon and grapefruits – these foods all have one thing in common, they are high in glutathione, the most important amino acid for cataract prevention. Parsley, capsicum, guava, red chilli, Brussels sprouts and kale – these foods are very high in Vitamin C.
  • Fish : Regular consumption of cold water fish may help to prevent cataracts due to the Omega-3 content. It pays to take in Omega 3 oil daily, 5mls is a good daily dose.
  • Brewer’s yeast – high in Vitamin B2, B5, and other B Vitamins
  • Wheat germ, sunflower seeds – Vitamin E
  • Brazil nuts – eat 4 – 6 daily for your selenium intake
  • Grapes, green tea, lovage leaves, dill, cranberries, spinach – all high in Quercetin

Eric’s Recommendations for Cataract Prevention and Treatment

  • Vitamin A    Higher levels are associated with developing a lower risk of developing cataracts. Take 20,000 – 50,000iu daily to slow down progression.
  • Vitamin C Preserves glutathione levels, protects against mineral imbalances in the lens. I would highly recommend that you maintain a good dosage for several years (daily) to really get the benefit long term from Vitamin C, there is no part of your body which doesn’t benefit from Vitamin C. . Aim for 1000 – 3000mg daily. Go for an Ascorbic acid which is balanced with Bioflavonoids in a 2:1 ratio, i.e.; 2 parts Ascorbic acid to 1 part Bioflavonoid. Why? This is how it is generally in nature.
  • Vitamin E – An antioxidant, increases glutathione levels, for cataract prevention. Aim for 400iu daily. I can remember reading a paragraph in the Framingham Heart Study, which said the Vitamin E is best taken in the middle of the day. Take 1 capsule of 400iu with lunch, and have a little selenium with it, generally about 100 – 200iu per day.
  • Vitamin B2 Vitamin B2 recycles the amino acid called glutathione. Take between 50 – 100mg per day, as part of a B Vitamin Complex. Some studies say the B2 may worsen existing cataracts, others say that there is no truth in this at all. My advice is to take one to two B Complex daily.
  • Lipoic Acid This nutrient “spares” Vitamins C & E 300 – 400mg daily
  • Quercetin Take this mainly if you have diabetic cataracts – Quercetin is an well known aldose reductase inhibitor. Remember the lactose in cow’s milk? Do avoid milk if you have any form of diabetes. Take 500mg two to three times daily, and Quercetin is better absorbed with a little fat.
  • Bilberry Powerful occular antioxidant – one study showed that along with Vitamin E, bilberry can halt progression. Dosage between 120 – 600mg daily. The standardized herb is better.
  • Carotenes  Occular antioxidant, higher levels (lutein and zeaxanthin) are associated with a decreased risk of developing cataracts. Diet first & foremost here – spinach, kale and eggs.
  • Glutathione A deficiency of this amino acid is noted in lenses with cataracts, the most important antioxidant in lens. Whey protein is a good source, and it makes more sense to eat proteins which are high in the amino acids glutamine, glycine and cysteine. Why? Simple – glutathione is called a tri-peptide – it is made up of these three amino acids. By eating sufficient high quality proteins, you will allow your body to have access to make it’s own glutathione. Forget it as a supplement, a lot of hype, fancy marketing and unnecessary expense to you. Let food be your medicine, remember?

Your Cataract Check list

  • Wear sunglasses and a wide brimmed hat when in the sun – protect your eyes.
  • Get your eyes checked – see your Optometerist.
  • Understand the causes – you are then in a better position to prevent cataract formation.
  • Are you taking one of the pharmaceutical drugs we mentioned? There will be an alternative.
  • Watch out for the free radicals – smoking, poor diet, stress, alcohol, toxins, etc.
  • Eat the right foods daily – particularly the carotenoids foods containing lutein and zeaxanthin.
  • Check for mercury and other heavy metals, a Hair Analysis is a valid method.
  • Are you a Smoker ? Well, you know my stand – what you sow you will reap.
  • Avoid all cow’s milk and lactose containing foods, particularly if you have diabetes.
  • Do take antioxidant Vitamins at the least – Vitamins A, C, E, B Complex and Bilberry
  • Start NOW – be proactive, the sooner you start, the sooner you halt progression.

References:

  • Chasen-Taber L, Willet WC, Seddon JM, et al. A prospective study of carotenoid and vitamin A intakes and risk of cataract extraction in US women. Am J Clin Nutr 1999;70:509-516.
  • Hankinson SE, Stampfer JM, Colditz GA, et al. Nutrient intake and cataract extraction in women: a prospective study. BMJ 1992;305:335-339.
  • Tavani A, Negri E, La Vecchia C. Food and nutrient intake and risk of cataract. Ann Epidemiol 1966;6:41-46.
  • Robertson JM, Donner AP, Trevithick JR. Vitamin E intake and risk of cataracts in humans. Ann N Y Acad Sci 1989;570:372-382.
  • Leske MC, Chylack LT Jr, He Q, et al. Antioxidant vitamins and nuclear opacities: the longitudinal study of cataract. Ophthalmology 1998;105:831-836.
  • Seth RK, Kharb S. Protective function of alpha-tocopherol against the process of cataractogenesis in humans. Ann Nutr Metab 1999;43:286-289.
  • Nishigori H, Hayashi R, Lee JW. Preventive effect of ascorbic acid against glucocorticoid-induced cataract formation of developing chick embryos. Exp Eye Res 1985;40:445-451.
  • Taylor A, Jacques PF, Nadler D, et al. Relationship in humans between ascorbic acid consumption and levels of total and reduced ascorbic acid in lens, aqueous humor, and plasma. Curr Eye Res 1991;10:751-759.
  • Schaumberg DA, Glynn RJ, Christen WG, et al. Relations of body fat distribution and height with cataract in men. Am J Clin Nutr 2000;72:1495-1502.
  • Cekic O. Effect of cigarette smoking on copper, lead, and cadmium accumulation in human lens. Br J Ophthalmol 1998;82:186-188.
  • Auricchio G, Libondi T. The physiologic and pharmacologic factors protecting the lens transparency and the update approach to the prevention of experimental cataracts: a review. Metab Pediatr Syst Ophthalmol 1983;7:115-124.
  • Saxena P, Saxena AK, Cui XL, et al. Transition metal-catalyzed oxidation of ascorbate in human cataract extracts: possible role of advance glycation end products. Invest Ophthalmol Vis Sci 2000;41:1473-1481.
  • Garner B, Davies MJ, Truscott RJ. Formation of hydroxyl radicals in the human lens is related to the severity of nuclear cataract. Exp Eye Res 2000;70:81-88.
  • Reddy VN, Giblin FJ. Metabolism and function of glutathione in the lens. Human Cataract Formation. Pitman, London (Ciba Foundation Symposium) 1984;106:65-87.
  • Spector A, Roy D. Disulfide-linked high molecular weight protein associated with human cataract. Proc Natl Acad Sci USA 1978;75:3244-3248.

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