Illnesses and disabilities

Cataracts

Category: Illness or disabilities

Type

Involuntary

Introduction and description

A cataract is a clouding of the lens in the eye leading to a decrease in vision. It can affect one or both eyes. Often it develops slowly. It is a specific form of blindness, macular degeneration and sight impairment, but because it is so prevalent and also treatable, we have given it its own section.

Cataracts are the cause of 33% of visual impairment worldwide. They are responsible for 51% of world blindness, about 20 million people. Globally, cataracts cause moderate to severe disability in 53.8 million people (2004). It is the cause of about 5% of blindness in the United States and nearly 60% of blindness in parts of Africa and South America. Blindness from cataracts occurs in about 10 to 40 per 100,000 children in the developing world and 1 to 4 per 100,000 children in the developed world. Cataracts become more common with age. About half the people in the United States have had cataracts by the age of 80.

There is a common misconception that somehow cataracts are an inevitable part of ageing, a degeneration of function one simply has to accept. But cataracts have a cause, as we shall see, and are not at all inevitable. The only way that age plays a part is that the immune function and repair functions are not as efficient as one ages. And the more pharmaceuticals one is taking the less efficient they are – but we shall get to this shortly.

Disability-adjusted life year for cataracts per 100,000 inhabitants in 2004: the darker the colour from light yellow [minimum] to the maximum of red the greater the number of people suffering [source Wikipedia]. This reflects the availability of surgery rather than the incidence of cataracts.

Symptoms

Symptoms may include faded colours, blurry vision, halos around light, trouble with bright lights, and trouble seeing at night. This may result in trouble driving, reading, or recognizing faces.

Doctors have given some unsuitably terrifying names to the symptoms associated with cataracts, none of which helps the patient and probably doesn’t help the doctor either. Nuclear sclerotic or brunescent cataracts result in a reduction of vision. Posterior subcapsular cataracts produce glare.

It is often an optician who first spots the development of a cataract, a good reason to have your eyes checked regularly. The tests done in the hospitals simply help to confirm the diagnosis. Any further test will be part of the treatment, for example, to measure for the lens to replace the damaged one.

Causes

All the recognised pathogens and exterior assailants have been implicated in cataract formation, in essence there is not one cause there are many.

The skin and the lens have the same embryological origin and can be affected by similar diseases. Thus if you manage to discover what is causing your dermatitis or eczema, you are quite likely to find the cause of the cataract.

Physical injury and surgery

Eye injuries can cause cataracts. What doctors call ‘blunt trauma’ may cause swelling, thickening, and whitening of the lens fibres. While the swelling may go down in time, the person can still be left with a damaged lens. In ‘severe blunt trauma’, or injuries which penetrate the eye, the capsule in which the lens sits can be damaged. This allows water from other parts of the eye to enter the lens leading to swelling and then whitening.

A 36-year-old man presented to an outside clinic with a traumatic cataract and corneal laceration of his left eye, which had occurred while grinding a shelf. The lacerated cornea was closed and the traumatic cataract was phacoemulsified. .. On arrival at our institution, the intraocular foreign body was removed as soon as possible …. Two months after surgery, atrophy of nearly half of the inferior retina was noted …. Analysis of the foreign body revealed that it was composed of 84.99% tungsten carbide, 15% cobalt and had traces of titanium and alumina. Cobalt containing metallic foreign bodies should be immediately removed, as they have the potential to cause permanent visual disturbance. PMID: 23826809

Inherited genes

Wikipedia
Examples of chromosome abnormalities associated with cataracts include 1q21.1 deletion syndrome, cri-du-chat syndrome, Down syndrome, Patau's syndrome, trisomy 18 (Edward's syndrome), and Turner's syndrome. Examples of single-gene disorder include Alport's syndrome, Conradi's syndrome, myotonic dystrophy, and oculocerebrorenal syndrome or Lowe syndrome.

But this is not a cause, it is another name for medics to remember. What caused the faulty gene? The answer appears to be the nanoparticle - invented by scientists and being released into the environment by scientists in the belief that they do no harm, except that yet other researchers have realised they do a lot of harm......

....DNA damage occurs chemically or physically by nanomaterials. Chemical and physical damage are associated with point mutation by free radicals and double strand brake, respectively. The failure of DNA repair and accumulation of mutations might occur when inflammation is prolonged, and finally normal cells could become malignant. These free radicals can not only damage cells but also induce signaling molecules containing immunoreaction. Nanoparticles and asbestos also induce the production of free radicals. .... Taken together,... a variety of diseases [may be] induced by nanomaterials. PMID: 25097864

Parasites

The role of parasites in developing countries in producing cataracts is well known, but it is also a cause in developed countries:

Early diagnosis and appropriate therapy are key elements for a good prognosis in Acanthamoeba keratitis (AK). AK should be considered in any case of corneal trauma complicated by exposure to soil or contaminated water, and in all contact lens (CL) wearers. PMID: 25169145

Toxoplasmosis is a parasitic disease caused by the protozoan Toxoplasma gondii. The parasite infects most genera of warm-blooded animals, including humans, but the primary host is the felid (cat) family - see Being with cats.

Another serious carrier of parasites is the fox which spreads Echinococcosis. In countries where dogs and cats are not wormed and their faeces safely disposed of, domestic dogs and cats can also be a problem. This parasite can also cause brain damage and cataracts.

One hundred and thirteen eyes from 113 patients (74 Spanish and 39 South American) with active ocular toxoplasmosis were analyzed with a 12-month follow-up. …. most frequent complications were macular edema (16.8%) epiretinal membrane (11.5%). … and the presence of cataracts PMID: 23548496

and

To report the clinical features of cataracts in eyes with ocular toxocariasis…………..Patients younger than 60 years who presented with a unilateral cataract and were diagnosed with ocular toxocariasis between January 2009 and January 2012 were included. Seven of 83 patients (8.4%) presented with an atypical cataract … All patients had small, round, white lens opacities resembling retinal granulomas. PMID: 23465648

and

A 60-year-old Hispanic male presented without complaints. During routine examination, the presence of peripheral anterior synechiae, posterior synechiae, and focal cataract were linked to an immobile, partly degenerated 2 to 3 mm long coiled nematode in the anterior chamber. PMID: 22543998

Toxins and heavy metals

The link between cataracts and the smoke inhaled from smoking has long been known, however, all sorts of inhaled pollutants or for that matter ingested pollutants can affect the eye.

Overproduction of reactive oxygen and nitrogen species can result from exposure to environmental pollutants, such as ionising and nonionising radiation, ultraviolet radiation, elevated concentrations of ozone, nitrogen oxides, sulphur dioxide, cigarette smoke, asbestos, particulate matter, pesticides, dioxins and furans, polycyclic aromatic hydrocarbons, and many other compounds present in the environment.
It appears that increased oxidative/nitrosative stress is often neglected mechanism by which environmental pollutants affect human health.
Oxidation of and oxidative damage to cellular components and biomolecules have been suggested to be involved in the aetiology of several chronic diseases, including cancer, cardiovascular disease, cataracts, age-related macular degeneration, and aging. PMID: 25140198

In other words, these same pollutants are also effecting other parts of you too, as such there are quite likely to be many concurrently suffered diseases like diabetes, or liver disease or heart disease. Diabetes, liver disease and heart disease do not cause cataracts. They are simply another indicator of a rather virulent and widely distributed pathogen, whether it be smoke particles or pesticides or insecticides, or endocrine disruptors or heavy metal nanoparticles …………………..

Titanium dioxide nanoparticles (TiO2 NPs) have been widely used in various applications including cosmetics, food additives and biomedicine. …In this study, we investigated the effects of TiO2 NPs on HLE B-3 cells with or without ultraviolet B (UVB) irradiation in vitro. We found that TiO2 NPs can inhibit HLE B-3 cell growth, cause the elevation of intracellular [Ca(2+)], produce excessive reactive oxygen species (ROS), further reduce Ca(2+)-ATPase activity and decrease the expression of plasma membrane calcium ATPase 1 (PMCA1), finally disrupt the intracellular calcium homeostasis and induce cell damage. PMID: 25059545

Other heavy metals are also implicated especially mercury. Interestingly, in a diet high in Selenium - a natural chelator of mercury from the body, the incidence of cataracts is lower than expected:

Age-related cataracts (ARCs) are an important cause of blindness in developing countries. In fish-eating populations of the lower Tapajós region, elevated exposure to mercury (Hg) has been reported, and blood levels of selenium (Se) range from normal to very high ….Our results suggest that persons in this population with elevated Hg, the cataractogenic effects of Hg may be offset by Se. PMID: 20716509

In this we should not forget the role of dental amalgam fillings, as they are mercury based. Where a filling is leaking or poor dental work has been undertaken, then the mercury may be the cause.

Pharmaceuticals

Although emphasis tends to be placed by governmental bodies on illegal drugs as a serious cause of cataracts, by far the biggest problem seems to be legal drugs handed out by doctors.

The eHealthme site collects the Adverse Drug reports submitted by doctors to the FDA and SEDA in the USA. It then summarises them for ease of use.

We originally provided a direct link to the various categories of cataracts listed on this site:

Cataracts
Cortical cataract
Subcapsular cataract
Traumatic cataract
Cataract universal

and the pharmaceuticals that can cause each type, but the eHealthme website developers frequently reorganise the site and thus break the links. Thus in order to find out which pharmaceuticals are implicated in the conditions above:

Follow the LINK to the eHealthme website
Using the ‘All conditions’ index find the appropriate entry
Now scroll down until you get to the section marked ‘Drugs that could cause ”

The list shows you all the drugs implicated in CAUSING the various types of cataracts as well as the number of people who have made a complaint to their doctor and had their case reported by him. Note that it is up to the doctor whether he reports or not.

As of October 2016, about 1,600 pharmaceuticals were in this list

Cataracts caused by pharmaceuticals: Source eHealthme

There are some widely prescribed drugs in these lists including paracetemol, thyroid disease drugs, ACE inhibitors, beta blockers [with high numbers of ADRs], and aspirin [very high association], drugs for rheumatoid arthritis and other autoimmune disorders [also high], diuretics and quite a number of drugs given to those with heart disease including of course statins

Here are the statistics for example for just one statin - not all statins, directly from eHealthme

On Oct, 17, 2016: 96,889 people reported to have side effects when taking Simvastatin.
Among them, 598 people (0.62%) have Cataract

And another one just to show it is not some abberration in reporting:

On Oct, 18, 2016: 177,997 people reported to have side effects when taking Lipitor.
Among them, 1,487 people (0.84%) have Cataract

What may not be realised is this problem is not new:

An outbreak of cataracts in 1935 caused by dinitrophenol (DNP), the active ingredient of popular diet pills, highlighted the inability of the U.S. Food and Drug Administration (FDA) to prevent harmful drugs from entering the marketplace. Just two years earlier, the FDA used horrific images of ocular surface injury caused by cosmetics at the World's Fair in Chicago to garner public support for legislative reform. The FDA had to walk a fine line between a public awareness campaign and lobbying Congress while lawmakers debated the need for consumer protection. The cataract outbreak of 1935 was conspicuous in the medical literature …… but questions persist as to how much it affected passage of the proposed Food, Drug, and Cosmetic Act (of 1938). The legislation languished in committee for years. PMID: 24913328

Still no real protection.

A special note on nasal sprays

There is a link between cataracts and sorbitol. Too much sorbitol trapped in retinal cells, the cells of the lens, and the Schwann cells that myelinate peripheral nerves can damage these cells, leading to retinopathy, cataracts and peripheral neuropathy, respectively.

There is a very vulnerable organ in the nose called the olfactory bulb. It provides access to the brain and via the various passages linking nose and eye to the eye itself. The olfactory bulb only accepts fine sprays when it transits substances into the brain, and what do we find:

Astepo nasal spray lists sorbitol as the first (i.e. largest in proportion) ingredient. Vicks Sinex 12 Hour Nasal Spray has purified water and sorbitol. Ectoine spray for treating allergic rhinitis contains sorbital. Sudafed 0.1% Nasal Spray used, in adults and children aged 12 years and over, contains sorbitol. Vicks Sinex Soother Nasal Spray Solution for a ‘blocked nose’ contains Sorbitol. Otrivine Sinusitis Spray contains sorbitol. ASTEPRO (azelastine hydrochloride) 0.1% nasal spray is an antihistamine .. azelastine hydrochloride in an isotonic aqueous solution containing sorbitol,

the above came from a search of a handbook on pharmaceutical formulations.

Nutritional deprivation

Vitamin imbalance - both overload and deficiency as well as Mineral imbalance - overload and deficiency can result in eye diseases of various sorts. One key vitamin deficiency connected with cataracts is that of vitamin D.

In this [research], vitamin D deficiency was associated with posterior subcapsular cataract, suggesting that raising the level of vitamin D intake may reduce PSC incidence. PMID: 26124632

But, it is not generally understood how overdosing is as bad as deficiency. The elderly are often dosed up on vitamin supplements and mineral supplements, but there is a direct link between supplements and cataracts for example. The following comes from eHealthme

On Sep, 11, 2014: 38,361 people reported to have side effects when taking Vitamins. Among them, 790 people (2.06%) have Cataract.

Bacterial infection and Fungal infection

It is not uncommon for a person to be given antibiotic eye drops after surgery. As it is also a practise to give immunosuppressant eye drops in order to reduce the sewlling that may occur as a result of surgery, the antibacterial eye drops are given as a precautionary measure. Bu they may also play another important under recognised role in some patients, because cataracts can be caused by both bacterial and fungal infection..........

a retrospective review of 33 consecutive patients with culture proven delayed post-cataract surgery endophthalmitis was done from January 2006 to March 2013. There were 22 bacterial and eleven fungal cases. Common isolates were Streptococci (seven cases), coagulase-negative staphylococci (five), Gram-negative bacilli (seven), Nocardia (two), Aspergillus (five), Candida (five). ...... Fungi being slow growing organisms are an important cause of delayed post-cataract surgery endophthalmitis. PMID: 26124631

Viral infection

Numerous viruses have been implicated in causing cataracts:

Ocular herpes (OH) is an infectious disease caused by the herpes simplex virus (HSV) characterized by a variable clinical presentation and often accompanied by complications that may lead to deterioration of visual functions, cataract development, or even blindness. PMID: 26310012

but what is not generally appreciated is that a virus caught in childhood or given to us as a live virus vaccine, may reappear later in life and cause cataracts

The ocular manifestations of viral infection vary greatly. …. infection with herpes simplex virus or varicella-zoster virus, …. may lead to corneal thinning or perforation, glaucoma and cataract formation. PMID: 6089128

All the viruses that exhibit latency may result in later reinfection when the immune system is at a low ebb due to stress or fatigue. The rubella virus is a latent virus, there in the mother of a new-born child:

Rubella virus identified in Vietnam belonged to the genotype 2B. Importantly, the infection rate of rubella virus in fetuses/newborns was 100% and all of them had congenital cataract. PMID: 23481444

Hypoxia

Shortage of oxygen can cause cataracts.

......several pieces of evidence indicate that oxidative stress may help explain the altered regulatory pathways in myopia and the appearance of associated eye diseases. On the one hand, oxidative damage associated with hypoxia can alter the neuromodulation that nitric oxide and dopamine have in eye growth. On the other hand, radical superoxide or peroxynitrite production damage retina, vitreous, lens, and so on contributing to the appearance of retinopathies, retinal detachment, cataracts and so on. PMID: 25922643

Radiation

All radiation whether 'cosmic' or electromagnetic impacts our bodies and depending on its frequency it resonates different parts of us. The reason that nuclear radiation is so dangerous is that it impacts cells, but what we appear to have overlooked is that all radiation impacts some part of us.

Every aggregate in our bodies - organs, cells, the body itself, has natural ‘resonance’. Resonance is a substance’s natural tendency to oscillate – vibrate – at maximum amplitude at certain frequencies, known as the thing’s resonant frequency.

And the eye has a natural resonance, which, if it subjected to high intensity and fairly constant stimulation can cause eye deterioration, degeneration and eventually cataracts.

Treatment

Once the cataract has formed the only treatment is surgery to remove the cloudy lens and replace it with an artificial lens.

What you may not realise is that cataract surgery has been performed over thousands of years – a comforting thought because doctors should have got the hang of it by now. Some of the earliest references to cataract surgery are in Sanskrit and described by the Indian physician, Suśruta in about 200 AD. The first references to cataracts and their treatment in Ancient Rome are found in 29 AD in De Medicinae, the work of the Latin encyclopedist Aulus Cornelius Celsus. Archaeological evidence of eye surgery in the Roman era also exists.

Muslim ophthalmologist Ammar ibn Ali, in his Choice of Eye Diseases, written circa 1000, wrote of his invention of a syringe and the technique of cataract extraction while experimenting with it on a patient.

Once we were all young and beautiful, now we

are just beautiful

Surgery is usually performed under local anaesthetic and you will be treated as an out-patient. In all types of surgery, the damaged lens is removed and replaced with an artificial lens, known as an intraocular lens, which stays in the eye permanently. Intraocular lenses are usually monofocal, correcting for either distance or near vision.

After you have had the surgery you are allowed to go home. Some patients are given an eye patch to protect the eye, but others may simply be told to wear protective glasses and not to shower or go out in inclement weather for a few days.

References and further reading

Vestn Oftalmol. 2015 May-Jun;131(3):76-81. [Evaluating the effectiveness of Solanum tuberosum shoots extract in experimental ocular herpes]. [Article in Russian] Alimbarova LM, Lazarenko AA, Kiselev AV, Stovbun EV, Bagaeva MI, Petryanina EV.
Photochem Photobiol. 2014 Nov-Dec;90(6):1324-31. doi: 10.1111/php.12322. Epub 2014 Sep 9. UVB irradiation enhances TiO2 nanoparticle-induced disruption of calcium homeostasis in human lens epithelial cells. Wu Q, Guo D, Du Y, Liu D, Wang D, Bi H. - Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China; The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
Surv Ophthalmol. 2014 Sep-Oct;59(5):568-73. doi: 10.1016/j.survophthal.2014.02.005. Epub 2014 Mar 5. Diet pills and the cataract outbreak of 1935: reflections on the evolution of consumer protection legislation. Margo CE1, Harman LE2.
Pediatr Infect Dis. 1984 Jul-Aug;3(4):358-68. Ocular viral infections. Matoba A.
Oxid Med Cell Longev. 2014;2014:671539. doi: 10.1155/2014/671539. Epub 2014 Jul 20. The protective role of antioxidants in the defence against ROS/RNS-mediated environmental pollution. Poljšak B1, Fink R1.
Oxid Med Cell Longev. 2015;2015:750637. doi: 10.1155/2015/750637. Epub 2015 Apr 1. Oxidative stress in myopia. Francisco BM1, Salvador M2, Amparo N1.
J Clin Virol. 2013 Jun;57(2):152-6. doi: 10.1016/j.jcv.2013.02.008. Epub 2013 Mar 6. Rubella epidemic in Vietnam: characteristic of rubella virus genes from pregnant women and their fetuses/newborns with congenital rubella syndrome. Pham VH1, Nguyen TV, Nguyen TT, Dang LD, Hoang NH, Nguyen TV, Abe K.
J Fr Ophtalmol. 2014 Oct;37(8):640-52. doi: 10.1016/j.jfo.2014.05.004. Epub 2014 Aug 29. [Acanthamoeba keratitis]. [Article in French] Bouheraoua N1, Labbé A2, Chaumeil C3, Liang Q4, Laroche L5, Borderie V5.
BMJ Case Rep. 2013 Oct 30;2013. pii: bcr2013201214. doi: 10.1136/bcr-2013-201214. Thelazia callipaeda discovered by chance during cataract surgery. Kim JH1, Lee SJ, Kim M. PMID: 24172775
Ophthalmologica. 2013;229(3):173-8. doi: 10.1159/000348740. Epub 2013 Mar 27. Clinical pattern of toxoplasmic retinochoroiditis in a Spanish referral center. Rey A1, Llorenç V, Pelegrín L, Mesquida M, Molins B, Rios J, Arévalo JF, Adán A.
J Cataract Refract Surg. 2013 Jun;39(6):830-5. doi: 10.1016/j.jcrs.2012.12.033. Epub 2013 Mar 1. Cataract formation associated with ocular toxocariasis. Ahn SJ1, Woo SJ, Hyon JY, Park KH.
Optom Vis Sci. 2012 Jun;89(6):E939-43. doi: 10.1097/OPX.0b013e318255d897. Nematode-induced low-grade chronic inflammation of the iris. Moyle W1, Purdy E.
Clin Ophthalmol. 2015 Jun 16;9:1093-8. doi: 10.2147/OPTH.S84790. eCollection 2015. Vitamin D deficiency and posterior subcapsular cataract. Brown CJ1, Akaichi F2.
Clin Ophthalmol. 2015 Jun 16;9:1077-9. doi: 10.2147/OPTH.S82852. eCollection 2015. Microbiologic spectrum and susceptibility of isolates in delayed post-cataract surgery endophthalmitis. Jindal A1, Pathengay A1, Jalali S2, Mathai A2, Pappuru RR2, Narayanan R2, Chhablani J2, Sharma S3, Das T4, Flynn HW Jr5.
Environ Health Perspect. 2010 Nov;118(11):1584-9. doi: 10.1289/ehp.0901284. Selenium and mercury in the Brazilian Amazon: opposing influences on age-related cataracts. Lemire M1, Fillion M, Frenette B, Mayer A, Philibert A, Passos CJ, Guimarães JR, Barbosa FJ, Mergler D.

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