Cataract prevention and treatment with natural supplements, herbs and vitamins by Ray Sahelian, M.D.
January 20, 2014

A cataract is a cloudy or opaque area in the lens of the eye. When an doctor looks in the eye with an ophtalmoscope, he or she can see a dark area in the lens. The darker and larger the cataract, the more it interferes with vision. Once a cataract is formed, I am not aware of nutritional approaches that could reverse this process. Cataract eye surgery remains the best treatment. Therefore, it is best to take steps early in life to prevent or reduce the likelihood of cataract formation and thus reduce the likelihood of cataract operation and lens removal. Improvement in vision after cataract surgery has been shown to have a positive effect on mental abilities. After all, vision is an extension of the brain.

Quitting smoking reduces the risk. JAMA Ophthalmology, news release, Jan. 2, 2014

Supplements helpful for cataract prevention
Please keep in mind that there are a number of eye disorders, and if you happen to have a serious problem with vision you should visit your doctor.
  
Various antioxidants may be helpful in prevention or reducing the risk of cataract formation. Some may even help improve vision in certain cases. However, not enough research is available to determine which one of these supplements, in what dosage, or in what combinations are most helpful.

Lutein is potentially helpful in slowing the process of cataract formation. Lutein is a carotenoid found in green and leafy vegetables such as kale and spinach, and it is also available as a supplement.

Alpha lipoic acid is a powerful antioxidant and helpful for those with diabetes.

Effects of DL-alpha-lipoic acid on the experimentally induced diabetic cataract in rats. Zhonghua Yan Ke Za Zhi. 2004.
Alpha lipoic acid ingested orally can effectively reduce STZ-induced blood glucose and inhibit diabetic cataract formation in rats.

Coq10 has been studied in the lab but as of 2011 no human studies are available.
Coenzyme Q10 prevents human lens epithelial cells from light-induced apoptotic cell death by reducing oxidative stress and stabilizing BAX / Bcl-2 ratio.
Acta Ophthalmol. 2010.
Beside others, cumulative light-exposure and apoptotic cell death are significantly associated with cataract development. In contrast, supplementation with antioxidants has been suggested to prevent premature cataractogenesis. This study investigates possible protective effects of Coenzyme Q10 (CoQ10) regarding light-induced stress and apoptotic cell death in human lens epithelial cells. Phototoxic cell death and apoptosis, as well as decrease of Bcl-2 and increase in BAX expression was significantly reduced, when cells were pre-incubated with CoQ10. In this study, CoQ10 significantly reduced light-induced lens epithelial cell damage and attenuated phototoxic effects on BAX and Bcl-2 expression. Therefore, CoQ10 supplementation might be useful in preventing lens epithelial cell death and consecutive cataract formation in vivo.

Vitamins C could be of benefit, but there is no reason to take high doses. In fact, one epidemiological study shows high dose use of greater than 1,000 mg a day for several years could increase the risk. Hence, it is best to limit your daily Vitamin C dosage to 500 mg or less. American Journal of Clinical Nutrition, February 2010.

Vitamin E could be helpful.

Curcumin has powerful antioxidant abilities.

Ginger root has been shown to reduce the risk in studies done in rodents.

Selenium has been linked with a reduced risk of cataract. Selenium activates the antioxidant enzyme glutathione peroxidase, protecting cell membranes from oxidative damage. A dosage of 100 mcg a day seems to be sufficient.

Bilberry has been studied in rodents as a way to prevent cataracts.

Ginkgo biloba has excellent antioxidants.

Cacao - natural antioxidants from cacao are helpful. Good news for chocolate lovers, proanthocyanidins, compounds found in cacao, have been shown to reduce the risk of cataracts in rodents.    

Cataract Diet - Foods as cause of cataract formation or those that are protective
High intake of fruit and vegetables has a protective effect on cataract. High intake of sugar and high glycemic carbohydrates increases the risk for cataracts.
   People who eat lots of high glycemic index foods increase their risk of developing a cataract. Glycemic index, or GI, refers to how rapidly a food causes blood sugar to rise. High glycemic index foods, like white bread, pasta, and potatoes, tend to spur a quick surge in blood sugar, while low-GI foods, such as lentils, soybeans, and many high-fiber grains, create a more gradual increase in blood sugar.
   People who eat lots of yellow or dark leafy vegetables, as well as foods rich in vitamin E, reduce their risk of developing cataracts. Lutein and zeaxanthin are the only carotenoids detected in the human lens and these nutrients play a role in preserving lens clarity. Archives of Ophthalmology, January 2008.
   Higher intakes of vitamin C or the combined intake of antioxidants had long-term protective associations against development of nuclear cataract. Am J Clin Nutr 2008;87 1899-1905.

While the biggest risk for getting cataracts is getting older, smoking is the most common "modifiable" risk factor reported in population studies. Sun exposure and poor diets have also been associated with increased risk. Those who eat diets high in fruits and vegetables have a lower risk. Archives of Ophthalmology, 2010.

Consuming garlic could be helpful. J Ocul Pharmacol Ther. 2009. Prevention of selenite-induced cataractogenesis in Wistar albino rats by aqueous extract of garlic.

Int Ophthalmol. 2013. Diet and cataract: a case-control study. Department of Hygiene, Epidemiology & Medical Statistics, Medical School, University of Athen, Greece. Totals of 314 cases and 314 frequency-matched controls of both sexes, aged 45-85 years and attending the ophthalmology department of a major teaching hospital in Athens, Greece, were included in the study. All participants were interviewed using a semi-quantitative food-frequency questionnaire, covering the average frequency of consumption of about 120 food items.  We found significant inverse associations of cataract with dietary consumption of fish, vegetables, fruits, and potatoes, while consumption of meat was positively associated with cataract. High intake of total fat and cholesterol increased the risk. There was a protective association between cataract risk and intake of carbohydrates, carotene, vitamins C and E. Diets rich in fruits, vegetables, fish, pulses and starchy foods may protect against cataract. In addition, high intake of vitamins C and E and carotene with reduction of intake in total fat and cholesterol may be beneficial.

Causes, medications, prescription drugs
Congenital cataract is uncommon but is one of the causes at birth. Secondary cataracts form as we age. Oxidation and high blood sugar - mostly from eating too many simple carbohydrates - are two common causes. Excessive sun exposure is also a cataract cause. It is thought that the more sunlight a person is exposed to in life, the greater the risk for a cataract. Airline pilots are at higher risk of developing cataracts because of exposure to cosmic rays while aloft.
   An increase in exposure to ultraviolet radiation as result of ozone depletion in the stratosphere could in future lead to a considerable increase in the incidence of cataracts in the US population. Ozone screens out most of the ultraviolet radiation coming from the sun. Although progress is being made in reducing the degree of ozone depletion, Dr. Sheila K. West of Johns Hopkins Hospital, Baltimore and colleagues note in the American Journal of Epidemiology that cataracts are still a health effect of particular concern. They also note that unlike skin cancer, which is much more prevalent in those with light skin, cataracts affect African Americans at higher rate than Caucasians.

Beta blocker heart medication use is associated with a higher incidence of cataracts. British J Ophthalmology 2009.

SSRI drugs, such as Prozac, Zoloft, and Paxil, increase the risk for this eye disease.

Commonly used drugs known to make people more sensitive to sunlight may slightly increase the risk of a certain kind of cataract. The good news: Eating a healthy diet loaded with fruits and vegetables may delay the development. Certain "sun-sensitizing" medications might be linked to cataracts in men.  For varying levels of sunlight exposure, people who use a number of drugs including the painkiller naproxen, the diabetes drug glyburide, the antibiotic ciprofloxacin, the antidepressant amitriptyline, and the blood pressure medication hydrochlorothiazide have a higher risk for developing cortical cataract.

Treatment with topical corticosteroids increases the risk.

Statin drugs used to lower cholesterol levels increase the risk.

Cataract symptom
Some of the symptoms of a cataract include cloudy or blurry vision, problems with light, including headlights that seem too bright, glare from lamps or bright sunlight, or a halo around lights, difficulty reading, faded colors and poor night vision. These symptoms may depend on the location of the cataract in the eye.

Cataract Surgery
If the cataract is advanced, then cataract eye surgery remains the best option. Surgery for cataracts can help older drivers see the road more clearly, and may get some former drivers behind the wheel again. A cataract is a clouding of the eye's lens that commonly arises as people age. When symptoms, such as blurred vision and trouble seeing at night, begin to interfere with daily life, surgery may be necessary. The procedure involves removing the clouded lens and replacing it with an artificial one.

Smokeless Tobacco and Cataract
Using snuff or chewing tobacco is associated with an increased likelihood of developing cataracts. Smokeless tobacco users have higher levels of cadmium in their blood than non-users. Cadmium present in tobacco inactivates superoxide dismutase, an antioxidant, resulting in oxidant damage to the lens of the eye.

Research
Long-term nutrient intake and 5-year change in nuclear lens opacities.
Arch Ophthalmol. 2005. Jacques PF, Taylor A, Moeller S, Hankinson SE. Jean Mayer USDA Human Nutrition Research Center on Aging, School of Nutrition Science and Policy, Tufts University, Boston, Mass
To determine if usual nutrient intake is related to a 5-year change in the amount of lens nuclear opacification assessed by computer-assisted image analysis. DESIGN: A sample of 408 Boston, Mass-area women from the Nurses' Health Study aged 52 to 74 years at baseline participated in a 5-year study related to nutrition and vision. Usual nutrient intake was calculated as the average intake from 5 food frequency questionnaires that were collected over a 13- to 15-year period before the baseline evaluation of lens nuclear density. Duration of vitamin supplement use before baseline was determined from 7 questionnaires collected during this same period. We assessed the degree of nuclear density (opacification) using computer-assisted image analysis of digital lens images with amount of nuclear density measured as a function of average pixel gray scale, ranging from 0 (clear) to 255 (black). Median (range) baseline and follow-up nuclear densities were 44 (19 to 102) and 63 (32 to 213). The median (range) 5-year change in nuclear density was 18 (-29 to 134) and was positively correlated with the amount of opacification at baseline . Geometric mean 5-year change in nuclear density was inversely associated with the intake of riboflavin (P trend = .03) and thiamin and duration of vitamin E supplement use. Our results suggest that long-term use of vitamin E supplements and higher riboflavin and/or thiamin intake may reduce the progression of age-related lens opacification.

Age-related cataract in a randomized trial of beta-carotene in women.
Ophthalmic Epidemiol. 2004.
To examine the development of age-related cataract in a trial of beta-carotene supplementation in women. The Women's Health Study is a randomized, double-masked, placebo-controlled trial originally designed to test the balance of benefits and risks of beta-carotene (50 mg on alternate days), vitamin E, and aspirin in the primary prevention of cancer and cardiovascular disease among 39,876 female health professionals aged 45 years or older. The beta-carotene component of the trial was terminated early after a median treatment duration of 2.1 years. Main outcome measures were visually-significant cataract and cataract extraction, based on self-report confirmed by medical record review. There were 129 cataracts in the beta-carotene group and 133 in the placebo group. For cataract extraction, there were 94 cases in the beta-carotene group and 89 cases in the placebo group. Subgroup analyses suggested a possible beneficial effect of beta-carotene in smokers. These randomized trial data from a large population of apparently healthy female health professionals indicate that two years of beta-carotene treatment has no large beneficial or harmful effect on the development of cataract during the treatment period.

Lutein, but not alpha-tocopherol, supplementation improves visual function in patients with age-related cataracts: a 2-y double-blind, placebo-controlled pilot study.
Nutrition. 2003 Jan.
We investigated the effect of long-term antioxidant supplementation (lutein and alpha-tocopherol) on serum levels and visual performance in patients with cataracts. Seventeen patients clinically diagnosed with age-related cataracts were randomized in a double-blind study involving dietary supplementation with lutein (15 mg), alpha-tocopherol (100 mg), or placebo, three times a week for up to 2 y. Serum carotenoid and tocopherol concentrations were determined with quality-controlled high-performance liquid chromatography, and visual performance (visual acuity and glare sensitivity) and biochemical and hematologic indexes were monitored every 3 mo throughout the study. Changes in these parameters were assessed by General Linear Model (GLM) repeated measures analysis. Serum concentrations of lutein and alpha-tocopherol increased with supplementation, although statistical significance was reached only in the lutein group. Visual performance (visual acuity and glare sensitivity) improved in the lutein group, whereas there was a trend toward the maintenance of and decrease in visual acuity with alpha-tocopherol and placebo supplementation, respectively. No significant side effects or changes in biochemical or hematologic profiles were observed in any of the subjects during the study. Visual function in patients with age-related cataracts who received the lutein supplements improved, suggesting that a higher intake of lutein, through lutein-rich fruit and vegetables or supplements, may have beneficial effects on the visual performance of people with age-related cataracts.

Human eye cells treated with lutein and zeaxanthin showed less damage after being exposed to ultraviolet rays, the sunlight ingredient considered a major contributor to cataracts. Cataracts occur when proteins in the eye's lens begin to clump together, forming a milky cloud that obscures vision. It is thought that the more sunlight a person is exposed to in life, the greater the risk for cataracts. Foods that contain particularly high doses of lutein and zeaxanthin include kale and spinach. Researchers at Ohio State University in Columbus grew human lens cells in a laboratory, then added lutein, zeaxanthin, vitamin E, or left the cells alone. The researchers then exposed the eye cells to ultraviolet (UV) radiation, in order to mimic the effect of sunlight. Lens cells mixed with lutein and zeaxanthin showed significantly less damage following UV-exposure than cells that had no shielding from antioxidants. Although vitamin E appeared to offer some protection from UV rays, it was surpassed by both lutein and zeaxanthin. Journal of Nutrition, 2004.

Moderate exercise combined with dietary vitamins C and E counteracts oxidative stress in the kidney and lens of streptozotocin-induced diabetic-rat.
Int J Vitam Nutr Res. 2005.
Oxidative stress has a key role in the pathogenesis of diabetes-induced cataract formation and diabetic nephropathy. Daily moderate exercise and vitamins C and E (VCE) supplementation can be beneficial to diabetes due to reducing blood glucose and free radical production. The aim of this study was to analyze the effect of moderate exercise with vitamin VCE on lipid peroxidation (LP) and antioxidative systems in the kidneys and lens of streptozotocin-induced diabetic rats. Forty female In conclusion, these data demonstrate that lipid peroxidation increases in the lens and kidney of diabetic animals and this could be due to decreases in antioxidant vitamins and enzymes. However, dietary VCE with moderate exercise may strengthen the antioxidant defense system through the reduction of ROS and blood glucose levels. The VCE supplementations with exercise may play a role in preventing the development of diabetic nephropathy and cataract formation in diabetic animals.

Effects of oral Ginkgo biloba supplementation on cataract formation and oxidative stress occurring in lenses of rats exposed to total cranium radiotherapy.
Japan J Ophthalmology. 2004.
To determine the antioxidant role of Ginkgo biloba in preventing radiation-induced cataracts in the lens after total-cranium irradiation of rats with a single radiation dose of 5 Gy. Sprague-Dawley rats were randomly divided into three groups. Group 1 received neither ginkgo biloba nor irradiation (control group). Group 2 was exposed to total-cranium irradiation, and group 3 received total cranium irradiation from a cobalt-60 teletherapy unit, plus 40 mg/kg per day of ginkgo biloba. At the end of the tenth day, the rats were killed and their eyes were enucleated to measure the antioxidant enzymes, the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), and the lipid peroxidation level [malondialdehyde (MDA)]. Irradiation significantly increased both the MDA level and the activity of GSH-Px, and significantly decreased the activity of SOD in the rat lenses. Ginkgo biloba supplementation significantly increased the activities of SOD and GSH-Px enzymes and significantly decreased the MDA level. Total cranium irradiation of 5 Gy in a single dose promoted cataract formation, and ginkgo biloba supplementation protected the lenses from radiation-induced cataracts. We suggest that Ginkgo biloba is an antioxidant that protects the rat lens from radiation-induced cataracts.

Antioxidant micronutrients and cataract: a review of epidemiological evidence.
Gac Sanit. 2002.
Cataract is one of the leading causes of blindness among the elderly and an important public health problem worldwide. Population ageing will lead to increased resources required to treat cataract. Epidemiological studies have suggested that intake of foods containing micronutrients with antioxidant potential may be protective against cataract, but the role of the individual antioxidant micronutrients on the cataract process has not been yet elucidated. Although surgical treatment to remove cataract is very effective, the incidence in developing countries is so high that it will overwhelm the capacity of surgical programs. An increased understanding of the aetiology of cataract may lead to the development of non-surgical strategies to delay o prevent cataract. A preventive approach appears to be essential to the global problems of cataract.

Antioxidant effect of curcumin in selenium induced cataract of Wistar rats.
Indian J Exp Biol. 2004.
Wistar rat pups treated with curcumin, a natural constituent of Curcuma longa before being administered with selenium showed no opacities in the lens. The lipid peroxidation, xanthine oxidase enzyme levels in the lenses of curcumin and selenium co-treated animals were significantly less when compared to selenium treated animals. The superoxidase dismutase and catalase enzyme activities of curcumin and selenium co-treated animal lenses showed an enhancement. Curcumin co-treatment seems to prevent oxidative damage and found to delay the development of cataract.

Ingestion of proanthocyanidins derived from cacao inhibits diabetes-induced cataract formation in rats.
Exp Biol Med (Maywood). 2004.
Proanthocyanidins derived from cacao have various antipathophysiological functions. We have tested whether dietary supplementation with proanthcyanidins prevents cataract formation in rats with diabetes induced by streptozotocin (STZ), using histological, histochemical, and biochemical analyses. Our findings suggest that proanthocyanidins from cacao inhibit diabetes-induced cataract formation possibly by virtue of their antioxidative activity.

Antioxidant and anti-cataract effects of Chlorella on rats with streptozotocin-induced diabetes.
J Nutr Sci Vitaminol. 2003.
The antioxidant activities of Chlorella in vitro and in vivo were investigated. Chlorella showed a strong antioxidant effect compared to various vegetables. To evaluate the antioxidant and anti-cataract effects in vivo, a 7.3% Chlorella powder was fed to rats with streptozotocin-induced diabetes for 11 wk. At the end of the experiment, Chlorella had decreased the blood glycated hemoglobin (hemoglobin A1c) and serum cholesterol levels significantly, however, it had not affected the serum glucose concentration. The serum lipid peroxide value (TBARS value) in the rats fed Chlorella was lower than that of the control rats. In the liver and kidney, Chlorella also reduced chemiluminescent intensities. In addition, it delayed the development of lens opacities. The lens lipid peroxide content of the rats fed Chlorella was lower than that of the control rats, however the differences were not significant. These results indicate that Chlorella has antioxidant activity and may be beneficial for the prevention of diabetic complications such as cataracts.

Oxidative damage to lens in culture: reversibility by pyruvate and ethyl pyruvate.
Ophthalmologica. 2006. Varma SD, Hegde KR. Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD
We examined this possibility with lens changes leading to cataract formation, since cataract genesis is intimately related to a continued generation of reactive oxygen species (ROS) in the aqueous humor. Since the formation of cataract is a well-defined progressive disease, starting with an early refractive change and leading to gradual enhancement of opacification, we hypothesized that even a belated start with an appropriate anti-oxidant could halt the pathological process and delay cataract maturation and vision impairment. Using lens cultures, we tested this hypothesis with pyruvate, known to be an effective and highly potent ROS scavenger. Adding pyruvate to the culture medium after lenses had sustained a 50% damage was significantly effective in preventing progress. This was apparent by better maintenance of the active rubidium transport activity in these lenses compared to controls without pyruvate treatment. Glutathione levels were also higher in the pyruvate group.

Cataract in dog
A canine cataract can occur. At this point it appears that the causes of canine cataracts would be similar to that of humans and nutritional approaches as discussed above could be tried.

Emails
Q. Have you heard about glutathione eye drops as a treatment for cataracts? I am a huge believer in taking glutathione in powder form orally which has helped my allergies tremendously. I just had one cataract removed surgically and have the other eye with just the beginnings of a cataract. I was hoping to possibly use glutathione eye drops to prevent it from getting worse.
   A. We are not familiar with glutathione eye drops and don't have experience using this product.

Q. Does Eyesight Rx have any effect on cataracts?
   A. We have not done any studies regarding its use for cataract treatment or prevention. Eyesight Rx was formulated to improve vision in those with age related visual decline.

Q. I have new forming cataracts in both eyes. Can Eyebrite be used to dissolve these? I just came from my yearly physical and am in excellent health, on no meds and doing fine. The doctor suggested I leave them alone until they are large enough to remove. I really don't want anyone messing with my eyes, especially the lenses.
   A. We are not aware of any natural herbs or supplements taken orally that reverse cataracts, but there could be some that would prevent or reduce the formation of further worsening of the cataracts.

Q. Dear Dr. Sahelian, Thank you so much for the Eyesight Rx formula! In September 2007, my eye care professional told me I needed to have cataract surgery on my right eye, and the left one was not far behind. I was having much difficulty reading, but at the time, I just didn't see how I could take even a week to take care of this situation. I have been an advocate of natural cures for many years and take anti-oxidants daily. I ran a search, and came upon your web site, and decided to try your Eyesight Rx, and was thrilled when it arrived so quickly. I immediately put half a tablet under my tongue and let it dissolve, then swallowed the other half with a glass of water. I couldn't believe I was seeing more clearly within hours. I continued on the program, breaking on the week-ends, and my eyes just kept getting better! I've been near-sighted for years, was having difficulty with night vision, floaters, and then the cataracts. I recently went in to get new glasses, and my doctor was "blown away" when he saw the improvement in my vision! I am no longer a candidate for cataract surgery, and just wanted to let you know! Thank you so very much for your work, and the help you give to others. I am still required to wear my glasses for driving, but I do not need them for reading, working at the computer, or other close vision at this time.

My daughter was born with bilateral congenital cataracts. Is there anything natural I can give her to dissolve them? I have tried $600 worth of NU-EYES to no avail.
   I have not studied the natural treatment of congenital cataracts. I  wish her the best outcome possible.

Q. Maybe this will be of interest to others and you will comment in your newsletter. I had cataract removal surgery about a year ago. Had both eyes done about 3 months apart. My right eye was at 20-20 soon after. Left eye did not turn out as well. It also has a 'smudge' in the lens. They have both changed somewhat over the past year or so. Driving during the day causes my right eye to feel like it has a cloud in front of it which causes me to blink trying to clear it. Also they itch quite a bit and water some. The OTC drops don't seem to help. My question to you is: Do you know if Eyesight Rx supplements have helped anyone with post cataract problems such as this. I'm just looking for some improvement if possible. I'm male, almost 76 years of age and have never taken any medications. I'm in good health overall.
   A. We don't have any feedback from anyone with post cataract surgery taking Eyesight Rx who has written to us.

I have very minute cataracs and my vision has decreased a little---How will eyesight rx---help my eyes and will it stop my cataracs---and vision---How does your product benefit me in my case.
    It is not possible to predict what effect Eyesight Rx will have on your cataracts, if any.

I have an incipient cataract. I would like to know if there are any supplements that might control and preventing it form growing. And is it true that taking alpha linolenic acid such as found in black current oil causes cataract? I am a 63 year old male.
    I have no reason to believe taking alpha linolenic acid found in black currant oil would cause cataracts.

Could a person benefit from taking Eyesight Rx after a cataract removal surgery which was done a few days ago, also, if one has vitreous detachment in the other eye?
    This eye formula was formulated for those who have age related visual decline, we have not had feedback in those who have had surgery or vitreous detachment, so we don't know what kind of effect it will have.

I have cataract on both eyes. Doctor found them almost five years ago but told me I had to wait until they obstructed my vision before they should be removed. Read or heard about the use of compounded drops of a percentage of DMSO, Vitamin C and Glutathione. Have you heard about this? Would it be safe to put in the eyes? Do you have any information about this eye condition and if there is anything to help remove them, other than surgery?
   I have not yet come across research regarding the use of any product with the combination of DMSO, vitamin C, and glutathione applied directly in the eyes.