Cataracts Overview and Treatment Options

Cataracts don’t get much press, but they should. They’re a major cause of vision loss. In the United States, more than 4 million people have vision-impairing cataracts, and some 500,000 people have cataract surgery every year. Those operations cost a lot of money—about $3 billion a year. In fact, cataract surgery is one of the largest items in the Medicare budget. Researchers at the USDA Human Nutrition Research Center on Aging at Tufts University in Boston, estimate that if cataract surgery could be delayed just five years, Medicare would save more than $1 billion annually.

A cataract is a cloudy spot in the normally clear lens of your eye, just behind your pupil. Light has a tough time getting through the cloudy area, so things seem dim, and in low-light conditions, like night driving, cataracts tend to scatter incoming bright light, so oncoming headlights cause potentially blinding glare.

Cataracts can be caused by diseases that affect your eyes (notably diabetes), or by long-term use of several drugs (corticosteroids, including steroid asthma inhalers), or by prolonged exposure to ultraviolet radiation, the same kind of sunlight that causes sunburn.

Beyond that, mainstream medicine acts as though cataracts are virtually inevitable with aging. One best-selling home medical encyclopedia says, “Everyone develops some eye-lens clouding with aging. Most people over 60 have some degree of cataract formation.”

Maybe conventional medicine has, well, cataracts. Its vision is certainly cloudy as far as this condition is concerned. Cataracts are not inevitable, says Alan Brauer, M.D., founder of TotalCare Medical Center in Palo Alto, California, one of the nation’s first clinics to combine mainstream and complementary therapies. A great deal of research published in mainstream medical journals shows that their underlying cause is oxidative damage, and that a diet rich in antioxidant nutrients has remarkable power to prevent and treat them.

Oxidative damage is caused by highly reactive oxygen ions (free radicals) that circulate in your blood and get into every body tissue, including the lenses of your eyes. Of course, oxygen is necessary for life, but just as oxygen rusts iron, free radicals cause damage the body, and contribute to cancer, heart disease, and many other conditions, including cataracts. Some free radicals occur naturally, but lifestyle choices greatly affect the number in your body. Smoking and a high-fat diet greatly increase free radicals, while fruits and vegetables—which are rich in antioxidant vitamins and minerals—eliminates them and minimizes the damage they cause.

Cataracts and Your Diet

• Eat more fruits and vegetables. Mom was right. Fruits and vegetables are high in antioxidants. The ones most clearly linked to cataract prevention, says naturopath Joseph Pizzorno, N.D., president of Bastyr University, the naturopathic medical school near Seattle, are vitamins A, C, and E, and the mineral, selenium. Many studies show that as consumption of these antioxidants goes up, risk of cataracts plummets:

• As part of the ongoing Nurses’ Health Study, a Harvard project that has tracked the health and lifestyles of 120,000 U.S. women nurses since 1972, researchers compared the diets of participants who either had or did not have cataract surgery over an eight-year period. The more vitamin A and C the nurses consumed, the less likely they were to have cataract surgery. Compared with those whose diets supplied the least of these vitamins, those who ate the most had about 40 percent less risk. The most protective food was spinach.

• At the Institute for Pharmacological Research in Milan, Italian scientists compared the diets of 207 cataract sufferers and 706 matched controls. Those with cataracts ate fewer fruits and vegetables, and more fat and salt.

• At the Social Insurance Institute in Helsinki, Finnish researchers compared the blood levels of antioxidants in 47 cataract sufferers and 94 matched controls. The blood of those with cataracts contained significantly lower amounts of antioxidant nutrients.

• Another team of Finnish researchers at the University of Kuopio, analyzed blood levels of vitamin E in 410 elderly men Compared with those who had the highest levels, the men with the lowest were 3.7 times more likely to have cataracts.

• Turkish ophthalmologists compared selenium in the blood and eye lenses of 48 cataract sufferers and matched controls. Those with cataracts had significantly lower levels.

For vitamin A, eat green and orange-yellow fruits and vegetables: carrots, spinach, apricots, and cantaloupe. The following foods are high in vitamin C: broccoli, Brussels sprouts, citrus fruits, red and green peppers, potatoes, spinach, and strawberries. You can find vitamin E in: vegetable oils (especially corn, safflower, and wheat germ oil), whole grains, dark leafy greens, nuts, and legumes. As for selenium, its content in plant foods varies depending on the selenium content in the soil where it was grown, according to Shari Lieberman, Ph.D., a clinical nutritionist in New York City. But whole grains are generally good sources. So are seafoods and nuts. “I often munch on Brazil nuts,” says Maryland botanist/herbalist James Duke, Ph.D., author of The Green Pharmacy. “They’re high in both vitamin E and selenium.”

• Eat a low-fat diet. Fatty foods, especially meats and whole-milk dairy items, increase free-radical activity around your body, including the lenses of your eyes, Dr. Brauer says.

Supplements for Cataracts

• Take your antioxidants. In addition to food sources, antioxidant supplements have been shown to help prevent cataracts. Studies dating back to the 1930’s demonstrate that supplemental antioxidants (vitamins A, C and E) improve vision in people with early-stage cataracts. The recent medical literature is filled with similar reports:

• At the USDA Human Nutrition Research Center on Aging at Tufts, researchers sampled the ongoing Nurses’ Health Study (mentioned above), selecting 165 middle-aged nurses who said they’d taken vitamin C since the early 1980’s, and 136 who did not. None of the women had been diagnosed with cataracts but about half of them showed early signs of lens clouding. Those with the clouding overwhelmingly did not take vitamin C. Those who had taken the vitamin for more than 10 years were 77 percent less likely to show it.

• As part of the ongoing Physicians’ Health Study, Harvard researchers asked 17,700 middle-aged doctors about their vitamin use. Over the next five years later, 370 of them were diagnosed with cataracts. Compared with the doctors who did not take a daily multivitamin, those who did were 27 percent less likely to develop cataracts.

• In one recent study, 350 elderly people, 175 with cataracts, completed supplement surveys. Compared with those who had cataracts, the participants who took vitamin E and C had 56 percent and 70 percent less risk of cataracts respectively.

• In another study, ophthalmologists checked 1,380 people for cataracts and asked them about their vitamin use. Compared with the people who did not take a daily multivitamin, those did were 47 percent less likely to have cataracts.

Dr. Pizzorno recommends 1,000 mg of vitamin C three times a day, 600 to 800 IU of vitamin E daily, and 400 micrograms of selenium daily.

Dr. Brauer also recommends glutathione eyedrops. Glutathione is a powerful antioxidant protein the body produces. Glutathione eyedrops are not carried at every health food store or supplement outlet, but if you can find them, he says they help.

Cataracts and Lifestyle Choices

• Don’t smoke. Even if smoke doesn’t get in your eyes, smoking can give you cataracts. Smoking boosts free-radical activity. “Smokers face a high risk of cataracts,” Dr. Duke says. “I saw one study that compared the cataract risk of nonsmoking women and women who smoked 30 cigarettes a day. The smokers were 60 percent more likely to have cataracts.”

• Watch your weight. The Harvard researchers running the Physician’s Health Study recently discovered another risk factor for cataracts—obesity. Compared with the slimmest participants, the heaviest were more than twice as likely to have cataracts. Obesity often results from a high-fat diet, which other studies have associated with cataracts.

Herbal Medicine

• Bilberry fills the bill. Bilberry, sometimes called European blueberry, produces a berry that has an age-old reputation for improving vision. As far back as World War I, British fliers munched bilberries before bombing missions to sharpen their vision. Now we know why, Dr. Pizzorno says: Bilberries contain high levels of compounds called anthocyanosides, potent antioxidants that have an unusual affinity for the eye. Bilberry is a close relative of blueberry, cranberry, and huckleberry, all of which also have folk reputations as vision enhancers. European herbalists have developed a standardized extract of bilberry that contains 25 percent anthocyanosides. In one Italian study, 50 people with early-stage cataracts were given this extract three times a day, along with some vitamin E. It stopped cataract progression in 97 percent of them.

Dr. Pizzorno suggests taking 80 to 160 mg of standardized bilberry extract three times a day. It’s available at many health food stores, or from most naturopaths. Dr. Duke prefers to eat blueberries. Use fresh berries when they’re in season, but at other times, frozen or canned berries also contain anthocyanosides. Compounds similar to anthocyanosides also occur in blackberries, raspberries, grapes, and plums.

• Rally to rosemary. “There’s rosemary for remembrance,” Ophelia tells Hamlet in Shakespeare’s play. She might have said, “There’s rosemary to prevent cataracts.” Rosemary is high in antioxidants, Dr. Duke explains. “Use it generously in cooking, or crush it and make tea.” Other culinary herbs rich in antioxidants include: mints, ginger, and turmeric.

Chinese Medicine

• Cool Heat. Relieve pressure. Chinese medicine considers both cataracts and glaucoma to be two forms of the same problem, says San Francisco Chinese physician Efrem Korngold, L.Ac., O.M.D., co-author (with Harriet Beinfield, L.Ac.) of Between Heaven and Earth: A Guide to Chinese Medicine. “The lens of your eye is governed by the Liver. Stagnation of chi and Blood in the Liver cause Heat to rise into your head and eye, where it dries the Moisture of your eye. Your body responds by directing more fluid into the eye to cool the Heat. That causes pressure, which, in turn, causes the lens clouding of cataracts or the nerve damage of glaucoma.”

Once your vision has become significantly impaired, Chinese physicians recommend surgery. But in the early stages of the disease Dr. Korngold says a Chinese herb formula, Huang Lian Yang Gan Wan can help. It contains many herbs, among them: the roots of coptis, gentian, philodendron, skullcap, and bupleurum, and abalone shell.

In addition, Chinese physicians recommend drinking chrysanthemum tea and eating lycii berries. “Chrysanthemum clears Heat and soothes the eyes,” Dr. Korngold explains, “and lycii berries are similar to bilberries. They contain anthocyanosides.”

Meanwhile, Japanese physicians prescribe a formula called hachimijogan to sharpen cloudy vision. In the early stages of cataract development, its benefits are “quite impressive,” Dr. Pizzorno says. Several animal studies show that the formula helps prevent cataracts. And in one human study in Japan, 60 percent of people with early-stage cataracts showed improved vision, 20 percent remained the same, and only 20 percent got worse. It turns out that the eight herbs in this formula, including cinnamon, are high in antioxidants. The standard dose is 150 to 300 mg daily, according to Dr. Pizzorno.

• Accupuncture. The United Nations World Health Organization suggests acupuncture for vision problems. Dr. Korngold says that acupuncture can help in the early stages of cataracts. “There are a number of points around the eye that help. Massaging around the eye also helps.”

In addition, he suggests:

• Gall Bladder (GB) 20. Just below the base of your skull, in the hollow between the two large neck muscles, two to three inches on either side of your midline, depending on the size of your head.

• Liver 3. On top of your foot, in the webbing between your big toe and second toe.

Other Good Choices

Home Remedies

• Let there be lights. Brighter bulbs can help, but talk to an electrician before replacing all your 60-watt bulbs with 100’s. Your wiring may not be able to handle the extra current. Also, reposition your seating and lights to minimize glare.

• Shield your eyes. When out in the sun, says family practitioner Anne Simons, M.D., an assistant clinical professor of family and community medicine at the University of California’s San Francisco Medical Center, wear sunglasses with good UV protection, and a hat with a broad, eye-covering brim. If your work or hobbies include welding, or exposure to other very bright lights, wear protective goggles.

Ayurvedic Medicine for Cataracts

• Amla to the rescue. The medicine Ayurvedic physicians use most frequently to treat cataracts is amla, a fruit that turns out to be 20 times richer in vitamin C than orange juice. To treat early-stage cataracts, Seattle Ayurvedic physician Karta P.S. Khalsa recommends 1 g a day for one to two years. He also suggest triphala, a three-herb formula that contains amla, and several other herbs, including: ginger, barberry, and licorice.

Homeopathy and Cataracts

• Try a microdose medicine. Edward Kondrot, M.D., of Pittsburgh, Pennsylvania, is a board-certified ophthalmologist. He is also a homeopath. He treats advanced cataracts surgically, but has had some success treating early-stage cataracts homeopathically. He prescribes: Causticum (potassium hydrate), Calcarea phosphoricum (calcium phosphate), Calcara carbonicum (calcium carbonate), Sepia (cuttlefish), or Phosphoricum (phosphoric acid).

Cataract Surgery

The bad news is that doctors recommend surgery when cataracts start interfering with your daily life. The good news is that the operation is quick (about an hour). It’s performed under low-risk local anesthetic. And in more than 90 percent of cases, it restores clear vision.

The surgeon makes a small slit in your cornea and removes your lens, replacing it with a clear plastic lens, and sewing the incision shut with fine thread (sutures) that your body absorbs over time.