Cataracts are a common age-related eye condition characterized by the clouding of the eye's lens. This opacification can lead to a gradual decline in vision, making everyday activities challenging. While cataract surgery is an effective treatment, preventive measures, particularly those related to diet and lifestyle, can play a significant role in delaying or even preventing cataract formation.
Understanding Cataracts
A cataract is a symptomatic opacification of the crystalline lens of the eye. Opacifications may be present without the patient having any awareness of them. Once symptoms develop, or changes in vision occur, these opacifications are referred to as "cataracts." If untreated, cataracts may lead to profound vision loss.
The most common type of cataract is referred to as "age-related." Its etiology is multifactorial. Although genetic factors may predispose an individual to opacifications, limiting the amount of ultraviolet (UV) light exposure as well as eliminating other risk factors such as obesity, type 2 diabetes, and cigarette smoking, may prevent the opacifications from becoming symptomatic.
"Age-related" cataracts are the most common type, but opacities may also be caused by congenital conditions, trauma, and radiation exposure. The condition is responsible for approximately half of all cases of severe vision loss in the world, affecting an estimated 20 million people. Opacities can be either diffuse or localized, and cataracts are usually classified according to the region of the lens affected: cortical, nuclear, posterior subcapsular, or mixed. Loss of transparency occurs with increasing accumulation of pigment within the lens.
Symptoms are progressive, not painful, and usually bilateral. Specific symptoms may include:
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- Difficulty seeing printed text or worsening ability to read.
- Excessive glare during night driving and in bright sunlight.
- Halo effect around lights.
- Deterioration of distance vision more than of near vision, known as "myopic shift," occurring with nuclear cataracts in individuals over 70.
Risk Factors for Cataracts
Several factors can increase the risk of developing cataracts. These include:
- Age: Cataracts are a normal aspect of growing older.
- Race: In the US, the prevalence of cataracts is highest in White individuals, followed by non-Hispanic Black and Hispanic individuals.
- Type 2 Diabetes Mellitus: Diabetes increases the risk for all types of cataracts.
- Corticosteroids: Systemic and inhaled steroids increase the risk of posterior subcapsular cataracts.
- Tobacco Use: Cigarettes and smokeless tobacco are both dose-related risk factors for cataract development. Up to 20% of cataracts in American men can be attributed to smoking. Quitting may partially reverse the disease in the nuclear and posterior subcapsular forms.
- Alcohol Use: Alcohol has been shown to be a risk factor in women.
- Extensive Sunlight Exposure: Photo-oxidation secondary to UV-B. Risk is dose-related. The sun’s UV radiation has been linked to an increased risk of cataracts.
- Chronic Lead Exposure.
- Metabolic Syndrome: Thought to be due to increased oxidative stress.
- Excess Body Weight: A meta-analysis estimated a 2% increased risk of age-related cataracts with every 1kg/m2 increase in BMI.
- Physical Inactivity: Activity such as walking, bicycling, and a nonsedentary occupation reduces risk of age-related cataract.
- High Dairy Consumption in Certain Individuals: Or deficient galactokinase activity.
- Other Factors: Risk of cataract is also increased by the use of phenothiazines, ocular radiation exposure, trauma, uveitis, HIV/AIDS, and malnutrition.
The Role of Diet in Cataract Prevention
The phrase "You are what you eat" holds true when it comes to eye health. Diet has a direct impact on the health of the eyes and can either contribute to or help prevent the development of cataracts. Eating a well-balanced, healthy diet will help prevent cataracts naturally and improve your overall wellness.
Antioxidant-Rich Foods: Your Eye's Best Defense
One of the main culprits behind cataract formation is oxidative stress, which damages the proteins in the lens of the eye. Oxidative stress is caused by an imbalance between free radicals, which are atoms that kill cells in your body, and antioxidants, which reduce them. Free radicals can come from a variety of sources, including unhealthy meals. Antioxidants like vitamin C, vitamin E, lutein, and zeaxanthin neutralize free radicals and help protect the eyes from damage. Vegetables and fruits have the highest antioxidant content. Look for fruits and veggies with a variety of colors when you’re out shopping.
- Leafy Greens: Spinach, kale, chard and other leafy greens are high in lutein, which is related to vitamin A and beta carotene. These essential nutrients protect eye tissues from degenerative disease and sun damage. Suggestion: Buy organic leafy greens if possible.
- Citrus Fruits: Oranges are a rich source of vitamin C, an essential antioxidant for strong blood vessels in the eyes and other parts of the body. Vitamin C has long been known to aid in the prevention of colds, but it can also aid in the reduction of cataract risk. Suggestion: Instead of drinking orange juice in the morning, eat a fresh orange.
- Nuts and Seeds: Seeds and nuts are high in vitamin E. Vitamin E is an antioxidant that aids in the protection of your eye’s membranes.
- Yellow, Red, and Orange Fruits and Vegetables: These include carotenoids, which are pigments that give them their color.
- Omega-3-Rich Fish: Salmon is one of the best sources of omega-3 fatty acids, which is associated with lower cataract risk. It also contains high amounts of selenium and iodine.
Specific Nutrients and Foods for Eye Health
- Omega-3 Fatty Acids: Omega-3 fatty acids are considered a superfood when it comes to keeping your eyes healthy. Research suggests omega-3 fatty acids may protect eyes against cataracts, dry eye syndrome and macular degeneration.
- Flax Seeds: Flax seeds are high in omega-3 fatty acids and are considered one of the best sources.
- Eggs: Eggs contain high amounts of DHA (docosahexaenoic acid), an omega-3 fatty acid that is important for cell, muscle and nerve function. Suggestion: Enjoy eggs scrambled, poached or sunny side up with a slice of whole grain toast in the morning. Top your salad with a hard-boiled egg.
- Salmon: Salmon is one of the best sources of omega-3 fatty acids, which is associated with lower cataract risk. It also contains high amounts of selenium and iodine.
- Vitamin C: Vitamin C significantly impacts eye health, especially when it comes to cataracts. Studies show that higher levels of vitamin C reduce the risk of a cataract. Good sources of vitamin C include citrus fruits, peppers, tropical fruits, cantaloupe, strawberries, kiwifruits, cruciferous vegetables, tomatoes, potatoes, and sweet potatoes.
- Kiwi: Kiwi has more vitamin C than any commonly eaten fruit.
- Vitamin E: Research proves that diets rich in vitamins A and E are associated with fewer cataracts. Good sources of vitamin E include wheat germ, cooked spinach, soy milk, many varieties of nuts, sunflower seeds, mangoes, and olive, peanut, and vegetable oils.
- Pumpkin: One serving of pumpkin provides 300 percent of the recommended daily intake of vitamin E and 10 percent of vitamin A.
- Lutein and Zeaxanthin: The consumption of higher intakes of lutein and zeaxanthin, 2 carotenoids present in dark green, leafy vegetables and corn, has been associated with a reduced risk of cataract in several extensive epidemiological studies. Within the crystalline lens, these carotenoids may protect against cataract by preventing the oxidation of lens proteins. The Age-Related Eye Disease Study found that carroteinoids addition to sufficient B vitamin intake was associated with lower occurrence of cataracts in individuals aged 55-80.
- Broccoli: Broccoli is also a good source of lutein and zeaxanthin. Suggestion: Steam, roast or saute broccoli with other vegetables for a healthy side dish.
- Green Tea: Green tea is minimally processed because it is made with unoxidized leaves. It is known to improve blood circulation and lower cholesterol due to its high polyphenol content. Suggestion: Drink green tea daily.
- Whole Grains: To prevent cataracts, eat three servings of 100 percent whole grains. This can include amaranth, brown rice, bulgur, buckwheat, millet, oatmeal, popcorn, sorghum, quinoa, rye and wheat.
Other Nutritional Considerations
- Maintaining Serum Lipids: Researchers have identified relationships between elevated levels of triglycerides, chylomicrons, and very-low-density lipoprotein and increased cataract risk. There appears to be an inverse association between high-density lipoprotein concentrations and cataract risk.
- Maintain Blood Glucose Levels: Diets including larger quantities of high-glycemic-index foods have been found to be associated with increased risk. High-fiber complex carbohydrates from whole grains, beans, and vegetables appear to be protective.
- Avoiding Dairy Products: People with heterozygous galactokinase deficiency and elderly people who have diminished activity of this enzyme are at higher risk for cataract. Dairy products, which contribute most of the galactose to the diet, should be avoided in these patients.
- Vegetarian and Vegan Dietary Patterns: Researchers in the UK examined the diets of 27,670 nondiabetic participants in the European Prospective Investigation into Cancer and Nutrition study (EPIC-Oxford) and found a decrease in risk in cataract formation among those who ate the least meat, with vegetarian and vegan diets being the most protective.
- Modifying Fat Intake: Compared with those eating the least fat (25% of calories), those eating the highest amount (37%) had a 10% greater risk for cataract. Women consuming the highest percentage of energy from essential fatty acids (6% of calories from linoleic acid and ~ 0.7% calories from alpha-linolenic acid) had over twice the risk for cataract compared with those consuming the least (4% and ~ 0.5%, respectively).
- Protein Intake: Several studies have shown that higher protein intakes are associated with reduced cataract risk.
Lifestyle Changes for Cataract Prevention
Besides fighting cataracts with your fork, you can make a few lifestyle changes to prevent or delay cataracts. Living healthy includes activities such as exercising, eating a balanced diet, and making well-informed health decisions.
Limiting Alcohol Consumption
Compared with nondrinkers, individuals who consumed more than 2 glasses per week of any type of alcohol (beer, wine, or distilled spirits) had a 13% higher risk for nuclear opacity. In the Swedish Mammography Cohort study of nearly 35,000 women, having 1 drink per day was associated with a 7% greater risk for cataract extraction compared with avoiding alcohol. Excessive alcohol intake has been linked to the formation of cataracts. Alcohol can deplete the body's reserves of key antioxidants like vitamin C and glutathione, which play protective roles in the eye.
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Quitting Smoking
Smoking increases oxidative stress and reduces the body’s ability to absorb essential nutrients, making it a significant risk factor for cataracts. It also increases the likelihood of developing glaucoma, macular degeneration, and retinal conditions.
Protecting Against UV Exposure
The sun’s UV radiation has been linked to an increased risk of cataracts. Prolonged exposure to ultraviolet (UV) rays can speed up the development of cataracts. UV rays cause oxidative damage to the proteins in the lens of the eye, making it more susceptible to clouding. To protect your eyes, it’s crucial to wear sunglasses that block 100% of UVA and UVB rays. Look for sunglasses labeled as offering “UV 400 protection.” Additionally, wearing a wide-brimmed hat can provide extra shade for your eyes. Taking these simple steps can also help prevent other UV-related conditions like cornea disease and eye floaters and flashers.
Managing Blood Sugar Levels
There’s a strong link between diabetes and cataract formation. High blood sugar levels can alter the lens of the eye, increasing the risk of cataracts as well as other complications like diabetic eye disease. Managing blood sugar is essential not just for overall health but also for maintaining clear vision.
Regular Exercise
Regular physical activity improves blood circulation, helps maintain a healthy weight, and can lower the risk of developing conditions like diabetes, high blood pressure, and high cholesterol-all of which are linked to cataract formation. Incorporating activities like walking, cycling, or yoga into your routine can help keep your eyes healthy. Physical exercise also supports the drainage of intraocular fluid, reducing the risk of glaucoma.
Staying Hydrated
While diet often gets the spotlight, hydration is just as crucial for maintaining eye health. Dehydration can lead to a variety of eye issues, including dry eye condition and blurred vision. When your body is well-hydrated, it helps keep the eye’s lens and tissues clear, reducing the risk of cataract formation. Aim to drink plenty of water throughout the day and limit the intake of diuretics like caffeine and alcohol, which can dehydrate the body and the eyes.
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Diagnosis and Treatment
Most cataracts are observed during routine evaluation. During a nondilated examination in a room with dim illumination and the focusing dial of the ophthalmoscope set at “0,” the doctor observes the patient at arm’s length. Opacified areas of the lens may appear as silhouettes within the red reflex, or the red reflex may be darker than normal. Once noted, a comprehensive eye exam should be performed. Providers should inquire about any changes in vision, recent eye injuries, or changes in medication. Once diagnosed with cataract, the patient should be referred to an ophthalmologist for further evaluation and possible extraction.
Current treatment for cataract is exclusively surgical. The opacification is removed when visual impairment begins to interfere with daily activities and an artificial intraocular lens is placed. Adverse events are rare, and the recovery time is short. There is no advantage to removing an asymptomatic opacity.
The Importance of Regular Eye Exams
How long has it been since you had a comprehensive eye exam? Your ophthalmologist can detect a developing cataract during your exam. Not all cataracts require surgery immediately, but your doctor can discuss a treatment plan and an appropriate timeline. It is important for the patient and family to understand that cataract is not a cancer, and that harm rarely occurs to the remainder of the eye structure. The timing of surgery, if decided upon, depends on the patient’s perceived degree of disability. When surgery is necessary, the chance for restoration of vision is excellent. Vision may not be restored entirely, however, if other factors have contributed to vision loss, such as diabetic retinopathy or age-related macular degeneration. Prior to cataract surgery, ophthalmologists perform tests to estimate how much vision may be recovered.
What to Tell the Family
It is important for the patient and family to understand that cataract is not a cancer, and that harm rarely occurs to the remainder of the eye structure. The timing of surgery, if decided upon, depends on the patient’s perceived degree of disability. When surgery is necessary, the chance for restoration of vision is excellent. Vision may not be restored entirely, however, if other factors have contributed to vision loss, such as diabetic retinopathy or age-related macular degeneration. Prior to cataract surgery, ophthalmologists perform tests to estimate how much vision may be recovered. Supplements of lutein or other antioxidants should not take the place of a diet rich in dark, leafy green vegetables. The possible benefit associated with vegetables may be partially due to the presence of other phytochemicals that have not yet been fully identified. Since family members of patients with cataract are also at risk for cataract, their adoption of a similarly healthful diet is advantageous. The family can also help the patient avoid tobacco, alcohol, and excessive sunlight. Tthese diet and lifestyle changes offer many additional health benefits.
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