Cataracts - An Integrative Medical Approach
By Marc Grossman, OD, LAc
The world is changing. Our concepts of Western medicine have shifted with new research coming out regularly supporting the benefit of lifestyle, diet, and targeted supplementation. The approach of a symptom-oriented treatment protocol isolates the person from the health condition, defining them in terms of diagnosis and specific medications for that diagnosis.
The holistic and Eastern medicine approach seeks to look at each person as a unique individual so treatment strategies can often vary from person to person even with the same diagnosis.
By combining the medical approaches of the East and West along with other alternative health modalities, we may be able to achieve better health with less cost and greater success in helping patients preserve vision.
Cataract Types and Prevalence
Cataracts are defined less by the age of onset than by the size and location. The age of onset does not determine the cause. Anyone with a genetic marker for cataracts could be more vulnerable to damage due to environmental toxins.(1)
Senile or age-related cataract occurs after age 45. Age-related cataracts are generally attributed to multiple environmental insults accumulated over a number of years, including ongoing exposure to sunlight, oxidation in the lens, as well as poor circulation and delivery of essential nutrients to the eyes.
Cataracts tend to worsen over time and are the major cause of blindness. Almost 40 million people in the U.S. alone, suffer from cataracts. Only 10% of people are affected with cataracts by age 55, but the figure jumps to 50% by age 75, and 70% by age 80+.(2) Cataract removal is the most common surgical procedure covered by Medicare with almost 3,000,000 surgeries performed per year.
Nuclear cataracts are those found in the central part of the eye lens. Due to the location of the cataract, these tend to impact vision to a greater degree than those located elsewhere on the eye lens, even in early stages of development.
Cortical cataracts are found on the outside part of the eye lens and are commonly found in people with diabetes. Given the location of this type of cataract, these may have little effect on vision, particularly in the early stage of development, but they can develop quickly in diabetics.
Posterior subcapsular cataracts appear on the back part of the eye lens. Symptoms can include sensitivity to bright light, seeing of halos, and/or difficulty in distance vision.
Secondary cataracts are not technically cataracts; however, they are called this in mainstream medicine. Secondary cataracts occur when old cells of the original lens remain in the eye and collect on the new artificial lens. They may occur in up to 50% of post-cataract surgery patients, and they can result in symptoms similar to the original cataract condition. Doctors use a YAG laser treatment to “burn” off the excess cells from the new lens. This procedure is typically fast, painless, and very effective, and usually done in the eye doctor's office.
About the Lens
The healthy eye lens is completely transparent, allowing the maximum amount of light to reach the retina. The lens is comprised of water and a highly concentrated mix of several proteins, including protective proteins that prevent the lens proteins from aggregating and clumping. A cataract results when the proteins start to clump up, clouding the lens, and reducing the amount of light that can pass through. If not treated, the color of the lens starts to change from being clear to yellowish and eventually brownish.
The lens has a microcirculation system which operates in lieu of blood vessels. It has been proposed that this system is a flow of ions that generates a flow of water through the lens. An extracellular flow of water moves nutrients into the lens; an intracellular flow of water removes wastes from the lens.(3)
Vision blurriness and sensitivity to glare, particularly at night, and/or seeing halos are signs of early stage cataract development. These symptoms can vary depending on the location of the cataract on the eye lens.
At this stage, the eye doctor will usually recommend surgery, particularly if vision cannot be improved better than 20/40 with eyeglasses, due to the cataract. The location of the cataract on the lens also determines whether surgery is recommended at that time. Symptoms again include blurriness of vision, sensitivity to glare (particularly at night), and possibly less color clarity. Double vision, or seeing multiple images, is another common symptom at this stage.
As cataracts get harder and stiffer, they are more difficult to remove. They can also liquefy, and if not removed, can cause substantial inflammation, pain, and possibly infection. At this stage, people often can see shapes, but not detail. While an advanced cataract raises the risk of complications from surgery, unless there is a medical reason to avoid it, surgery should be performed. This is a crucial point in the development of cataracts, and if left unaddressed, further complications could result.
Causes and Risk Factors
Here are a few specific known causes of cataracts that most doctors acknowledge:
• Increase in age,
• Excessive use of alcohol,
• High blood pressure,
• Use of pharmaceutical drugs, long term use of steroids,
• Diabetes, persistent blood sugar imbalances, even not diagnosed as diabetes,
• Long-term exposure to sunlight,
• Physical trauma, such as getting hit in the eye with a ball,
• Exposure to chemicals.
Less known to most doctors, but theorized by some researchers, is that radiation from cell phones can lead to early cataracts (in addition to causing other ocular problems).(4)
Cataract surgery is performed when the cataract is considered "ripe enough." Typically, eye doctors begin to recommend surgery if one’s vision cannot be refracted to 20/40 or better, due to the cataracts. Of all the eye diseases, cataracts are the most amenable to treatment with conventional medical methods. The standard treatment is an outpatient procedure to remove the lens using a technique called phacoemulsification. A surgeon uses an ultrasonic beam to break-up the hardened lens, and then vacuums up the pieces from the eye with a suction device. An artificial lens, called an intraocular lens or IOL, is inserted to replace the cataract lens.
Patients who may not be considered good candidates for cataract surgery include those with a history of heart conditions, retinal bleeding, or other health issues considered risky for surgery.
Vision improvement may be noticed immediately after surgery, but there can be initial blurriness due to inflammation, so that improvement is typically noticed within two to three days. One may feel itchiness and discomfort for a few days, which should disappear with the antibiotic and anti-inflammatory eye drops prescribed by the eye doctor. An eye patch can help temporarily protect the eye. Complete healing usually occurs within eight weeks after surgery.
Your eye doctor will recommend avoiding physical movements and activities for the first week after surgery. These include bending from the waist and lifting heavy objects.
Risks After Surgery
Although cataract surgery is typically very successful, it can cause trauma to the eye for a small percentage of people. Such trauma can include choroidal hemorrhage, macula edema, retina tears/detachment, vitreous tears/detachment, and/or flashes, and eye floaters.(1,5)
Overall, up to 20% of all cataract procedures are for diabetic patients.(6) High levels of sugar in the blood contribute to cataract formation; diabetics are two to five times at risk for getting cataracts.(6-8)
Blood sugar interferes with the lens's ability to pump out excess fluid from the eye and maintain its clarity. With too much dietary intake of sugar, this function can become difficult or impossible.
Diabetics with severe non-proliferative and proliferative diabetic retinopathy have a higher risk of progressive disease after surgery.
Though most conventional physicians attribute cataracts to general aging, we believe that a cataract is often a symptom of an underlying condition due to a metabolic imbalance. It signals that the natural processes of your body are breaking down on some level, and that the normal flow of nutrients into the eyes and waste products out of the eyes has been compromised.
While we do recommend cataract surgery for those with moderate to severe vision loss, we prefer to use complementary therapies, including nutritional intervention, where surgery is not considered essential. Through these and other complementary medical treatments, it is possible to slow and even reverse the growth of cataracts.
Even people preparing for cataract surgery should seek to improve their overall health before they go through this invasive procedure, as this will aid in healing times and help protect the retina. Because cataracts typically progress slowly over many years there is often time for preventive measures to work quite successfully.
Studies have shown that rather than looking at vitamins and nutrients in isolation, combinations tend to decrease cataract risk significantly. For example, a combination of antioxidant group carotenes, vitamins A and C, and an omega-3 group were more effective than those nutrients in isolation.(9) Another study showed a combination of vitamins B1, B2, B3, C, E, and carotene in the diet significantly lessened the risk of all cataract types.(10)
Vitamin C (buffered and ascorbated), 2,000 mg per day, split up and taken with meals. The normal healthy lens of the eye contains a higher level of vitamin C than any other organ of the body, except the adrenals. When cataracts are forming, there is a decreased level of vitamin C in the aqueous humor as well as in the overall body. Vitamin C has been shown to control sugar imbalances that often play a role in cataract formation. Good sources are citrus fruits, red peppers, and tomatoes.(11-15)
Note. When supplementing with vitamin C, for better absorption make sure the formula you take is ascorbated and buffered (to slow the breakdown of vitamin C and extend absorption time in the body) with nutrients such as bioflavonoids, rutin, rosehips, calcium, magnesium, and/or potassium. Plain ascorbic acid flushes out of the body quickly.
Glutathione, 500 mg–900 mg, if taken in capsule or pill form. The sublingual form has 5-10 times greater absorption so the dosage will be smaller. Follow label instructions. Referred to as the anti-aging antioxidant, glutathione is considered the most important antioxidant made by the body.
It is very effective in preventing cataract formation and is crucial in possibly altering free radical damage. Some studies have shown that many lenses with cataracts contain approximately one-fifth of the amount of glutathione as compared to normal lenses. Glutathione levels are even lower in nuclear cataract lenses compared to cortical cataract lenses.(16,17)
Food sources that help boost glutathione naturally include milk thistle extract, whey protein, and foods high in sulfur such as arugula, avocado, bok choy, Brazil nuts, broccoli, Brussels sprouts, cabbage, cauliflower, collard greens, dried apricots, eggs, garlic, kale, mustard greens, onions, radishes, roasted peanuts, turnips, and watercress.
The Perfect Pair: Glutathione and Vitamin C
The importance of vitamin C to eye health cannot be overstated; concentrations of vitamin C in the lens are 20–30 times higher than those in the plasma.(18) Vitamin C doesn’t work alone: it needs glutathione to improve the use of ascorbic acid (the purist form of vitamin C) in the body.
Glutathione and vitamin C are thought to work together to promote proper water balance within the lens and prevent the protein clumping that can lead to cataracts.
Very Important Nutrients
Lutein, 6 mg–20 mg per day. This powerful antioxidant is found both in the lens of the eye and retina, and it helps protect the eyes from damage due to sunlight exposure by filtering out light.(19-23)
Zeaxanthin, 2 mg–12 mg per day. This powerful antioxidant is found in the lens of the eye and the retina, which helps protect the eyes from damage due to sunlight exposure by filtering out light.(21-24)
Alpha-lipoic acid, 120 mg–300 mg per day. Alpha-lipoic acid has been found to halt complications resulting from blood sugar imbalances and hardening of the lens. Oxidative damage results in cataract formation, and increasing antioxidants, particularly alpha-lipoic acid, can help prevent or stop cataract formation.(25-27)
An optimal potency multivitamin is an important foundation of any cataract prevention program. It should include flavonoids and carotenoids. Scientists found that the risk of cataract formation decreased in the regular users of multivitamin supplements (one-third risk decrease).
Flavonoids, 1,000 mg per day. Quercetin and rutin are important antioxidants that are synergistic with vitamin C, meaning they need each other to work efficiently. Of the two, quercetin seems to be one of the most effective flavonoids in the prevention of cataracts.(28,29)
Green tea extract, 500 mg–725 mg per day. High in antioxidants, this supplement helps protect the eyes against oxidative damage.(30)
Selenium, 200 mcg per day. Patients with senile cataracts were found to have significantly lower blood- and intraocular levels of the mineral selenium than controls.(31)
N-acetyl-carnosine (NAC), 500 mg per day. Statistical analysis revealed the significant differences over 6 and 24 months in cumulative positive changes of overall characteristics of cataracts in a group taking NAC.(32)
Bilberry, 180 mg–240 mg per day, taken along with vitamin E, 400 IU per day. Some studies suggest that bilberry may slow cataract formation. Bilberry combined with vitamin E stopped cataract formation in 48 of 50 patients with senile cortical cataracts.(33) In an animal model, supplementation with bilberry extract helped to protect DNA and improve enzyme activity in lens tissue.(34)
Resveratrol, 250 mg per day. Resveratrol activates an enzyme called sirtuin type 1 (SIRT1), which protects against oxidative stress in human lens epithelial cells.(35) This enzyme inhibits oxidation in the eye's lens and protects against cataract development.
Melatonin, 1 mg–3 mg before bedtime. Melatonin can help increase levels of reduced glutathione in the body.(36)
Milk thistle, suggested dosage 480 mg–960 mg per day. Milk thistle contains silymarin (its main ingredient), which possesses both anti-inflammatory and antioxidant properties. Because of this, milk thistle may help boost glutathione by preventing glutathione depletion in the liver and helping to cleanse the liver, which is essential for lens health.
Vitamin E, suggested dosage 400 IU per day. In percentages that were statistically significant, studies have found that high levels of dietary vitamin E, supplemental vitamin E, and high levels of vitamin E in the bloodstream are all tied to a lower risk of cataract. As the levels of vitamin E dropped, the incidence of cataract increased.(32,37-39)
Saffron, suggested dosage 20 mg per day. An interesting and related study found that crocin, a saffron apocarotenoid, was helpful in reducing diabetic cataracts.
There is a strong correlation between the risk of cataract onset and the patient’s diet. Subjects who ate the most meat had the highest rate of cataracts, and those who ate fish but not meat had a lower rate. Vegetarians had a lower rate and vegans had the lowest rate of cataract incidence.(41)
Whenever possible, a nutritional program should be maintained for at least three to four months to help with quicker recovery and retinal support, before considering cataract surgery.
Juicing is a great way to deliver nutrients to the body. Our juicing recipe for cataracts is some combination of the following. You can add your favorite fruits and vegetables.
· Fresh apple, endive, carrots, celery, parsley, blueberry, and fresh leafy-green vegetables.
· Not too many carrots because of their high natural sugar content.
This combination helps warm and detoxify the body and provide great nutrients for nourishing the eyes.
It is very important to reduce or eliminate all types of refined sugars (particularly white sugar, but also fructose, sucrose, fruit juice concentrates, maltose, dextrose, glucose, and refined carbohydrates). This includes “natural” drinks that contain a lot of sugar, including all fruit juices. Those people who are lactose intolerant are at higher risk for cataracts.(42)
Drink eight glasses of water per day (preferably filtered or purified). This is optimally taken as a four-ounce glass of water every half-hour, to equal 16 four-ounce glasses.
Our bloodstream can only effectively handle about four ounces at any one time. When you drink more at a time, this means more work for the kidneys to filter water that hasn't had a chance to travel through the lymph system and to clean body tissues. Adequate water intake helps to maintain the flow of nutrients to the lens and to release wastes and toxins from tissues.
Eat foods high in vitamin A or beta-carotene, vitamin C, and vitamin E. These substances are called antioxidants, and most of the nutritional components of cataract prevention and reversal are related to boosting antioxidant levels. Antioxidants are one of the most important combatants against free radicals, a major cause of cataract formation (and other eye disease). A good diet supplemented with antioxidant vitamins and minerals can help prevent the damage due to oxidation and free radicals.(43-48) Foods high in antioxidants include leafy-green vegetables, garlic, onions, beans, celery, sea vegetables, apples, carrots, tomatoes, turnips, and oranges.
It is also important to eliminate dairy products, at least temporarily. Some foods, particularly dairy products, can exacerbate eye problems by creating mucus and causing sinus congestion, which can impair lymph and blood drainage from the area around the eyes. When lymph and blood can't flow in and out of the eyes, nutrients don't reach the eyes effectively, and toxins and metabolic wastes aren't eliminated as efficiently. Try avoiding dairy for a month to see whether you become less congested and your eye issues clear up.
Note. Many people are lactose intolerant to some degree. Generally, reducing or eliminating dairy from one’s diet has innumerable positive benefits on the eyes and the entire body.
While supplementation is important, nothing replaces a positive, healthy lifestyle that includes regular exercise, daily meditations or walks in nature, and a healthy diet.
The rapid pace of life often interferes with people taking time to care for themselves properly, and on all levels—mental, emotional, spiritual, and physical. However, proper care maximizes the mind/body connection and its inherent healing potential, which is essential for restoring and maintaining health.
Avoid smoking. Researchers have established that smoking cigarettes substantially increases the risk of developing age-related cataracts. Smoking accounts for about 20% of all cataract incidences.(49-51)
Eye Drop Recommendations
The following eyedrops have either a long history of safe usage for cataract management and/or have research studies showing related benefits to lens health. Take one eyedrop formula to start or any combination of the three. We recommend taking eyedrops for at least three to six months to start; this will help you determine their efficacy. Look for a reduction in common symptoms to cataracts, such as related reduction in blurriness and/or less sensitivity to glare, particularly at night.
Cineraria homeopathic eyedrops, one drop in each eye, two to three times per day, best taken at least 30 minutes apart from other eyedrops. This eyedrop has been listed in the Ophthalmology Physician’s Desk Reference herbal section for over 38 years as a treatment for cataracts. They can be taken by themselves or with other eyedrops.(52)
N-acetyl-carnosine eyedrops 1%, two drops in each eye, two times per day, best to separate each eyedrop by approximately one minute. See Appendix Section 5 for product recommendations.(32)
Oclumed eyedrops, one drop in each eye, two times per day. These eyedrops contain a range of antioxidants including l-carnosine, n-acetyl-l-carnosine, l-glutathione, cysteine ascorbate (providing a source of vitamin C), l-cysteine, taurine and other nutrients to support the repair of the damaged lens tissues.
Long-term regular exercise, as opposed to a burst of exercise training, reduces the risk of cataracts. High levels of inactivity increase cataract risk.(53)
Many therapies promote improved flow of energy and circulation throughout the body. The daily stress that we encounter due to a poor diet, emotional imbalances, lack of regular exercise, and more can cause areas within the body to tighten up, which restricts circulation. The eyes are the second most biologically active part of the body; only the brain is more active. So, they require a great deal of nutrition and the free flow of blood and energy to remain healthy. Eye exercises are helpful for maintaining good vision and promoting microcirculation in the eyes.
Inversion poses in yoga have been shown to aid blood flow to the heart and head. It may seem counter-intuitive, but the blood is more freely able to move to the upper extremities, these exercises can be very relaxing to the eyes and face. As such, they are particularly helpful in the prevention of eye conditions. One of the best and safest inversion poses is lying on the floor with your legs up a wall. Beginning, as well as advanced yoga practitioners equally enjoy this posture.
After cataract surgery, avoid inversions. This includes standing forward bends like Uttanasana and Prasarita Padottanasana (wide-leg forward bend), and even downward-facing dog. You can still include modified poses like half dog pose at the wall. If you apply the rule of not bending past 90 degrees from vertical, you will minimize the pressure increase to the head and subsequently to the eye. Other rather obvious poses that could have a similar effect are those that require strong, sustained contraction of the abdominal muscles, which would also increase blood pressure in the eyes.
Poses like boat pose (Navasana), deep held twists (even sitting versions), and arm balances like crow pose also fall into this category.
In a time of healing you want to keep the nervous system quiet, spending more time in the “rest and digest” part of the autonomic nervous system. So, spend the two-week healing period doing gentler practices, including lots of supported restoratives and guided meditations on health and healing.
Traditional Chinese Medicine (TCM) views the development of cataracts as often being related to a chronic imbalance in the Kidney meridian, which is related to the emotions of fear and grief.
The Liver meridian “opens to the eyes” and is associated with overall eye health, and the Kidney meridian “opens to the lens” and provides blood and nourishment to the retina.
Since most of the major meridians (in terms of energy flow) pass through the eyes, the imbalance inherent in eye issues may be related to an imbalance in other meridians, that may affect the Kidney and Liver meridians. Where the imbalances lie is best determined through an intake evaluation by an acupuncturist.
Here are the common Chinese medicine patent formulas related to cataracts:
· Kidney yin tonic may be taken in a dosage as directed by your practitioner.
· Shi hu ye guang wan (dendrobium pill for night vision) nourishes Kidney yin and clears the Liver to improve vision. It is indicated for cataracts as well as red, irritated, or swollen eyes, poor or blurred vision, eye strain from reading or from computer use, excessive tearing, and pain around the eyes.
· Ming mu di huang wan (brighten the eyes) nourishes the Liver, enriches the Kidneys, and improves vision.
· Zhu jing wan (preserve vistas pill) tonifies and nourishes the Liver and Kidneys, enriches the yin, and improves vision. Symptoms related to deficiencies in these meridians include weak and aching lower back and knees, excessive thirst, poor memory, cough, asthma, shortness of breath, and wheezing.
· Qi ju di huang wan (rehmannia 6 plus chrysanthemum and lycii) nourishes Kidney, Liver blood,and yin. This formula is a classic adaptation of “liu wei di huang wan” (rehmannia 6), with a special emphasis on the eyes. In particular, the formula is helpful for dry eyes, redness, and heat caused by yin (fluid) deficiency.
· Celosia 10 was designed for disorders such as cataracts as the lens and cornea are exposed tissue easily subject to "wind" disorders.
· Laurel leaf helps with lymph support.
· Clary sage helps balance the endocrine system.
· Saffron benefits include the following properties: antibacterial, blood purifier, antioxidant, decongestant, and memory enhancer.
· Frankincense helps relieve chronic stress and anxiety, reduces pain and inflammation, and boosts immunity.
· Carrot seed properties include antiseptic, disinfectant, detoxifier and antioxidant.
Keep essences away from the mouth, eyes, and mucous membranes; if a few drops get in one of these sensitive areas it may be uncomfortable for 15-30 minutes but not harmful. You can lessen discomfort by adding a pure oil, like olive or coconut oil, to neutralize the irritating effect. For the eye area, dab a few drops around the outside of the eye. Do not put the neutralizing oil in the eye.
Put 1⁄4 cup of avocado oil with 1⁄4 cup of calendula-infused oil. Slowly add 5 drops each of the essential oils. Then close the bottle and shake well; apply 4 drops of this mixture on your clean face. Massage in gentle circular motions. Leave overnight.
Acupuncture supports the healthy flow of energy and circulation through the eye. There are eight acupressure points around the orbit of the eye, which can be massaged periodically throughout the day to help relax the eyes and stimulate energy and circulation flow.
Eyedrops containing lanosterol showed reduced severity of cataracts in animal research. Future research needs to be done on humans to identify the effectiveness. The application of the molecule lanosterol was shown to dissolve the lens protein buildup that causes cataracts in animal subjects; it may provide a non-surgical treatment for humans in the future.(54)
Using lasers as a pretreatment to cataract surgery is showing potential for improvement in the safety and results of surgery.
Use of stem cells to regrow the eye lens after cataract surgery is another potential treatment of the future. Researchers at the University of California, San Diego School of Medicine, and Shiley Eye Institute, with colleagues in China, have developed a new, regenerative medicine approach to remove congenital cataracts in infants, which permits remaining stem cells to regrow functional lenses.(55)
Since 1980, Dr. Marc Grossman has helped many people maintain healthy vision and even improve eyesight. He is best described as a holistic eye doctor, dedicated to helping people with conditions ranging from myopia and dry eyes to potentially vision threatening diseases such as macular degeneration and glaucoma. His combined multi-disciplinary approach using nutrition, eye exercises, lifestyle changes and Chinese medicine provides him with a wide array of tools and approaches to tackle difficult eye problems.
Dr. Grossman founded the Rye Learning Center in 1980, a multidisciplinary center for learning problems, in 1996 co-founded Integral Health Associates in New Paltz, New York, and in 1999 co-founded Natural Eye Care, Inc.
His background includes degrees in optometry, biology, physical education and learning disabilities, coupled with yoga, bioenergetics, nutrition, Chinese medicine and acupuncture, the Alexander Technique and Feldenkrais. This orientation provides the foundation for an integrated approach to vision and its influence on the body, mind and spirit of each individual patient.
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