Alternatives to Cataract Surgery: Are They Effective?

As we age, almost all of us develop cataracts, a clouding of the lenses of the eyes, in one or both of our eyes. The way cataracts develop is not fully understood, but the process is likely multidimensional involving factors that we may not be able to control. Cataract surgery or removal and replacement of the natural lens is the only time-tested, clinically proven medical treatment. There are promising new treatments being investigated that may offer more affordable and accessible alternatives to cataract surgery or the prevention of cataracts.

Cataract surgery vs. non-surgical treatment options

Cataract surgery is recommended when cataracts are impairing a person’s quality of life. Cataract surgery is meant to help people with cataracts achieve clear vision, though they still may need reading glasses. A replacement lens provides improved visual acuity and color discrimination.

Cataracts can also cause a foggy, filmy view, day and night glare, double vision, and vision weakness while wearing glasses or contact lenses.

Prevention of cataracts includes wearing sunglasses to protect your eyes from UV light and using brighter lights at home or work. It also includes paying careful attention to other potentially harmful health issues which may affect your eyes such as diabetes.

Preclinical research studies

Almost a decade ago, researchers began studying the effects of lanosterol, an amphipathic molecule, on the lens. There has been some indication that lanosterol may reverse protein aggregation in cataracts.

Amphipathic molecules are chemical compounds that possess both polar and nonpolar portions. Examples of amphipathic molecules include cholesterol, phospholipids, and soaps. In fact, lanosterol is the compound from which all steroids are formed.

Lanosterol has been found to be a key component in keeping the eye lens clear. Preclinical, or animal, studies have indicated that lanosterol may offer a possible method of reversing and preventing cataracts. Some researchers found that lanosterol cleared the vision in dogs after just six weeks of treatment.

The concept is that in studies involving animals, lanosterol may restore the clarity of the lens by physically dissolving the protein aggregates and other dense proteins that cloud lenses. Much of the focus from the animal studies prompted investigators to focus more on developing anti-cataract drugs that reverse rather than prevent cataract formation.

Unfortunately, most of the lanosterol eye drops that have been commercialized have failed to be independently confirmed as being effective. Part of the problem is that lanosterol is very difficult to get to dissolve in water. Some formulations have used olive oil instead, but the results have been inconclusive.

Aldose reductase inhibitors in diabetes

The concept is that diabetic cataracts may be formed following an increase in sugars in the lens. Aldose reductase inhibitors are multifunctional enzymes that are being studied for their effects on preventing eye and nerve damage.

Aldose reductase is an enzyme that is normally present in many parts of the body. It helps convert glucose to fructose. In diabetes, aldose reductase activity increases because of the increased glucose in the body, particularly in those who are not insulin sensitive. The result is damage to the lenses of the eyes, peripheral nerves, and the kidneys.

The diabetic cataract forms because of the increase in sugars in the lens. The lens becomes more apt to increase its intake of water and therefore the lens internal pressure increases, promoting cataract formation.

Topical aldose reductase inhibitors have been shown to be effective in prevention of cataracts in some animal studies.

Aldose reductase inhibitors are naturally found in spinach, cumin, orange, fennel, lemon, basil, and black pepper. Drugs which include aldose reductase inhibitors may inhibit or reduce secondary complications from diabetes.

Non-surgical cataract treatment

About five years ago, researchers at the University of Massachusetts Amherst licensed a new technology to Janssen Pharmaceutics, Inc.

The non-surgical cataract treatment research began by experimenting with delivering light into clumps of protein that form cataracts to break them up. Light technology also may be useful in treating presbyopia, or the loss of ability to see things up close that occurs in middle-aged or elderly adults.

The research focuses on how light passes through the lens and how the proteins causing the clouding may be rearranged. Hypothetically, if the protein arrangements can be altered, the light will not scatter and solve many issues with cataract formation. The innovation may be years away from actual clinical applications and it is unknown if it will actually work.

Other methods

Various other non-surgical methods have shown promise. These include anti-cataract medications being investigated such as sorbitol-lowering agents, aspirin, glutathione-raising agents, and antioxidant vitamins C and E. None of these methods have replaced the benefits of cataract surgery.

Considering surgical vs. non-surgical treatment for cataracts

Cataract surgery remains the only proven treatment for cataracts and the only way to entirely remove cataracts from your eyes.

While non-surgical treatments, including eye drops and the promise of new light technology, may reduce the severity or slow the progression of cataracts, none have been shown to be reproducible.

There are instances where cataract surgery is not indicated for your particular situation because of underlying eye conditions or medical problems. Your best solution is to discuss your best treatment options with your ophthalmologist to determine what constitutes the best path for you.

Regular comprehensive eye exams every year after age 65 may help prevent missing out on new developments and keep your eyeglass or contact lens prescriptions current. If you smoke, quit. Always maintain vigilance regarding any other health issues, particularly diabetes.