Note: treatment of existing cataracts is always or almost always unsuccessful with purely nutritional methods, so our discussion will focus on prevention and slowing of cataract prorgression. However, for an estimated 1/3 of our patients recently (2008 and 2009) use of L-carnosine eyedrops to remove cataracts has shown clinical success. For this reason we are now recommending these eyedrops in addition to the suggestions below.

The crystalline lens of the eye is a specialized epithelial structure developed from the ectoderm embryonic layer, enveloped in a surrounding capsule developed from the mesoderm.  The lens is sufficiently elastic to be acted upon by muscles of accommodation, which then allows light from objects to be focussed onto the retina.  Because the lens has neither nerves nor blood vessels, it depends on the internal flow of fluid inside the eye (aqueous humor) to provide oxygen and nutrients, especially scavenger and chaperone molecules to remove toxic products.  Over time, oxidative stress from light pushes the old focusing fibers into the center, causing haziness (alteration in light transmission) or a film to develop.  Any clouding of the lens is a cataract.

The lens focuses light constantly, from distant objects to near objects.  Some light wavelengths such as ultraviolet light are especially toxic.  UV light creates more free radicals, which can accelerate the clouding of the lens over the years.  A cataract may be central (called nuclear); peripheral (on younger fibers near the outer edge of the lens); or sub-capsular (at the very front or very back of the lens.) Cataracts are the number one cause of blindness in the world.  It is a preventable condition.

Symptoms of cataracts include hazy vision, glare, difficulty focusing on the printed page, rapid eye fatigue, and even double vision.  Some people will develop second sight.  This means that as they grow older, they may see better without their glasses because the cataract actually changes the prescription of the eye.  Always have your vision checked to see if your glasses can be improved.

Studies in the United States are gradually accumulating evidence that antioxidant nutrients can help prevent cataract formation (Bron et al., 2000, Hammond BR et al, 1997).  Epidemiological studies in Germany clearly show that high dietary consumption of fruits and vegetables is important preventive measure to reduce the risk of cancer, coronary heart disease, and cataracts (Pelz R et al., 1998). 

Among the dietary antioxidant nutrients shown to be important in cataract prevention (epidemiological studies and pharmacology studies) are Vitamin E (Bates CJ et al., 1996), Vitamin C (Bendich and Langseth, 1995), glutathione (Stewart-DeHaan et al., 1999), curcumin (Awasthi S et al., 1996) and the carotenes lutein and zeaxanthin.  You can augment the action of glutathione by taking it with foods containing high levels of sulfur such as onions, avocados, eggs, asparagus and garlic.  Dietary sources of carotenes include carrots, pumpkins, spinach, squash, watermelon, asparagus, broccoli and cantaloupe.  

There are many common risk factors associated with cataract development, and most are avoidable.

• Sunlight, especially UV light, is a major cause, especially if your body has a low antioxidant bank account.  Ask for UV blockers not only in your sunglasses, but also in your regular glasses.

• Dehydration can hasten the development of cataracts (Moffat et al., 1999).  Drink six to eight glasses of water per day to avoid dehydration.  Sodas, iced tea, coffee and any other caffeinated beverages do not fulfill this requirement.

• Drink alcohol sparingly—moderate amounts of red or white wine are okay.

•  Smoking and second-hand smoke are known causative factors in many ailments.  Don’t even try to argue this one.  STOP smoking, and avoid smoky environments.

• Recent studies have identified obesity as a factor in the development of cataracts (Leske et al., 1999).  Follow a diet and exercise program to combat obesity.  Limit sugar intake, eat lots of raw vegetables and salads, and plenty of water.

• Diabetes, heart disease, hypertension, arthritis (and the medications that treat them) can contribute to the formation of cataracts.  For example, cholesterol lowering drugs frequently speed up the formation of cataracts by virtue of their effect on the liver and otherwise may be negative to use.  Ask your doctor if you can decrease your dose, or if there are any other natural means of controlling or treating these conditions.
• There are more than 300 commonly prescribed medications that speed up cataract formation when coupled with sunlight exposure.  Ask your pharmacist about your medication.  Wear your UV-protective sunglasses to eliminate this possibility so you don’t have to discontinue necessary medications.

• Lack of exercise is a causative factor in all age-related disorders.  Just do it.

•  Estrogen apparently has a protective effect against cataracts.  Studies show women are almost twice as likely as men to develop cataracts after the age of 50, so, it makes sense to use herbs that aid with menopausal symptoms

• Get plenty of sleep, because night (darkness) is when your eyes get a chance to rest and to heal.  They are bombarded by light and the formation of free radicals all day, and this is the opportunity for the liver and other parts of the body to send the necessary antioxidants and minerals to replenish the tissues of the eyes.

Herbal Treatment for Cataract Prevention

The goal of herbal therapy for cataract prevention is to keep the lens sufficiently bathed in a solution of antioxidant nutrients.  To do this, your body needs to keep high levels in your system at all times.  If the levels are high enough, those in your aqueous humor will also be high.  As in life, you should strive to save more in your bank account than you spend.

Various free radicals participate in cataract formation. The reduced form of the molecule called glutathione is a key cellular antioxidant which has been shown to reduce oxidative stress and eliminate poisons both in test tube and animal studies (Shamsi et al., 2000, Stewart-DeHaan, 1999, Lu, 1998). The body’s production of glutathione in the liver is dependant upon a diet high in fruits and vegetables (providing precursors), membrane transport activities of the three sulfur amino acids (cysteine, cystine and methionine), and adequate conversion of methionine to cysteine via the trans-sulfuration pathway (Lu SC, 1999).  Therefore, any of the many herbs and nutrients that aid this biochemical process are valuable in cataract prevention. Nutrients include NAC (N-acetyl cysteine), MSM (methylsulfonylmethane), alpha-Lipoic acid. Many herbs affect glutathione status because they contain glutathione(or members of the glutathione family) or other wise boost it’s action. Some of these are elderberry, blueberry, astragalus root, milk thistle seed,  turmeric root, garlic bulb and oil, and wheat sprouts. (note – Chrysalis clinic has developed a combination called iFolia which contains many of these herbs)

Additionally, imaging studies using magnetic resonance microscopy have been done on eye lenses to elucidate the kinetics of water transport.  Results show that as lenses age, there is a reduction in the rate at which water can enter the lens cells.  This of necessity also causes a decrease in the rate of transport of nutrients and anti-oxidants (Moffat et al., 1999).  This shows why prevention is best, when the lens can still absorb the nutrients, and also why it is so difficult to reverse the damage.  These facts precipitate some of the following strategies.

• Two equally important factors in healthy eye care are quenching free radicals and reducing whole body inflammation.  Use antioxidant vitamins, make sure you avoid unhealthy fats and oils, and use a supplement supplying omega-3 fatty acids.  Currently, several companies make nutritional supplements that are designed for the eyes.  These are a good way to start.  Check for one with lutein.

• Turmeric root has been shown to prevent cataract formation in animal studies (Awasthi S, et al, 1996).  I estimate you would need about two 500-mg.  capsules twice per day to get enough for this protective effect.

Triphala, the Ayurvedic “three-fruits” compound, is extremely high in antioxidants, and has been used for centuries to treat a wide variety eye problems including caratacts.  Use 1-2 grams per day.

• Eclectic physicians stress the importance of digestive and liver health in avoiding cataract.  Two herbs recommended for “hepatic torpor” are celandine (Chelidonium majus) and fringe tree bark (Chionanthus virginicus). As a general rule any of our liver herbs are good for the eyes, and this connection is very clear in TCM.

• Eye drops made by rubbing the fingers in wateris a preventive treatment for ametropia, cataract and amblyopia (dim or weak vision), according to Ayurvedic physicians.  Cleanse the hands thoroughly, prepare a small glass of spring water, then gently rub the submerged fingers back and forth for 2-3 minutes.  Use an eyedropper to draw the oil off the top surface and apply in each eye as eye drops twice daily.

Dr. Abel has been using MSM eye drops and monitoring their effects on cataract progression.  MSM (methylsulfonylmethane), a natural, biologically active and easily absorbed (due to low molecular weight) form of sulfur (Jacob et al., 1999).  Preliminary results indicate a slowdown of cataract progression, but drinking water, good nutrition and exercise will do that too.

Complex Formulations

TCM herbs traditionally used to prevent cataracts include celosia seed (qing xiang zi or C.  argentea), plantago seed (che quian zi or P.  ovata), chien-li flower (qian li guang or Senecia scandens), lycium fruit (gou qi zi or L.  chinense) and buddleia flower (me meng hua or B.  officinalis).  These would be used in formulas along with herbs for systemic imbalances, based upon signs and symptoms. 

The most common TCM imbalances are:

• Spleen Qi deficiency (digestive insufficiency) – Use ginseng root, white atractylodes, poria mushroom, dang gui root, white peony root, cimicifuga rhizome (sheng ma or C.  foetida), kudzu, siler root (fang feng or Ledebouriella species), schisandra berry, tangerine peel and licorice root.  Other herbs from the digestive group may be used.

• Kidney deficiency (degenerative changes associated with aging).  Use raw and cooked rehmannia root, dioscorea root (shan yao or D.  opposita), cornus fruit (shan zhu yu or C.  officinalis), poria mushroom, moudan bark (mu dan pi or Paeonia suffruticosa), dang gui root , kudzu, and schisandra berry.

• Liver heat/wind clouding the vision (inflammation) – Use white and red peony root, chrysanthemum flower , gentiana root (long dan cao or G.  scabra), bupleurum root, cnidium rhizome (chuan xiong or Ligusticum wallichii), abalone shell (shi jue ming or Haliotidis diversicolor), and scute root.  

For maintenance treatment (prevention of cataract progression), Ayurvedic doctors use Sukhavata Varti. This medicine is not practical to use in the West, and is mentioned here for historical reasons. It is a tablet made from equal parts of kataka fruit (Strychnos potatorum), conch shell (Haliotidis diversicolor), trikatu, mineral salt, sugar, seafoam, darvi extract (Berberis nepalensis), honey, vidanga seeds (Emblica ribes), purified realgar (manashila bhasma) and chicken eggshell.  To prepare, make a fresh paste each day by rubbing the tablet into a small amount of water on a flat, clean plate made of unpolished marble or stone.  A small amount of paste is then carefully and fully diluted in pure water, strained, and a few drops placed into the eye several times per day.

Sukhavata Varti is considered by TAM dcotros to be very effective, used not only for cataract, but also ametropia, pterygium, corneal ulcer, eye itching, pus formation, and optic neoplasm.  This formula, currently illegal to import because it contains realgar (arsenic), must be prepared by an experienced Ayurvedic doctor and made into a tablet (see section on heavy metals).  Arsenic is now being investigated for its effect on leukemia (Kinjo et al., 2000).  Seafoam is the common name for the cuttlefish bone (Sepia species) which is found floating on sea-water, then collected and dried into a layered natural product.