Nothing is better than having an eye drop that would cure the cataract, and you would never need to undergo cataract surgery. It would be an actual miracle treatment as cataract still accounts for nearly half of the blind people living in our country. But the real question remains unanswered – Can cataract be treated without surgery.
Around 58% of Indians over the age of 60 have a cataract. So if your parents are above 60, one of them is likely to have a cataract. These make something around 110 million people which is about one-third of the total US population.
What exactly is a cataract?
National eye institute defines cataract as
“A cataract is a clouding of the lens in the eye that affects vision.”
Most cataracts are related to aging.
What exactly is a cataract?
National eye institute says that Age-related cataracts can affect your vision in two ways:
“Clumps of protein reduce the sharpness of the image reaching the retina. “
The lens consists mostly of water and protein. When the protein clumps up, it clouds the lens and reduces the light that reaches the retina. The clouding may become severe enough to cause blurred vision. Most age-related cataracts develop from protein clumpings. When a cataract is small, the cloudiness affects only a small part of the lens. You may not notice any changes in your vision. Cataracts tend to “grow” slowly, so vision gets worse gradually. Over time, the cloudy area in the lens may get larger, and the cataract may increase in size. Seeing may become more difficult. Your vision may get duller or blurrier.
“The clear lens slowly changes to a yellowish/brownish color, adding a brownish tint to vision. “
As the clear lens slowly colors with age, your vision gradually may acquire a brownish shade. At first, the amount of tinting may be small and may not cause a vision problem. Over time, increased tinting may make it more difficult to read and perform other routine activities. This gradual change in the amount of tinting does not affect the sharpness of the image transmitted to the retina. If you have advanced lens discoloration, you may not be able to identify blues and purples. You may be wearing what you believe to be a pair of black socks, only to find out from friends that you are wearing purple socks.
.Cataract eye drop or cataract surgery?
The cataract per se does not need any treatment. So just because you have a cataract does not mean you need surgery. But if you are having a problem in day to work like reading, driving, reading labels on the product you are buying, seeing a road sign, etc., you can be considered for cataract surgery.
Cataract surgery offers a solution to the problem faced by a cataract patient due to cataract,
but not the treatment of the cataract itself.
Do you need cataract surgery rather than a cataract eye drop?
It’s a complicated eye surgery which has a steep learning curve for a surgeon and involves the use of a lot of advanced surgical equipment.
Studies show that it takes a surgeon to have the experience of operating around 3000 cases before he/she becomes an “expert” in modern cataract surgery. So if a practicing eye surgeon is working 300 cases every year ( which is a considerable practice), it will take him a decade to be an expert.
In cataract surgery, all the surgeon does is to
replace the natural lens in the which has become cataractous ( or hazy) with an artificial lens ( Intra-ocular lens).
What is a cataract eye drop?
There were 320,000 cataract operations carried out in the UK between 2012 and 2013 (HSCIC 2013). In the United States, the figure is estimated at 1.7 million procedures carried out in Medicare beneficiaries in 2004 (Schein 2012).
Currently there is no treatment for cataracts apart from surgery.
One of the causes of cataracts may be oxidative stress within the lens. Oxidative stress results from the formation of free radical species.
Carnosine is a naturally occurring dipeptide, implicated in reducing free radicals in the body
(Dahl 1988).
Anti‐cataract drops are instilled onto the affected eye twice a day. A course of treatment is recommended for a minimum of two months and maybe required indefinitely to prevent the progression of the cataract.
The topical application of carnosine onto the ocular surface does not result in penetration into the eye. Hence, a vehicle has been developed, called N‐acetyl carnosine (NAC). When NAC is instilled into the eye, it penetrates the anterior chamber of the eye through the cornea. Subsequent metabolism of NAC within the eye produces L‐carnosine, the active drug (Babizhayev 1996).
L‐carnosine has been shown to have an antioxidant effect on the cataractous lens (Babizhayev 1989). Consequently, it is possible that topical administration of NAC could lead to a reduction in cataract by either slowing down the progression of the cataract or indeed reversing the cataractous change.
What Cataract Eye-drops can / cannot do?
A Cataract is a surgery known to have a high success rate. Overall success rates for cataract surgery include 95% of patients being satisfied with the results of the surgery (Lum 2000); the quoted risk of sight‐threatening infection is 0.1% (Montan 2002).
Still it has some practical, downside.
- High cost of surgery
- Non availability of trained ophthalmic surgeon
An eye drops such as NAC eye drops would save money a lot of money. Primary care physician, which are readily available, can prescribe these drops.
Two UK bases researchers from London School of Hygiene & Tropical Medicine, and Aintree University Hospital NHS Foundation Trust, conducted a study, to check whether the evidence supports the theory.
Prestigious Cochrane Library, published this study in the year 2017.
Shall we still need cataract surgery, in spite of using cataract eye drops?
The researchers concluded that there is no credible evidence that these cataract eye drops reduce, much less reverse the age-related cataract in patients who receive it.
As of now, there is no available evidence that these cataract eye drops can help in delaying or reversing the cataract progression. But the issue of conservative management of cataract is open for research. We need but designed studies in this field to establish the role of cataract eye drops in the management of age-related cataract. Till then, the cata.ract surgery remains the procedure of choice, for satisfactory visual rehabilitation
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