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From the Townsend Letter
April 2019

Cataracts – An Integrative Medical Approach
by Marc Grossman, OD, LAc
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Researched NutritionalsThe 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 US 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.

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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

Early Stages
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.

Moderate Stages
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.

Late Stages
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: 
•   Smoking,
•   Increase in age,
•   Excessive use of alcohol,
•   Obesity,
•   Genetics,
•   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

Conventional Treatment
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.

After 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

Allergy ResearchRisks 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. 

Complementary Approach
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.

Essential Nutrients
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 sub-lingual 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.

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