Cataracts are the number one cause of blindness in the world (50 percent of cases). Cataract extraction and artificial lens replacement is the most commonly performed surgical procedure in the United States, accounting for more than 10 percent of the annual Medicare budget and 60 percent of annual eye-related spending. If there was a way to delay surgery by just 10 years, half as many people would need the surgery and that money could be spent on other important health concerns.
An inexpensive supplement may be the way to do that: There is clear evidence now that a multivitamin can reduce the risk of cataracts and perhaps even cataract surgery. But this hasn’t been embraced by many in conventional medicine circles because the results didn’t come from an official Phase 3 clinical trial, even though the results are equivalent. I am dumbfounded by this, especially when you consider that patients routinely report loss of sight as one of their biggest health-related fears! (Note: Please see the Macular Degeneration section; both conditions have similar advice.)
What is Cataracts?
The lens of the eye is normally transparent, but due to age, unhealthy lifestyle habits, or UV exposure, proteins clump together and create cloudy, opaque areas that are known as cataracts. Common symptoms include blurry vision, double vision, seeing “halos” around lights, sensitivity, glare or floaters, and decreased depth perception. Eventually the cataract can completely obstruct vision, leading to blindness. Cataract risk doubles every 10 years after the age of 40, to the point where most people walking the planet in their eighties and nineties will be affected. However, not everyone with cataracts needs surgery, especially if you can still read, drive, or watch TV; it’s an individual decision.
Now for a little anatomy lesson! The lens of the eye is made up of four layers of crystalline tissue: the cortex, nucleus, capsule, and subcapsular epithelium. In this section, I’m going to discuss three types of cataracts that can potentially cause visual problems as we age, and these are named for the layer they impact.
- Cortical cataracts
- Nuclear cataracts (the most common type)
- Posterior subcapsular cataracts (PSC)
Each type of cataract is given a grade from 1 to 4, with a higher number typically indicating a more severe cataract.
Home Remedies For Cataracts
1. Low-dose multivitamin, such as Centrum or Centrum Silver one tablet daily
The Age-Related Eye Disease Study (a.k.a. AREDS 1—there were two trials) was the largest randomized trial ever conducted with a daily combination dietary supplement versus a placebo for macular degeneration. The results showed a significant reduction in the risk of macular disease progression (for those with intermediate to advanced stages of the disease) over the 6-year study using a product that contained 500 milligrams vitamin C, 400 IU vitamin E, 15 milligrams beta-carotene, 80 milligrams zinc, and 2 milligrams copper.
However, the supplement did not have any effect on cataract development or progression. But the researchers did a smart thing at the beginning of this study: They knew many of the participants wanted to either keep taking or start taking a multivitamin, and in order to make sure everyone took the same one, they provided Centrum, a simple multivitamin/mineral supplement (see table, opposite), in addition to the AREDS 1 pill and placebo.
Here’s where it gets really interesting, I swear: Researchers followed 4,590 individuals who had at least one natural lens for about 6.3 years to check for the development or progression of cataracts. They found that Centrum was associated with a significant (16 percent) decrease in the progression of any type of cataract, but it was especially protective (a 25 percent reduction) against the progression of nuclear cataracts.
Because these results were so promising, the National Eye Institute supported a randomized placebo trial at the University of Parma in Italy to determine the impact of Centrum use on the development and progression of any type of cataract. This trial, known officially as the Italian-American Clinical Trial of Nutritional Supplements and Age-Related Cataract (CTNS), had 1,020 participants (average age of 68).
Researchers found a significant 18 percent reduction in the risk of any lens event (geek speak for cataract) compared to the placebo. Nuclear cataracts were significantly reduced by 34 percent, but the risk for posterior subcapsular cataracts was significantly increased in the participants taking the multivitamins (keep reading, though)! There was a nonsignificant 22 percent reduction in cortical cataracts, and no difference in moderate visual acuity loss or in the need for cataract surgery.
There was also no difference in side effects between the placebo and the multivitamin group. It is possible the increase in PSC cataracts was a chance finding. In fact, the most recent and largest review of clinical studies and trials (14 in all), published in the journal Nutrients, found no increased risk of PSC cataracts or cataract surgery and significant reductions in the risk of nuclear, cortical, and any cataracts in well- nourished individuals. Hmm, interesting.
Additionally, the Physicians’ Health Study II, one of the best and most recent studies to address cataracts, found significantly fewer cataracts and a significantly lower chance of having cataract surgery when taking a daily Centrum Silver multi-vitamin. All of this for just pennies a day!
Despite all of this data, there are bone-headed (I could have used worse language) “experts” who continue to tell the public that multivitamins are worthless and do not prevent chronic diseases! This is absurd and an embarrassment. If an inexpensive pharmaceutical had similar data with minimal side effects, there’s no way any expert would reject it.
2. N-acetylcarnosine drops dosage varies; follow package instructions
Carnosine is an antioxidant that’s found throughout the body, including the eye lens. It’s composed of two amino acids (beta-alanine and histidine), and when it gets converted to N-acetylcarnosine, it may be more resistant to enzymes that could break down and damage the lens.
A randomized, placebo-controlled study with patients who had cataracts in one or both eyes but had not undergone surgery compared subjects who received N-acetylcarnosine drops (1 percent; sold as Can-C from Innovative Vision Products in Great Britain), placebo drops, and no drops.
Vision improved (including clarity, glare sensitivity, and color perception) with the N-acetylcarnosine drops after 6 months, and the results were sustained over 2 years, which makes this the only antioxidant preliminarily proven to help patients in the early stage of cataract formation, regardless of the type of cataract. (Side effects appeared similar to the placebo.)
3. Lutein 10 milligrams a day and zeaxanthin 2 milligrams a day
The macula of the eye contains high concentrations of these two carotenoids, which offer photoprotection, meaning they help filter or absorb potentially damaging light rays as they enter the eye. The body cannot make lutein or zeaxanthin, so you have to get them from your diet or supplements. Experts believe if you can increase the macular pigment of the eye with lutein and zeaxanthin, then you can reduce the risk of age-related eye diseases, such as cataracts and macular degeneration. However, this still needs some more research.
In the AREDS 2 clinical trial, a follow-up to the first one, researchers found that lutein and zeaxanthin supplements can help prevent cataracts, primarily in people with lower intakes of these nutrients. There was a significant reduction in the risk of being diagnosed with any type of cataract, any severe cataract, and of having cataract surgery for participants with lower dietary intakes of these nutrients who also took the basic AREDS 2 supplements (500 milligrams vitamin C, 400 IU vitamin E, 25 to 80 milligrams zinc oxide, and 2 milligrams cupric oxide).
The “free form” (non-esterified version) of lutein is getting the most attention compared to bound lutein (an esterified form), but the form does not matter that much in terms of absorption. (The AREDS 2 trial used a water-soluable triglyceride form.) You can increase absorption by taking these with a meal that has some fat in it. Naturally then, any medications that block the absorption of fat (such as the weight loss drug Orlistat) may reduce uptake of lutein and zeaxanthin. Do not take these supplements if pregnant or breastfeeding since this has not been studied.
Be warned that lutein can cause a harmless yellowing of the skin. It’s temporary and should go away when blood levels of the carotenoids drop. The safety of these two carotenoids has been outstanding so far in 1- to 2-year-long studies, but it’s still early.
What Supplements Are Useless For Treating Cataracts?
High doses of some supplements
As mentioned earlier, the high-dose combination of vitamins and minerals used in the AREDS 1 trial did not work for cataracts. This just provides further evidence that megadoses of supplements are not usually any better for prevention or treatment than low or regular doses.
Omega-3 fatty acids
The supplement forms of omega-3 fatty acids (EPA and DHA) have not been found to slow the progression of macular degeneration, so I’m skeptical as to whether they’ll impact cataracts either. Dietary (plant and marine) sources of omega-3s—salmon, sardines, tuna, trout, walnuts, flaxseed, and chia seeds—may be beneficial, though, based on preliminary research. Some studies suggest fish high in mercury might increase the risk of cataracts, but the research is preliminary and I have not bought into it yet.
Blueberry and bilberry extracts
These supplements have not been adequately tested for cataracts outside of the laboratory, so stick with eating real berries for now. The same holds true for bil-berry, which contains high levels of antioxidant compounds called anthocyanins. If you’re a mouse or a rat, however, I believe these supplements can cure all of your eye diseases.
I believe any relationship between higher vitamin D blood levels and lower risk of eye disease has more to do with weight than anything else. As you gain weight, your vitamin D level goes down and your risk of eye disease goes up. When you lose weight, vitamin D in the blood rises and your risk drops. In other words, vitamin D supplements are getting way too much credit!
This carotenoid (it contributes to the red color of cooked shellfish and salmon) is being studied and getting a lot of hype, but I believe it will end up being one of the most overrated supplements—along with resveratrol —of my time! It has been combined with lutein and zeaxanthin in a few studies, but I don’t see how the results are any better or cannot just be improved by changing the dose of lutein and zeaxanthin.
What Lifestyle Changes Can Help With Cataracts?
Heart healthy = eye healthy
Virtually all of the factors associated with a higher risk of heart disease increase the risk of cataracts, including smoking (a major risk factor that also increases the severity of the disease quickly), diabetes, weight gain, and heavy alcohol consumption. Again, your goal is to reduce your risk of heart disease to as close to zero as possible.
Sunglasses reduce the risk of cataracts. Look for a wraparound pair that blocks UVA and UVB light.
Add eye-boosting nutrients to your diet
Multiple studies have suggested that getting more lutein and zeaxanthin from food (6 milligrams or higher total) can lower the risk of cataracts and age-related macular degeneration. The following foods contain high quantities of both nutrients (they’re usually found together).