What is a cataract?
Key points to remember:
- Cataracts are the leading cause of surgical intervention in France (830,000 interventions per year).
- Cataracts are a degenerative disease of varying duration in which the lens becomes opaque, causing a decrease in visual acuity.
- Surgical treatments exist: phacoemulsification, femtosecond laser.
- Research has demonstrated the benefits of antioxidant supplementation in reducing the risk of developing cataracts.
Introduction: What is a cataract?
Cataracts are the leading cause of blindness worldwide: they account for 25 of the 50 million people with visual acuity < 1/20. Cataracts are a very common condition, affecting more than one in five people over the age of 65 and nearly two out of three after the age of 85.
It is constantly increasing in developed countries due to the lengthening of life expectancy and therefore constitutes a major public health issue.
Description of cataracts and anatomical reminders
The lens is a transparent structure located just behind the iris. It consists of a cortex and a nucleus made up of fibers, enclosed in a capsule. The lens plays a major role in vision; it acts as a lens and focuses light rays, thus forming a clear image on the retina (remember that the eye behaves like a kind of camera). The lens can become opaque (less permeable to light) over time or due to various factors. This loss of transparency obstructs the passage of light rays, causing a gradual decrease in visual acuity.
Cataracts are a progressive process that generally lasts several months or even several years and results in a sensation of a veil or fog before the eyes, or more rarely, other distortions such as double vision. While they can sometimes have genetic causes or be triggered by medication, cataracts are generally caused by the aging of the eye's cells due to age. (1)
What is ocular aging, a root cause of cataracts?
The precise identification of factors that lead to aging of the eye remains partly mysterious. However, several avenues are being explored and should lead to the development of preventative treatments. Among the most promising avenues, oxidative stress is the most studied. This is caused by "waste products" from the normal functioning of our body, known as " free radicals ."
In the body, this stress is normally controlled with the help of antioxidants present in large quantities at the beginning of our lives, but whose quantities decrease with age.
Oxidation phenomena could be a very early or initiating event in the overall process of cataract formation.(2)
In cells, and particularly in the eyes, free radicals can trigger chemical reactions that impair cell function. Fortunately, numerous corrective and protective mechanisms are present. However, over time these mechanisms become less effective, and errors and other alterations accumulate (3).
Studies in animals and humans have shown that oxidative stress is a key factor in the initiation and development of cataracts.
The overproduction of free radicals and the reduction of antioxidant stores contribute to the development of oxidative stress and the formation of cataracts.
Oxidative stress increases particularly with certain factors such as:
- smoking
- alcohol consumption
- a diet of poor nutritional quality
- Too little or too much sports practice
- a limited intake of antioxidant vitamins through diet
What are the therapeutic approaches to combating cataracts?
The therapeutic options for cataracts are quite limited. Indeed, the only effective treatment today is surgical, and therefore curative .
The standard treatment for cataracts is phacoemulsification . In this technique, the lens is fragmented, then removed and replaced with an artificial lens. (4)
In 2017, France performed approximately 830,000 cataract surgeries, making it the most frequently performed surgical procedure in the country. Recent decades have seen the widespread adoption of phacoemulsification, significantly improving the results of the surgical procedure in terms of visual quality and its impact on patients' lives. The advantage of this surgery is its low rate of postoperative complications: approximately 2 to 4%.(5)
Another surgical technique was introduced in 2009: femtosecond laser-assisted cataract surgery ( FLACS ). In this technique, cavitation bubbles are formed with a laser to separate the damaged tissue without heat or damage to surrounding tissues. This is a true innovation in terms of safety and efficacy, as it limits the impact of human variability during the operation and thus reduces the risk of errors. (6)
In parallel, promising avenues are being explored in preventive medicine to reduce the factors that contribute to or accelerate the development of cataracts and to delay or prevent the need for costly surgery. Among the most promising approaches, dietary modifications to increase antioxidant intake and reduce damage related to oxidative stress play a key role.
Supplementation with antioxidants not found in our diet (for example, pigments found in certain plants or algae), as well as supplementation with antioxidant compounds initially present in the body such as glutathione, are serious avenues for reducing the impact of oxidative stress and therefore the risks of triggering and progressing cataracts.
At Phytocea We have developed dietary supplements specifically for eye health. The high-quality antioxidants in our ORetine dietary supplement, designed to maintain vision, are suitable for preventing cataracts and slowing their progression.
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The Age-Related Eye Diseases Study (AREDS1 and 2) demonstrated the beneficial effects of oral supplementation with vitamins, antioxidant minerals, and carotenoid pigments on the development of various age-related diseases such as AMD and cataracts. (7) Supplementation with lutein, zeaxanthin, as well as omega-3 fatty acids and zinc, would be beneficial in terms of prevention to slow the onset and development of such diseases. (9)
