Wednesday, February 7, 2024

The Essential Guide to Cataracts: Symptoms, Causes, Treatments, and Natural Approaches

Excellent review item here and worth the effort.  I have watched this issue be largely resolved during my lifetime and that is good as a lot of blindness is avoided.

Like most i do have some risk, but watch it.

All good.

The Essential Guide to Cataracts: Symptoms, Causes, Treatments, and Natural Approaches

By the age of 75, around half of Americans develop cataracts.

Cataracts are the most common cause of blindness. (Illustrations by The Epoch Times, Shutterstock)

Medical ReviewedDr. Beverly Timerding

A cataract is a painless clouding of the eye’s lens, obstructing the passage of light to the retina. The retina’s nerve cells detect light and transmit signals to the brain, enabling vision. Cataracts, by impeding light transmission, can lead to vision issues. They are the primary cause of blindness globally and the foremost cause of vision impairment in the United States.
Around 20.5 million Americans, accounting for 17.2 percent of those aged 40 years and older, are estimated to have cataracts in one or both eyes. Additionally, 6.1 million people, constituting 5.1 percent, have undergone surgical removal of their lenses. By the age of 75, around half of Americans develop cataracts.

What Are the Types of Cataracts?
The main types of cataracts include:Age-related cataracts, which can develop as early as age 40 due to natural changes in the lenses. Age-related cataracts progress slowly, initially having little impact on vision. They are also known as senile cataracts. Cataracts in younger individuals or those with diabetes may develop more rapidly. These are the most common type.
Traumatic cataracts stemming from eye injuries that can occur at any age. These cataracts may result from blunt force injuries (e.g., injuries caused by a fist or elbow) or penetrating injuries, where the eye is pierced by something sharp. Traumatic cataract formation may occur shortly after an injury or months to years later.
Radiation cataracts. Exposure to ultraviolet radiation (UV) from sunlight and other types of radiation can cause radiation cataracts. Wearing sunglasses that provide 100 percent UVA and UVB protection in sunlight can decrease the risk of developing this type of cataract.
Pediatric cataracts, which can affect children either at birth (i.e., congenital cataracts) or later in childhood. While rare, these cataracts are often genetic but can also result from prenatal issues (e.g., Rubella infection during pregnancy), illnesses during childhood, eye injuries, radiation, or steroid use. Timely treatment is crucial to prevent additional issues such as amblyopia (lazy eye) when cataracts impact a child’s vision. In some cases, small cataracts may not immediately affect vision, but regular monitoring by an eye doctor is necessary to ensure they do not cause problems over time.
Secondary cataracts, which result from various medical conditions such as diabetes, eye surgeries, or eye infections such as uveitis and retinitis. Prolonged use of oral steroids, such as prednisone, also increases the risk.Cataracts can also be named after their location in the lens, as follows:Nuclear: A nuclear cataract is situated at the lens center, where the nucleus typically darkens over time, transitioning from clear to yellow or brown.
Cortical: A cortical cataract affects the lens’ surrounding layer, presenting as a wedge or spoke-like pattern.
Posterior capsular: A posterior capsular cataract is located in the back outer layer of the lens and often progresses more rapidly than the other types.

What Are the Symptoms and Early Signs of Cataracts?
Cataracts can develop in one or both eyes and do not spread from one eye to the other.
Early Signs and SymptomsInitially, mild cataracts may not result in noticeable symptoms. However, as they progress, vision changes may become apparent. Some of the early signs may include:A loss of contrast; for example, difficulty seeing gray or dark cars on the road.
Glare: Examples include halos and starbursts around lights.
An increased need for light to see clearly.
Common Signs and SymptomsCataracts often do not result in any vision difficulties, and individuals experience different symptoms, which may include:Hazy or blurred vision: The sensation is akin to having a film over the eye that doesn’t dissipate with repeated blinking.
Glare or halo caused by lights. Lamps, sunlight, or headlights may appear excessively bright.
Difficulties with night vision.
Double vision or ghost images.
Perceived faded colors and often an overall yellow tint.
An increase in nearsightedness.
A white or grayish area on the eye: However, many cataracts are not visible to the naked eye, as they are situated too far back in the lens.
“Second sight”: This refers to the ability of an individual who typically relies on reading glasses to read without them suddenly. If the cataract progresses, this effect disappears.
Brown spots in the visual field.
Challenges in perceiving details.
Impaired central vision.
Drusen: Small yellow spots seen with an ophthalmoscope composed of proteins and lipids that accumulate beneath the retina in the eye

What Causes Cataracts?
Cataracts develop when proteins in the eye’s lens clump together, causing cloudiness. The typically clear lens focuses light onto the retina, enabling vision. With cataracts, protein clumps impede the passage of light, leading to gradual vision impairment. Over time, these protein clumps increase in size and thickness, further hindering vision. In addition, the lens may acquire a yellow or brown tint, affecting color perception.

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Many cataracts are classified as idiopathic, developing without a known or identifiable cause.
Various degenerative processes also cause coagulation of proteins within lens fibers, leading to the loss of transparency and the eventual formation of cataracts. The following processes are involved in specific types of cataract formation:Disturbances during lens growth result in congenital cataracts.
Fibrous cellular transformation of lens epithelium causes subcapsular cataracts.
Cortical hydration between lens fibers leads to cortical cataracts.
The deposition of specific pigments (like urochrome, the chemical that makes urine yellow) causes nuclear cataracts.The exact reason for the proteins clumping together remains unknown. Some believe it’s due to chemical changes in the lens associated with aging. These changes could be caused by:Genetics: Approximately 25 percent of congenital cataracts result from genetic factors potentially associated with metabolic, hormonal, or chromosomal conditions such as Down syndrome. Another 25 percent are hereditary, indicating that one of the child’s parents also had a cataract during childhood. Over 100 gene mutations have been identified in congenital cataracts.
Oxidative stress: Oxidative stress is a crucial and likely shared factor in the development of both age-related and pediatric cataracts. It occurs when the production of reactive oxygen species, including harmful molecules called free radicals, exceeds the body’s ability to neutralize them with antioxidants. The oxidation process, mainly triggered by factors such as exposure to UV light or ionizing radiation, can cause structural damage to the lens, contributing to the formation of cataracts.
Oxidative stress is a factor in cataract development. Aging, compounded with oxidative stress, can result in disordered proteins that clump together and obscure the passage of light, hindering vision. (Illustration by The Epoch Times, Shutterstock)

Who Is More Likely to Develop Cataracts?
The following factors make one more likely to develop cataracts than the general population:Age: The primary factor contributing to the risk of developing cataracts is advancing age, as most cataracts are observed in individuals aged 65 and above.
Sex: Cataracts are more frequently observed in females than males, with a ratio of approximately 1.3 to 1.
In utero effects: Research has established a strong link between congenital cataracts and factors such as maternal malnutrition, Rubella, Rubeola, or chickenpox infections, and insufficient oxygenation due to placental hemorrhage.
Obesity: Obese individuals exhibit increased systemic inflammation marked by elevated C-reactive protein and proinflammatory cytokines. These factors may contribute to cataract development due to their association with eye inflammation.
Other eye diseases: Chronic anterior uveitis is the most prevalent cause of secondary cataracts. Acute congestive angle closure can result in small anterior gray-white subcapsular or capsular opacities known as glaukomflecken. High myopia is associated with posterior subcapsular lens opacities and early-onset nuclear sclerosis. Hereditary fundus dystrophies, which include retinitis pigmentosa, Leber congenital amaurosis, gyrate atrophy, and Stickler syndrome, are characterized by genetic mutations that may result in cataracts in addition to vision loss from irreversible retinal degeneration.
Race: Research from 2010 indicates that cataracts are most prevalent in the white American population, affecting approximately 17 to 18 percent. Blacks have the second highest prevalence at 13 percent, followed by Hispanics with an almost 12 percent prevalence rate.
Family history: Having a family member or close relative with cataracts increases the risk of developing a cataract.
Other medical conditions: Diabetes can lead to cataracts by causing a buildup of sorbitol, resulting in lens cloudiness. Elevated and sustained blood sugar levels in diabetes cause this sorbitol to accumulate more rapidly in the lens. As per a longitudinal study involving over 120,000 participants, chronic kidney disease was linked to an increased occurrence of both existing cataracts and the development of new cataracts over time. In individuals with biopsy-confirmed celiac disease, one large-scale study observed a moderately increased risk of developing cataracts. In HIV-infected adults, cataracts tend to manifest at an earlier age, a phenomenon attributed to multiple intraocular inflammatory processes leading to premature degeneration.
Alcohol: Increased lifetime alcohol consumption is associated with a higher risk of incident cataract surgery in both men and women. Looking at drink-years—the number of drinks per day multiplied by the number of years—the risk significantly rises at over 90 drink-years for men and over 40 drink-years for women.
Smoking: Individuals who smoke cigarettes have a two- to threefold higher risk of developing cataracts compared to nonsmokers.
Excessive sunlight exposure: Prolonged sunlight exposure, particularly without proper eye protection, can lead to the development of cataracts at an earlier age.
High altitudes: Individuals in high-altitude areas are more susceptible to cataract development.
Genetic disorders: Cataracts can be associated with multisystem genetic disorders, including chromosome abnormalities, Lowe syndrome, neurofibromatosis type 2, myotonic dystrophy, atopic dermatitis, and Down syndrome.
Medications: Prolonged use of glucocorticoids poses a notable risk for the emergence of posterior subcapsular cataracts.
Eye surgeries: One example is glaucoma surgery. To avoid this, lens replacement surgery is often done at the same time.
Physical trauma: Perforating trauma occurs when a foreign object penetrates the eye. Blunt trauma (no perforation) can lead to cataracts with a distinctive flower-shaped opacity.
Nutritional deficiency: While the findings are not definitive, research indicates a potential connection between the development of cataracts and reduced levels of antioxidants, such as vitamin C, vitamin E, and carotenoids.
High blood pressure: Arterial hypertension increases the risk of cataracts, particularly the posterior subcapsular subtype.
Radiation: Cataract-inducing radiation can be due to natural ultraviolet light exposure or cancer therapies.
Chemical injuries: Chemical injuries involving substances such as naphthalene and thallium can also contribute to the development of cataracts.
Electric shock: Electric shock is a rare cause of cataracts and may result in a chalky opacification and the formation of multiple snowflake-like opacities.

How Are Cataracts Diagnosed?
Routine eye exams play a crucial role in identifying early signs of cataracts. For individuals aged 60 or above, it is recommended to undergo a dilated eye exam every one to two years.

To determine whether you have cataracts, your doctor will examine your eyes, ask about your symptoms and health history, and conduct tests. These tests help confirm the presence of cataracts and rule out other potential causes of vision issues, such as glaucoma, macular degeneration, diabetic retinopathy, optic atrophy, and retinitis pigmentosa.
In the comprehensive eye examination, dilation will be performed using eye drops to widen the pupils. The examination involves the following several tests:Visual acuity tests assess the sharpness and clarity of your vision. It involves reading letters using a Snellen chart. This test helps determine the severity of any vision impairment and its impact on daily activities.
Visual field tests evaluate your peripheral (sides, up, and down) vision, measuring how well you can see objects without moving your eyes.
Refraction assesses whether adjustments are needed in eyeglass or contact lens prescriptions. It serves as a vital factor in planning the management of vision correction.
Cover tests can detect strabismus (crossing eyes) that may occur due to poor vision caused by cataracts.
Eye muscle function tests evaluate the muscles around your eyes by observing your ability to follow an object moved by the doctor.
Tonometry tests can measure intraocular pressure, which signifies the fluid pressure inside the eye. It is a crucial test to assess the risk of conditions such as glaucoma, where elevated intraocular pressure can be a contributing factor.
Ophthalmoscope and slit-lamp examination: Using instruments such as the slit lamp and ophthalmoscope, the doctor checks for cataract signs, looks for glaucoma, and examines the retina and optic nerve. A slit-lamp examination is a diagnostic test performed to examine the eye structures in detail. The instrument called a slit-lamp biomicroscope is a microscope that emits a thin, focused beam of light that enables a close and magnified view of the eye to detect cataracts.
Other TestsWhile uncommon, additional tests may be conducted to aid in the diagnosis and management planning of the disease, such as:Glare test: During glare testing, the patient reads Snellen letters with lights calibrated to simulate the brightness of oncoming headlights (both high and low beams). The acuity is measured after recording the results of glare testing. If lens opacities are present, the visual acuity often decreases significantly, especially with high-beam light.
Contrast sensitivity test: This test evaluates visual performance under real-life conditions by measuring the minimum amount of contrast required to detect a visual stimulus.
Color vision test: Age-related cataracts significantly affect people’s color vision.

What Are the Complications of Cataracts?
The complications of cataracts may include:Blindness: This is nearly always reversible by surgery if there is no other blinding eye disease.
Phacolytic glaucoma: Phacolytic glaucoma is a rare type of secondary glaucoma that happens when an old, very dense cataract leaks large proteins, causing pressure to increase inside the eye.
Eye inflammation.
Dislocation of the lens: This occurs when the crystalline lens is partially displaced but remains within the space designated for the lens. It can be caused by hypermature cataracts, which are dense, hard, untreated cataracts.
Secondary glaucoma: Secondary glaucoma is a type characterized by elevated eye pressure caused by a known factor, leading to damage to the optic nerve and potential loss of vision.

What Are the Treatments for Cataracts?
Your doctor will determine the most suitable treatment based on factors such as age, overall health, medical history, visual impairment level, ability to tolerate specific interventions, and personal preferences.
In some instances, especially at the initial stages, a cataract may manifest as a small dot at the center of the lens, and there is enough space for light to pass around it. In these cases, it has minimal or no impact on vision, so treatment may not be necessary. Monitoring for worsening visual symptoms and adhering to a routine checkup schedule may be recommended.
Home CareMild cataracts can also be managed for months or even years with home care, such as:Increasing lighting in your home or workplace.
Using anti-glare sunglasses and contact lenses.
Using magnifying lenses for reading.
Regular eye exams and adjustments to the prescription of corrective eyeglass lenses can be beneficial in preserving functional vision as cataracts progress.
Using technologies, such as video enlargement systems or speech/hand gesture software for smartphones (built-in apps iOS and Android) and computers.
MedicationsAldose reductase inhibitors may be beneficial in preventing or delaying cataracts in individuals with diabetes.
Eye drops containing phenylephrine and homatropine, which dilate the pupil, may help improve vision. Discuss using these eye drops with your primary physician before beginning, as some people will be more susceptible to side effects.
SurgeryWhen a cataract reaches a stage where it interferes with your daily activities, surgery may be necessary. Cataract surgery is considered safe and highly effective in the United States, with around 90 percent of patients reporting improved vision post-surgery. Following cataract surgery, scar tissue in the eye that clouds vision, called posterior capsular opacification, sometimes develops. This occurrence is common, affecting up to 40 percent of individuals who undergo cataract surgery. It can be easily resolved with a quick laser procedure.

Children born with a dense cataract also require prompt surgery for removal. Failure to do so may impede light from reaching the retina, hindering the transmission of visual information to the brain. If this occurs during the crucial period of visual development, the child’s brain may never learn to see, even after cataract removal.

Cataract surgery entails removing the eye’s natural lens and replacing it with an artificial one. It requires no maintenance and can greatly enhance vision, with some lenses mimicking the natural focusing ability of a healthy young lens. Once a cataract is removed, it cannot regrow.
There are several ways to extract the natural lens:Intracapsular extraction: This technique involves removing the cataract and lens capsule as a single unit. It is rarely used due to complications.
Extracapsular extraction: The central nucleus (i.e., hard and often opaque core) is extracted as a single unit, followed by the removal of the softer cortex in multiple small pieces.
Small-incision extraction: This type of extracapsular cataract extraction method involves creating a side incision in the cornea and using a small probe emitting ultrasound waves to soften and break up the lens. The fragmented lens is then suctioned out in a process known as phacoemulsification. Since this procedure uses the smallest incision for rapid healing, it is typically the preferred choice.The natural lens is then replaced with a clear plastic lens known as an intraocular lens (IOL), typically positioned on or within the lens capsule (posterior chamber lens). However, placement in front of the iris (anterior chamber lens) or attached to the iris and within the pupil (iris plane lens) are also options. If IOL implantation isn’t feasible due to other eye issues, alternatives such as contact lenses or eyeglasses may be considered for vision correction.
Another relatively new technique is femtosecond laser-assisted cataract surgery, performed during the previously described extracapsular extraction. This technique uses a femtosecond laser to perform certain steps of cataract surgery. The laser helps create a precisely shaped opening in the lens capsule, construct clear corneal incisions, and soften or break up the lens during the cataract removal. It aims to improve the accuracy and safety of the surgery.
Though rare, cataract surgery can result in complications such as bleeding, retinal detachment, and infection. After the surgery, the doctor may recommend a course of antibiotics and steroid eye drops.

How Does Mindset Affect Cataracts?
Although an individual’s mindset does not directly affect the development or progression of cataracts, a positive mindset and proactive approach toward health care, including regular eye checkups, may contribute to overall well-being and early detection of cataracts. A positive mindset can also foster healthy lifestyle choices, such as eating a balanced diet, restricting alcohol, and practicing safe sun exposure, which can indirectly support eye health.

What Are the Natural Approaches to Cataracts?
The only recognized and validated cure for cataracts remains surgical intervention, but certain complementary and alternative methods can potentially delay the condition’s progression.
Medicinal HerbsWhen using medicinal herbs, it’s essential to exercise caution, as they may have side effects and interact with other medicines, and higher-quality clinical research is often absent. Therefore, it’s advisable to use herbs under the guidance of your doctor.Bilberry (Vaccinium myrtillus): Bilberry extract is an antioxidant traditionally used to lower the risk of cataracts. In one study involving 50 patients with mild senile cataracts, a four-month supplementation with bilberry anthocyanins and vitamin E showed a 97 percent success rate in preventing cataract progression. Note that this study was very brief, and cataracts often change over the years.
Onion (Allium cepa): In one study, applying 50 percent diluted onion juice into rat eyes was shown to prevent the formation of cataracts caused by selenite. This prevention is linked to increased levels of superoxide dismutase, which provides a significant defense against oxidative stress in the body. The authors noted that further study was needed to determine if eating more onions is beneficial since the juice cannot be put in human eyes.
Indian gooseberry (Emblica officinalis): Amla, also known as Indian gooseberry, is a highly valued medicinal plant in Ayurveda. It exhibits a wide range of health benefits, including analgesic, adaptogenic, cardioprotective, gastroprotective, anti-anemia, wound healing, anti-diarrheal, hepatoprotective, and neuroprotective properties. One study showed that an oral alma aqueous extract could slow the advancement of sodium selenite-induced cataracts in rats.
African tulip tree (Spathodea campanulata): The African tulip tree is a significant medicinal plant traditionally utilized in tropical zones. Its flower bud exudates are commonly used as a local eye drop in Nigeria to improve vision. One study using incubated rat lenses discovered that those treated with higher-dose tulip tree exudate exhibited a delay in opacification, suggesting that the exudate exerted its anti-cataract effects through its antioxidant activities.
Bitter orange (Citrus aurantium): Dried bitter orange peels have been used for their antioxidant properties and ability to combat Helicobacter pylori bacteria in the gut and act as an anti-scurvy agent. One study administered naphthalene to rats to produce cataracts and also treated the rats with a bitter orange peel extract orally, which delayed the onset and maturation of cataracts and provided protection against peroxidative damage induced by naphthalene. The researchers believed this extract might be beneficial in slowing the progression of cataracts.
NutrientsLutein and zeaxanthin are two carotenoid compounds that may aid in preventing cataracts by filtering harmful blue light, minimizing oxidative damage, and maintaining membrane integrity. When used as a supportive therapy, lutein and zeaxanthin may slow the advancement of certain eye conditions such as cataracts. Kale, spinach, broccoli, peas, corn, and egg yolks are rich in these carotenoids.
Olive and ginkgo leaf extracts exhibit inhibitory activity on aldose reductase, an enzyme that converts glucose into sorbitol. Thus, these extracts offer effective and safe therapeutic options, showing significant promise for treating not only diabetic cataracts but also other ocular diseases marked by uncontrolled aldose reductase activity.
Quercetin is a flavonoid with anti-inflammatory properties. Whether applied directly or included in the diet of rats with cataracts, it has been found to have anti-cataract effects and delay lens damage. When quercetin was applied topically to the eyes of newborn rats with diet-induced cataracts, it reduced the development of cataracts in their lenses.
Oxysterol, an oxygenated cholesterol derivative, successfully reduced lens opacity in 61 percent of cases in one study involving mice, suggesting its potential as a nonsurgical treatment for cataracts.
Rosmarinic acid is a natural polyphenol found in certain plants, including rosemary, basil, and mint. In one study involving human lens fragments from routine cataract surgery, rosmarinic acid was observed to restore full lens transparency. When tested in a rat model with selenite-induced cataracts, rosmarinic acid also delayed opacification and reduced cataract severity.
Vitamin C appears to have a protective effect against cataracts, especially cortical and nuclear. Studies have shown up to a 40 percent decreased risk of nuclear cataracts and a 35 percent decreased risk of cortical cataracts in people who took 135 milligrams of vitamin C daily. However, notably, too much vitamin C (about 1,000 milligrams daily) has been shown to increase the risk of cataracts by roughly the same percentages, so appropriate dosages are crucial.
AcupunctureDespite unknown mechanisms behind acupuncture’s healing effects, a review of over 500 cases suggests its success in treating various eye diseases, including cataracts. Acupuncture seems to improve central acuity while not affecting the overall retina. However, it is not a substitute for established medical interventions and can only provide relief from symptoms instead of restoring irreversibly damaged tissues or organs.

How Can I Prevent Cataracts?
There is currently no definite way to prevent cataracts. However, there are certain things you can do to potentially delay or reduce their progression:Minimize sunlight exposure by using UV-blocking lenses and a hat.
Avoid sunlamps and tanning booths.
Use protective eyewear while participating in sports or using power tools to minimize the risk of eye injuries.
Avoid risk factors such as alcohol, tobacco, and corticosteroids.
Manage other health conditions, including blood glucose levels in diabetes and blood pressure, to delay the onset of cataracts.
Increase the intake of eye-friendly nutrients and antioxidants such as lutein, zeaxanthin, vitamins A, C, and E, and zinc through vegetables, leafy greens, whole grains, and supplements. This has been associated with a lower risk of specific eye conditions, including cataracts.
Regularly consume fish. Doing so at least three times a week has been linked to a reduced risk of cataracts in women, as indicated by one study. The overall intake of fish showed an inverse association with cataract development.
Consider taking aldose reductase inhibitors if you have diabetes.
Maintain a healthy weight.
Undergo regular eye checkups, as they can identify cataracts in their early stages.Medically reviewed by Beverly Timerding, MD.

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