Eradicating Cataracts

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Eradicating Cataracts

The October 1994 issue of Townsend Letter for Doctors contained a report of a proprietary multivitamin formula (Nutri-Plex by Bio-Zoe) which the author, Gary Price Todd M.D., an ophthalmologist, reported improved vision among 22 subjects with early-stage cataracts. The test subjects took 4 tablets per day of an undisclosed formulation for a period of five years, and 43% experienced improvement in visual acuity while 57% showed no significant visual change. None deteriorated. Dr. Todd does not disclose how long it took for vision to improve. The formulation was based upon studies that showed cataracts are produced by deficiencies of vitamins A,C,E, B2, B3, selenium and zinc. The author showed a graph displaying mineral deficiencies among 2000 patients, but does not indicate whether the 22 test subjects exhibited these same deficiencies. It is assumed the Nutri-Plex formula is centered around minerals with additional antioxidants. Readers were invited to contact the manufacturer for further information about Nutri-Plex as a proprietary remedy for cataracts. The author cited but three medical references, only one of which was published within the past decade.

Dr. Todd's small long-term study is valuable, especially since his success rate in preventing or delaying a cataract operation was 100%. This study, along with others, documents that cataracts do not always progress. Some regress, apparently due to nutritional factors. Most cataract patients are told by ophthalmologists that their cataracts will only get worse.

This paper proposes that a nutritional "cure" for cataracts has been documented in the medical literature for decades, and that modern studies confirm earlier research. A more comprehensive approach to cataract prevention is proposed, along with suggestions on how to make practical application of an anti-cataract regimen in an age of health reform.

What is a Cataract?

Only 16% of the public is aware that a cataract is a clouding of the natural lens of the eye.(1) The definition of a cataract is generally considered to be an observable lens opacity upon eye examination which may or may not impair daily activity levels. While 20/50 is generally regarded as the criteria for a cataract operation (20/40 is required to drive an automobile), any level of visual acuity loss may present a handicap. Baby cataracts should not be taken lightly. A mild cataract in one eye with vision of 20/30 to 20/80 increases the risk of hip fracture among older adults by nearly three times!(2)

Various studies indicate the Snellen visual acuity chart used by most physicians does not adequately measure the visual handicap caused by lens opacities. Pinning a Snellen acuity chart against a window re-creates the outdoor glare environment and more accurately measures what the patient really sees outdoors.(3) Ultraviolet sun rays are scattered by lenticular opacities and thus reduce visual acuity. The hallmark symptoms caused by cataracts are glare and loss of contrast as well as diminished night vision. In one study, when tested indoors, 76.4% of cataract patients could see 20/40 or better, but when tested outdoors only 31.2% could see as well.(4)

The crystalline lens turns pale yellow over the years due to solar ultraviolet exposure, thus impairing the ability to see blue and violet colors. The discolored natural lens can cause a sense of gloom, especially when surrounding illumination is low.(5) Mild cataracts may cause false senility,(6) unexplained depression,(7) premature retirement, avoidance of night driving, premature nursing home admission,(8) greater risk of fatal auto accidents,(9) poor recognition of faces, difficulty reading medication labels, and may make foods appear to be less palatable.(10)

The adult crystalline lens weighs about 250 mg. It more than doubles in thickness from birth to age 80 and contains nearly 40% insoluble protein in late adulthood, greater than any other organ.(11) Light transmission through the lens begins to decline early in life, falling from over 80% at age 25 to less than 30% by age 80.(12) This is equivalent to wearing a dark pair of sunglasses all the time. It is a mistaken idea that lens opacification is an exclusive process of old age. Lens aging begins early in life and is accelerated by oxidative challenges primarily from sunlight. Permitting the lens of the human eye to age and progressively lose clarity until visual impairment is perceived in the sixth and seventh decades of life appears to be sheer folly. Cataract prevention can begin at any age.

The Framingham Eye Study reveals that only 3.3% of cataracts are worse than 20/50 while 96.7% fall between 20/10 and 20/40 and are candidates for preventive measures.(13)

Historical Evidence

Historically, Sir Stewart Duke-Elder, the noted British ophthalmologist, cited Peters in 1900 as the first to advance the idea that age-related cataracts are a result of disturbed nutrition.(14) In 1935 E.M. Josephson cited the use of ascorbic acid (then called cevitamic acid) and glutathione-rich foods to resolve cataracts caused by a drug.(15) G.M. Koepcke in 1937 then reported a case of congenital cataract where subjective and measured visual assessments were improved by administration of vitamins A and C.(16) In 1939 S. Miles Bouton reported on the use of 600 mg. of ascorbic acid to resolve cataracts. Six patients were studied over a period of three months, most who had visual acuity in the 20/70 range. The majority of the eyes improved between 20/30 and 20/70 vision. One patient who was legally blind (20/200) prior to taking vitamin C regained sight to the 20/70 level. Some patients subjectively claimed they could "read faster" or "do needle work without glasses."(17)

Adams in 1925 was the first to observe that the glutathione content of the crystalline lens of the eye is reduced following exposure to either heat or ultraviolet sun rays.(18) Glutathione will be shown below as the primary agent that maintains lens clarity.

In 1952 Donald T. Atkinson, M.D., a San Antonio, Texas ophthalmologist, remarked that cataracts "represent a lens starving for nutrition." He noted that most early stage cataracts progressed to a mature stage within four years, but patients who followed his dietary prescription showed little or no progression of their cataracts and some patients actually improved. Dr. Atkinson's anti-cataract prescription of 40 years ago consisted of 8 to 10 glasses of water daily, fresh vegetables, 45 mg. of chlorophyll tablets, 1000 mg. of vitamin C, and 200,000 units of vitamin A. Each patient was also asked to eat one egg (which contains the glutathione precursor cysteine) and drink a pint of milk a day (which contains riboflavin, a precursor for glutathione reductase).(19)

Daily Vitamins and Cataracts

It is not surprising that multivitamins provide some level of protection against cataracts. The plasma levels of antioxidants vitamin E, vitamin C and beta carotene are lower in patients undergoing cataract surgery.(20)

The most recently reported study is that of 17,744 U.S. doctors in the Physicians Health Study. This is the same study that reported that low-dose aspirin reduces the risks of cardiovascular disease and caused the nation's news media to advise the public of this preventive measure. Probably millions of adults began taking a daily aspirin tablet as a result of this report. In a companion study, this same population of U.S. physicians was found to have a 27% decreased relative risk of developing cataracts when taking multivitamins.(21)

A similar study among 121,700 females, the Nurses Health Study, reveals that antioxidant-rich foods and vitamin supplements exhibit anti-cataract effects. This study is interesting because it shows the importance of dosage in supplements and the diet to produce an anti-cataract effect. Women whose intake of dietary carotene was 14,588 I.U. of vitamin A activity per day experienced a 30% lower relative risk of cataract compared to women whose carotene intake was 2935 I.U. per day. There was only a weak difference in cataract extraction rates among those whose intake of vitamin C was 705 mg. per day vs. those whose intake was only 70 rag. per day. But when those nurses who had been taking higher dosages of vitamin C for more than 10 years were isolated, a 45% reduction in cataract risk was revealed. More intriguing is the fact that the combination of carotene, vitamin C, vitamin E and riboflavin obtained exclusively from dietary sources produced a 40% lower risk, but this dropped to only 24% when these same nutrients were obtained from supplements.

This prompts the question, what unidentified nutrients were provided in vegetable sources of antioxidants that were not provided in the supplements? Carrots, squash and sweet potatoes were not associated with a decreased cataract risk. But those nurses who ate spinach or other green leafy vegetables five or more times per week experienced a 47-65% reduced risk for cataracts compared to those who consumed these plant foods less than once a month. Spinach is a green leafy vegetable high in glutathione and other mixed carotenes such as lutein and zeaxanthin.(22,23) The importance of glutathione in lens nutrition is underscored below.

A recent randomized double-masked study in China, 5-6 years in duration, showed a 36% reduction in the prevalence of certain types of cataracts among adults age 65-74 who took multivitamin supplements. A second study showed that older adults taking riboflavin/niacin supplements experienced a 44% reduction in cataract prevalence.(24)

In a case-control study with 175 cataract cases and 175 controls, it was found that subjects taking 400 I.U. of vitamin E daily and/or 300-600 rag. of vitamin C exhibited at least a 50% relative reduced risk of cataract. This work was done in Canada by James McD Robertson and colleagues.(25)

Jacques reports low plasma carotenoid levels increase the relative risk of various forms of cataracts by 5.6-7.1 times; low levels of vitamin E by 1.2-3.0 times; and low levels of vitamin C by 3.6-11.1 times.(26)

A study of 112 subjects, 77 of whom had a cataract in one eye, revealed that a high intake of fat soluble vitamins (vitamin A, carotenoids, vitamin D and vitamin E), and a high intake of vitamin C and riboflavin, appears to reduce the relative risk of cataracts compared to those who have low blood levels of the same nutrients. Contrary to Dr. Todd's claim, high blood levels of minerals (selenium, copper and zinc) appeared to increase the risk of cataract.(27)

Some studies attempt to correlate the serum levels of nutrients with cataract prevalence. These studies usually group patients into high and low serum levels. The problem with these types of studies is that they don't consider that dietary and even common vitamin supplements may still not provide the levels of antioxidant nutrients required to prevent cataracts.(28) Such studies are not only a waste of research dollars, but are often the only studies eye surgeons can recollect when advising patients.

For example, a recent study sponsored by the National Eye Institute indicated nutritional supplements showed some preventive effect for certain types of cataracts and were of no value for others. The researchers divided vitamin supplement users into four groups: those who took no vitamins, those whose intake was less than 10% of the median daily intake, those whose intake was ranged from greater than 10% to 110% of median daily intake, and those whose daily supplement intake for specific nutrients exceeded 110% of median intake. These four groups were called "no intake, low, moderate and high" supplement users. But the "high" group of vitamin C users ranged from only 66 mg. to 4250 mg. Robertson and others (cited above) reported anti-cataract effects at levels far exceeding the 60 mg. Recommended Daily Allowance for vitamin C. VitAmin A users were classified into the "high intake" group if they took in as little as 5500 I.U. It took only 1100 I.U. of vitamin A activity from beta carotene, 22 mg. of vitamin E, only 28 mcgs. of selenium and 1.9 mg. of riboflavin to be classified as a "high" intake vitamin supplement user.(29) These are not considered to be therapeutic dosages of nutrients by most nutritional experts. It is this type of study that will obfuscate the revelation that a "cure" for cataracts is already at hand.

Oxidative Stress on the Eyes

The lens of the eye is bombarded daily by ultraviolet sun rays, increasing free radical formation, and in cataractous eyes produces a three-times increase in undesirable hydrogen peroxide in the aqueous fluid. The eye must have some built-in antioxidant defense system to preserve its clarity. Paul F. Jacques, Sc.D. and Allen Taylor Ph.D. describe three built-in antioxidant enzyme systems, that of glutathione peroxidase, catalase and superoxide dismutase. The hallmark sign of cataract development is a reduction in glutathione. Cysteine, an amino acid, accelerates the synthesis of glutathione. Selenium and riboflavin are co-factors for glutathione peroxidase and reductase respectively. Vitamin C and vitamin E have sparing effects on the glutathione redox cycle.(30)

The loss of transparency of the crystalline lens of the eye is caused by the clumping or cross-linking of proteins as a result of oxidation. The reduced form of glutathione interferes with this aging process. Japanese researchers have cited the progressive decline of glutathione in surgically extracted lenses.(31)

Because the aspirin-sized natural lens never sheds its cells, and grows toward its center (resembling the rings in an onion), it becomes more compacted and develops a hard center over the years. The mature adult lens is essentially dehydrated at its center. Glutathione and other nutrients do not easily penetrate to the center of a mature adult lens and are thus concentrated at the epithelium (skin) of the lens.(32)

Ultraviolet light drives the oxidative process. To protect against solar oxidation, the lens is bathed with aqueous secreted by the ciliary body behind the iris. The aqueous fluid of the inner eye contains a very high concentration of vitamin C, 35 times greater in concentration than serum. Aqueous levels of ascorbic acid largely depend upon serum levels, but impaired blood flow through the ciliary body (the gland the secretes aqueous humor) may negate serum values.(33)

Super Sight with Glutathione

The universal reduction of glutathione in all types of cataracts (diabetic, sunshine, age-related, phototoxic, steroid or calcific) has long been known. Yet no human studies have been launched. This is despite scientific consensus on the role of glutathione in maintaining lens clarity.

With increasing age the glutathione content of the lens drops by four to fourteen times.(34) German researchers have shown that glutathione is dramatically reduced in posterior subcapsular cataracts, which can be deduced logically. The posterior skin (capsule) of the lens is the furthest away from the aqueous flow at the front of the eye and thus receives less glutathione.(35) The same studies are repeated ad nauseam by researchers for no apparent reason.(36)

Modern studies, while refinements on previous research, have only confirmed what Adams claimed in 1925 - that lower glutathione levels are involved in all forms of cataracts, in both animals and humans. To cite but a few studies: Japanese researchers challenged rats with a high sugar (35%) diet and observed a reduction in glutathione levels within the lens.(37) Researchers in France found that glutathione levels are reduced in all forms of human cataracts regardless of age, but that red blood cell levels of reduced glutathione cannot serve as a marker of the disease.(38)

Italian researchers administered intravenous glutathione and lens clarity improved in about 30% of cataract patients, whereas none of the patients who received a placebo (water) experienced any improvement.(39)

Any disease that produces a deficiency of glutathione reductase can result in cataracts, as in the reported case of two children with cataracts whose mother fed them nothing but beans and no green leafy vegetables.(40) The chemical buthionine sulfoximine prevents the natural synthesis of glutathione. Injection of buthionine sulfoximine in mice results in total depletion of glutathione in the lens followed within a few days by the appearance of dense cataracts.(41)

In 1985 William Rathbun, Ph.D., a leading researcher in glutathione and cataracts, stated in the Journal of the American Medical Association that glutathione is the "Achilles heel of the human lens," again noting the loss of glutathione in every form of cataract. Glutamylcysteine synthetase, the first enzyme in the synthesis of glutathione, decreases rapidly from its high point at the age of six months and continues to decline throughout life. At middle age glutathione production is "only barely adequate to maintain a clear lens," said Dr. Rathbun, who suggested that supplements of the amino acid cysteine, the rate limiting factors in glutathione synthesis, "might be protective." Rathbun suggested a topical medication be developed.(42)

Using guinea-pigs, researchers explored whether diabetic cataracts were caused by a reduction in glutathione synthesis or a lack of the amino acid cysteine. The lack of cysteine was linked with the decreased production of glutathione.(43) The use of N-acetyl cysteine has been documented to raise glutathione levels within incubated lenses of old and young animals.(44)

Researchers continue to attempt to develop an anti-cataract-specific agent, failing to recognize that the gradual decline of glutathione is not exclusive to the lens but is a marker of aging throughout the body. For example, lens and liver levels of glutathione have been associated.(45)

The observation that glutathione levels are diminished in cases of AIDS has prompted a flurry of research. Healthy volunteers, given 30 mg. per kilogram of body weight of N-acetyl cysteine, a more stable form of amino acid, dramatically increases glutathione levels and T-cell counts.(46) The dietary intake of glutathione in U.S. adults is quite variable, ranging from 10 to 100 mg./day.(47) Supplements can be recommended in cases of cataract and other oxidative challenges. N-acetyl cysteine has been shown to be safe even in high doses.(48)

Not only would supplements of N-acetyl cysteine be advantageous to retard the undesired clumping of proteins in the lenses of older adults, 60% of whom exhibit cataract formation, but would also be beneficial to improve immune systems known to be compromised in old age. The loss of clarity of the human lens serves as an observable marker of diminished glutathione levels in the body and is probably more reliable than a blood test.

Normally, cysteine is synthesized in the body from the amino acid methionine. Deficient levels of vitamin B6 impair the production of cysteine from methionine. Thus low glutathione levels in adults may also be corrected with B6 supplements.(49)

Glutathione: The Riboflavin Connection

Further evidence for glutathione as the key antidote for cataracts is provided by studies with riboflavin, the co-factor for glutathione reductase. As early as 1927 researchers noted cataracts accompanied by alopecia, conjunctivitis, swollen corneas, sticky eyelids, and vitreous and lens opacities among riboflavin deficient animals.(50) In a study of 48 rats, supplementation with riboflavin stopped a progressive cataract in one animal and effectively resolved the external eye symptoms in the other animals.(51) In one study a total absence of riboflavin deficiency was found among older adults with clear lenses compared to those with cataracts.(52) While riboflavin deficiency did not appear to be cataractogenic, the absence of riboflavin deficiency had a protective effect. A study in India found 81% of cataract patients were riboflavin deficient while only 12% of healthy controls lacked this B vitamin.(53) Biochemical analysis revealed a severe deficiency of glutathione reductase in 23% of surgically extracted lenses, reflecting a dietary deficiency of riboflavin.(54)

Minerals and Cataracts

Dr. Todd's Nutri-Plex formula features the use of mineral supplements in cataract prevention, though he cites only one medical report in support of this supposition. Because zinc is such a useful coenzyme throughout the body its supplementation has been shown to be anti-cataractogenic.(55) The daily dietary intake of zinc for older adults is in the range of 7-13 mg., less than the Recommended Daily Allowance of 15 mg.(56) But a more recent report suggests that elevated levels of copper and zinc may damage the lens.(57) Another report shows that zinc, copper and calcium are found in greater concentration in cataractous lenses, while greater concentrations of potassium over calcium appeared to have anti-cataract properties.(58) Zinc appears to be more important in the retina than the lens.(59,60) G.E. Bunce, a researcher with the Department of Biochemistry and Nutrition at Virginia Polytechnic Institute, says "mineral-dependent antioxidant enzymes (glutathione, super oxide dismuta se, catalase) are vital to the defense against oxidant stress, but nutritional deficits of their mineral co-factors do not seem to be likely candidates as factors in the emergence of senescent disease of the lens or retina. In fact, iron, copper and selenium in excess may pose potential hazards."(61)

The total calcium in the clear human lens ranges from 0.1 mM to 0.5 mM, while in cataract formation calcium concentration rises to over 20 mM.(62) Excessive calcium supplementation may be cataractogenic. A calcium-channel blocker given to diabetic rats reduced the incidence of cataracts by 41%.(63)

Fixation on Eye Drops

Financial incentives encourage pharmaceutical companies to develop a topical anti-cataract agent. In Europe and Asia, anti-cataract eye drops are openly marketed in ophthalmic medical journals. The prospect of an eye drop that a person would have to take throughout life, once an accelerated rate of lens opacification was detected, would produce significant profits. While the lens of the human eye loses transparency throughout life, when increased glare symptoms begin to occur after age 40 is when most adults could begin taking an anti-cataract eye drop for the remainder of life. At $350 per year, this would amount to more than the cost of cataract surgery in a 30-year period and the patient may still require surgery.

Alcon Laboratories, manufacturer of lens implants, surgical irrigating fluids and post-operative medications, has quietly conducted a study of a topical glutathione mimic called AL-3823A. Rat lenses exposed to fluorescent lamps begin to lose transparency due to a build up of hydrogen peroxide. The use of the glutathione mimic prevented loss of clarity of the lens.(64) No human studies have ensued.

The idea of a glutathione eye drop is not new. British eye physicians successfully used an acetylcysteine drop to break up mucus strands in dry eye patients in 1968,(65) but for whatever reasons, this never materialized into a commercial product. Indian eye physicians used Tathion, trade name for a Japanese glutathione eye drop (Yamanouchi Pharmaceutical Co., Ltd.), and found it did not slow down the progression of cataracts.(66)

Another example is the development of a pantethine eye drop. The Oculon Corporation in Massachusetts was formed with $10 million of capital to develop a lens protein-clumping inhibitor. The eye drop along with an instrument to detect early-stage cataract formation is currently being developed. Initially Oculon is applying to the FDA for use of its eyedrop following vitreous surgery, which is known to hasten cataract development. Oculon indicates its eye drop would cost approximately $350 per year.(67,68)

The problem with the eyedrop approach to cataract prevention is the obvious re-instillation of the medication which would be required throughout the day. It is unlikely that an eye drop will prove to maintain lens clarity without accompanying protection from UV radiation to reduce the oxidative challenge.

Cataracts as a Marker of Aging

The increased incidence of systemic disease among cataract patients has been well documented.(69) Patients undergoing cataract surgery have a 1.35 times increased risk of dying within a five-year period following their operation than equally-aged adults 65-79 years of age.(70) Among adults over age 75, those with mature cataracts have a three times increased risk of mortality compared to those who have no cataracts.(71) One study revealed that mild degrees of visual impairment were more strongly associated with increased mortality among older adults than severe visual loss.(72) Mild cataracts, as stated elsewhere in this paper, should not be ignored.

Cataracts have been positively linked with atherosclerotic changes.(73) In one study the pulsatile blood flow of patients with cataracts was found to be in the range of 400 microliters per minute versus nearly 600 microliters per minute among patients without cataracts.(74) More advanced vascular occlusion in blood vessels on one side are a likely explanation of why cataracts don't develop in both eyes at the same rate.

The attempt to develop an antioxidant formula that has specific action in restoring or preserving lens clarity does not address the fact that cataracts are often a sign of premature aging and increased mortality. Kunio Yagi, M.D., Ph.D., of the Institute for Applied Biochemistry in Mitake, Japan has said that "all human disease has some relationship with free radical species."(75) Lens aging may be a sign of local or systemic oxidative stress.

Putting Cataract Prevention Into Practice

The nation's news media has given widespread coverage to preventive measures for cataracts as they are announced in the medical literature. In 1991 the New York Times and other papers across the country gave widespread coverage to a report that multivitamins reduce cataract risk. USA TODAY gave front-page coverage to vitamin E as an antidote for cataracts in its May 11, 1993 issue. In January of 1993 the University of California at Berkeley Wellness Letter said "there's hope that with good health habits you may be able to postpone or, in some cases, prevent cataracts." The Wellness Letter suggested the use of UV-blocking sunglasses, avoidance of tobacco, and a high intake of antioxidant nutrients. The April 1993 issue of the Harvard Health Letter made similar suggestions. Yet few eye doctors recommend dietary changes or nutritional supplements to their patients with early-stage cataracts. While a survey of ophthalmologists reveals 56% now recommend nutritional supplements,(76) these nutrients are primarily prescribed for cases of macular degeneration. A recent report actually documents that cataracts do regress, but the authors of the research make the incredulous claim that the cataract regression is due to "misclassifications" when grading lens opacities.(77) This is just another example of the "cataract coverup" going on within the research community.

Calculating the Cost of Prevention

Dr. Todd in his October report in the TL indicates the Nutri-Plex nutritional by Bio-Zoe would cost only $216 per year, far less than the $6000-8000 required to surgically remove two cataracts. If an adult begins taking a similar priced antioxidant formula beginning at age 40, when observable symptoms of cataract glare begin and lens proteins exhibit accelerated clumping, 35 years of continuous supplement use would cost $7560 in constant dollars. Leo T. Chylack, M.D., a leading researcher in the medical treatment of cataracts, indicates modern cataract surgery with lens implants is 97% successful. He suggests that any preventive measures for cataracts would have to equal the 97% success rate of surgery and cost less than $3000 per eye for surgery.(78) Such thinking leaves the patient's wishes out of the equation. When eye surgeons hand surgical candidates a consent form it only explains the patient's surgical options, not non-surgical alternatives.

More than 1.5 million cataract operations are performed in the U.S. annually at an estimated cost of $4.5 billion annually (Medicare and non-Medicare billings). Cataract care represents about 5% of the entire Medicare budget (not the 12% frequently misreported in the medical literature). There are an additional 7 million office visits made to eye physicians for cataracts annually.(79) An untold number of premature nursing home admissions, auto accidents, medication errors and broken hips can be attributed to cataracts, costing much more than the nation's surgical billing for this malady.(80)

Cataract surgery, especially when performed by an experienced surgeon using small-incision methods of extraction with lens implants, is an absolute cure-all for cataracts. A cloudy lens is removed and a clear artificial replacement lens placed within the eye. It can be likened to a person having a pitted windshield removed from their car and replaced with a new one.

At age 40 or 50 most people do nothing to prevent a highly probable and impending problem like cataracts. The advancement of cataracts is so gradual as to not be easily perceived. Most people unconsciously adapt by resorting to stronger wattage light bulbs or other compensatory measures. The nutritional approach to clearing up cloudy cataracts is not likely to be as successful as surgically implanted lenses in restoring clarity to the ocular media. Most older adults have cataracts for years before diagnosis, making them more difficult to treat with nutrition or medicines later on.

What Should Cataract Patients be Told?

Aging is synonymous with eye troubles. Senior patients should be informed that advanced age increases the chance of eye problems by ten times compared to younger adults. Ideally, patients who experience frequent changes in their eyeglass prescription, glare and other symptoms, need to advised of measures that retard lens aging. Those who have diagnosed lens opacities, which do not require surgery (the vast majority of cases), should be advised of a comprehensive anti-cataract regimen that includes dietary changes, nutritional supplements, UV-protection, control of blood sugar levels, smoking cessation, limitation on alcohol consumption and a review for any photosensitizing drugs or steroids which may quicken cataract formation.

Unlike the formula advocated by Dr. Todd, nutritional supplements to prevent or reverse cataracts should be centered around glutathione and glutathione precursors N-acetyl cysteine, selenium and riboflavin, with glutathione-sparing agents vitamin C and vitamin E. Carotenes also appear to have anti-cataract properties, especially mixed carotenes containing lutein, zeaxanthein and beta carotene. Vitamin B6 supplements are a natural way of encouraging natural synthesis of cysteine from methionine in the body and may also be considered.

Other nutrients have been identified as anti-cataractogenic, such as coenzyme Q10, (81) quercetin (aldose reductase inhibitor for diabetic cataracts)(72-84) and other bioflavonoids. Green leafy vegetables that are rich in glutathione should be included in the diet.

The habitual wearing of UV-filtering sun glasses, preferably of the wrap-around design, is necessary to reduce the oxidative stress upon the human lens. Tobacco and alcohol should be avoided.

At least 22 different brands of nutritional formulas are marketed as antioxidant remedies for eye conditions. Most of these formulas were developed to meet the demand for an antioxidant formula for macular degeneration following one report which indicated zinc may slow down the progression of this eye disorder.(85) Most of these formulas provide only RDA levels of antioxidants per pill. More pills can be taken to achieve therapeutic or preventive intake levels. But some of these formulas are unbalanced and doubling up on daily pills would provide excessive levels of zinc. Only 8 of these 22 antioxidant brands include glutathione, L-cysteine or N-acetyl cysteine, the key anti-cataract nutrients. One brand popularly advertised to ophthalmologists originally included L-cysteine, the glutathione precursor, but for unexplained reasons this ingredient was later removed from the formulation.

Anti-cataract formulas should concur with recent studies that show that a minimum of 100 I.U. of vitamin E reduces the risk of heart attack by 40%(86) 200-600 mcg. of chromium to increase life span and increase HDL/LDL cholesterol ratios among adults taking beta blockers;(87) 50 mg. of beta carotene every other day reduced the risk of a cardiac event by half;(88) replacement of 25 mg. of vitamin C for every cigarette smoked (a 20-cigarettes a day habit equals 500 mg. of vitamin C).(89) Current smokers of 20 or more cigarettes per day have a statistically significant two-fold increase in cataract risk relative to nonsmokers.(90) Whatever the dosage of antioxidants provided in an oral supplement, it must exceed the most acute oxidative challenge placed upon the body and the eyes at any given time without resorting to levels of nutrients that produce significant side effects.

According to available medical reports, nutritional supplements may clear up cloudy cataracts within a 3-6 month period of time. Cataract surgery is a safe, reliable and cost effective method of improving vision. While nutritional supplements should become part of everyone's daily routine, they should not be used to endlessly postpone a cataract operation. If vision does not improve in a reasonable time period and cataracts are interfering with daily activities, consultation with an eye surgeon may be advisable.

Some patients are not likely to comply with a daily nutritional regimen due to strokes, hearing problems, senility, arthritis, home environments, and other health problems or a combination of the above. Consultation with patients will reveal their level of interest in preventive measures and nutrition. Some patients will not be ready to give up smoking or change their diet.

Likewise, some cataract patients are not ideal surgical candidates, having high myopia, diabetes, uveitis or other conditions that make them prone to experience complications during or following cataract surgery, such as poor wound healing, vision-threatening inflammation, glaucoma, and retinal detachment. Some patients are difficult to treat on an operating table because of asthma or other health problems. Preventive or therapeutic measures for cataracts should be attempted before these patients are scheduled for a cataract operation.

The World Cataract Problem

Most reports claim that the worldwide burden of cataract blindness is 17 million people, a figure which is estimated to grow at the astounding pace of 1 million per year.(91) A more accurate figure by the World Health Organization is that 50 million people worldwide experience visual impairment caused by cataracts (that's 100 million eyes!).(92)

The futility of trying to solve the cataract problem with surgery is evident in India. An estimated 1.3 million cataract operations are performed in India annually, not enough to even keep up with the newly diagnosed cases reported annually. Indian authorities now estimate there are 12 million who are blind from cataracts in their country alone and that this figure increases by 3 million annually. Only about a third of India's 7500 eye physicians perform cataract surgery at the community level. Due to poor organizational skills most eye surgeons can perform no more than 150 operations annually.(93) In India the typical surgical cataract patient is 55 years of age compared to 72 years in the U.S. Most surgical patients are functionally blind in India on the day of their eye operation, while most U.S. patients undergo surgery long before their vision ever reaches 20/100 Snellen acuity.(94)

If cost were to be used as the only rationale for preventive measures for cataracts, it would be difficult to justify prevention on a global scale. Cataract surgery, if available in developing countries, costs as little as $15 per eye. Lens implants are fabricated in India for as little as $8 and surgeons are paid an equivalent of $1.80 to $3.60 to perform the operation. More than half of the surgical patients in India are willing and able to pay $10-54 (15-30days wages) to have their vision surgically restored.(95) For this same amount, people in developing countries could afford to purchase nutritional supplements that could potentially clear up their vision as well as improve their general health.

There are many financial, medical manpower, social, geographical and religious barriers to receiving cataract surgery, with fear of an eye operation at the top of the list. A small survey of U.S. cataract patients who had unoperated cataracts revealed that 46% claimed they were fearful of an eye operation.(96) Even with the availability of modern cataract care in the U.S. and financial provisions through Medicare, cataracts are the leading cause of blindness among Black Americans in Baltimore.(97) Prevention is attractive to fearful patients.

A majority of the cataract surgery in developing countries is the simple "yank out the cataract with an ice probe" technique that has largely been abandoned in the U.S. and which has inherently higher rates of postoperative complications. Even when a more modern surgical technique is used a 10% complication rate was experienced in Ghana. Yet 29% of these Ghanian patients couldn't be located for a return visit 16 months following surgery.(98) Twenty percent or more of the patients undergoing the modern cataract operation will experience hazy vision due to the growth of a cloudy membrane inside the eye postoperatively. Many of these patients will have to live with this problem because they are unable to return to the hospital.

Furthermore, many surgical patients still do not have an artificial lens implanted in their eyes. They require thick coke-bottle glasses to bring their eyes into focus which provide a narrow field of view and a magnified and distorted view of objects. In Gambia fewer than half of the surgical patients reported having glasses and often there are no replacement glasses available for those that have been lost or broken.(99)

The availability of eye surgeons in developing countries is limited. In Africa there is one ophthalmologist for every I million persons. One report says "the probability of training enough ophthalmologists in the next decade and placing them in positions to manage the cataract problem is slim."(100) Preventive approaches to cataract blindness look all the more appealing when all of these factors are considered. Even if cataract surgery were made available at an affordable price, rural villagers often cannot or will not travel more than 20 miles to see an eye specialist in a hospital.(101)

The only hope for millions of people afflicted with cloudy cataracts worldwide is nutritional therapy. It is cheap, safe, requires no special training of medical personnel nor equipment as does surgery, and is likely to be readily accepted by populations at large. Organizations dealing with blindness prevention (WHO, UNICEF, Helen Keller International, Lions Clubs International SightFirst) know how to organize a vitamin distribution program since they already provide vitamin A to prevent xerophthalmia (a severe dry eye condition) throughout the world.(102)

Why No Cataract Cure?

Currently the only approach to eradicating cataract blindness in both developing and industrialized countries is surgery. Ophthalmic drug companies direct their efforts toward the development of proprietary drugs or eye drops rather than simple, inexpensive methods using oral nutritional supplements and UV sunglass protection. The desire to profit from a medical or nutritional cure for cataracts is keeping the world from discovering that a simple inexpensive cure is already at hand. Even Dr. Todd claims his Nutri-Plex formula is "intellectual property."

The major ophthalmic drug companies have sponsored research and are fully aware of the glutathione/antioxidant "cure" for cataracts. While Alcon Laboratories has attempted to develop a proprietary glutathione eye drop, oral supplements will do just as well and provide additional health benefits, at less cost than an eye drop. Once a "cure" is discovered for cataracts, research dollars would cease and surgical fees would be curbed. Hence the reluctance for researchers and eye surgeons to push for implementation of obvious prevention. The glutathione/antioxidant/sunglass "cure" for cataracts has been kept under wraps far too long -- 50 million people too long.

The National Eye Institute is also derelict in its duty by not yet sponsoring a clinical study combining glutathione, glutathione precursors and antioxidants vitamins as a preventive measure against cataracts. Based upon previous studies, a clinical study lasting only six months or less would be all that is required to prove that early-stage cataracts can be reversed. There is no need for five-year longitudinal studies, as patients are not willing to wait five years to have their vision restored. Any therapeutic measures for cataracts must be able to clear up cloudy vision within a six month period or less. Prolonged delay of surgery may put the patient at risk for accidents or other problems.

With increasing life spans in developed countries, the burden of providing health care to the growing populations of senior adults is enormous and is expected to outgrow allocated financial resources of the industrialized world. In the year 2000 there will be 35 million Americans over age 65, 18% of whom will have cataracts that cause 20/30 vision or worse when wearing corrective lenses.(103) That amounts to 6.3 million people (12.6 million eyes) that are approaching the need for surgery or are surgical candidates. While there are more than 1.5 million cataract operations performed in the U.S. annually, that's a drop in the bucket next to the upcoming demand for eye surgery. Some 73% of Americans over age 65 have detectable aging changes in the lenses of their eyes (a pre-cataract condition), which will affect 25.5 million of the 35 million seniors in the population in the year 2000! No society on Earth has the financial resources to provide all of the needed cataract surgery f or so many people. Prevention is the only answer.

Whereas cataract surgery is available upon demand in the U.S. at the current time, rationing of care is anticipated in the near future. This will be accomplished as it is currently in Britain and Canada where cataract operations are delayed for up to 36 months. In Britain 75% of the cases of "low vision" are caused by cataracts, a totally needless circumstance in an age of lens implants and modern surgery.(104) In the U.S., the government's way of curbing demand for cataract surgery has been to scare prospective patients away from the operation, falsely claiming 30% of the surgery is unnecessary. Without a prevention program patients have no alternatives but surgery.

Nutritional therapy for cataracts would only need to delay a cataract operation for a period of two years for 30% of surgical candidates in order to save billions of dollars.

A reduction of 500,000 surgical cases annually would save $1.5 billion annually. If all 1.5 million surgical candidates were to take nutritional supplements costing $20 per month, this would cost $360 million. A pair of sunglasses @ $10 each would cost an additional $15 million. It would behoove Medicare officials and others involved in public health funding to advocate government payment for an initial 90-180 day supply of nutritional supplements for all patients exhibiting early visual acuity changes due to cataracts. Such a program can be likened to prophylactic flu shots which are now provided to the elderly.

Optometry and Cataracts

An estimated one-third of all cataract patients, are examined and diagnosed by optometrists. Optometrists, by virtue of the fact they have fewer financial incentives to recommend surgery than do ophthalmologists, are in a key position to advocate preventive measures for cataracts. There are 34,000 optometrists vs. 14,000 ophthalmologists in the U.S. Like medical doctors, most optometrists are poorly trained in nutrition and simply do not understand the basics of cataract prevention. Optometry is a likely profession to launch cataract prevention programs in the U.S.

Self-Care of Cataracts

As the American public hears more about the health benefits of vitamins, more and more are taking daily supplements. The Berkeley Wellness Letter, Prevention Magazine, and the Alliance for Aging Research have all come out with similar recommendations for daily nutritional supplements, all of which exceed the Recommended Daily Allowances.

As more and more people begin to take daily supplements with these levels of antioxidants, the incidence of cataracts will shrink. Whether eye physicians ever advocate measures to prevent cataracts or not, the public still has direct access to information on how to preserve their sight and prevent cataracts on their own. A medically unguided personal regimen to prevent cataracts does not appear to be hazardous.

The University of California at Berkeley Wellness Letter now recommends that adults take 6-15 mg. of beta carotene, 250-500 mg. of vitamin C and 200-800 I.U. of vitamin E daily, as a method of insurance against chronic disease. These dosages are safe. If this advice by the U.C. Berkeley Wellness Letter were to be put into practice, there is a strong likelihood that a significant reduction in the incidence of cataracts will be experienced in the population at large. The growing pool of senior Americans with cataracts will likely offset reductions in the demand for surgery brought about by preventive measures.

In 1991 the American Academy of Ophthalmology joined the American Association of Retired Persons and the Department of Health and Human Services in setting eye disease-prevention goals for the nation. "These objectives only relate to prevention, not treatment or care or management of conditions," said a government spokesperson. The objective is to reduce the incidence of visual impairment in people aged 65 and older from 87.7 per 1000 to 70 per 1000 by the year 2000.(105) The Healthy People 2000 project is now three years old, and no drop in the incidence of visual impairment has been reported. While their objective is laudable, no specific methods or programs were suggested in order to achieve this goal. Nutrition and sunglass protection are ways to achieve this objective.

The preponderance of medical literature supports the use of glutathione and glutathione precursors along with sunglasses to prevent cataracts, for which there is scientific consensus. Glutathione and its precursors have cleared cataracts in laboratory studies, in animal and human studies, and when given intravenously, topically and orally. Glutathione has also been shown to be helpful in reducing oxidative stress at the retina where it may play an important role in thwarting macular degeneration.(106) Since many thousands of healthy and ill patients already take similar supplements without significant side effects, there is no reason why the populations of the world cannot begin their own cataract prevention programs today. A cataract prevention program should be attractive to capitated health plans.

Richard W. Young, Ph.D., an advocate for sunglass protection, indicates individuals who live past age 75 face a 50% probability of diminished vision from cataracts. He writes: "The price of inaction is a future, 50 years from now, when 50 million elderly Americans will have diminished vision due to cataracts and macular degeneration. To go forth knowingly toward that predictable outcome without a plan for prevention, without hope for a medical cure, and without having tested the possible beneficial effects of a simple and safe method of delaying the onset of these diseases seems unwise."(107)

Townsend Letter for Doctors & Patients.

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By Bill Sardi

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