Article Wjpps 1533027420

WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES
Rajashree et al. World Journal of Pharmacy and Pharmaceutical Sciences

SJIF Impact Factor 7.421
Volume 7, Issue 8, 321-345 Review Article ISSN 2278 – 4357
SAY NO TO CATARACT SURGERY: HEAL BY EYE DROPS
Krishna Jadav, Charmi Panchal, Riddhi Patel and Rajashree Mashru*
Faculty of Pharmacy, G. H. Patel Building, Donor‘s Plaza, The M.S. University of Baroda,
Vadodara, 390 002, India.
Article Received on
ABSTRACT
02 June 2018, Cataract is the leading cause of world blindness. Cataract surgery is the
Revised on 24 June 2018,
Accepted on 15 July 2018 removal of the natural lens of the eye (also called ―crystalline lens‖)
DOI: 10.20959/wjpps20188-12095 that has developed an opacification, which is referred to as a cataract.
During cataract surgery, a patient's cloudy natural cataract lens is
removed and replaced with a synthetic lens to restore the lens's
*Corresponding Author
Rajashree Mashru transparency. Now a days Cataract can be treated by cataract surgery
Faculty of Pharmacy, G. H. and also can be treated by eye drops like lanosterol and NAC eye
Patel Building, Donor‘s drops. Lanosterol treatment could reduce cataract severity and increase
Plaza, The M.S. University
transparency. Lanosterol might have the ability to prevent or even
of Baroda, Vadodara-390
eliminate cataracts. It could potentially be a safe, non-invasive
002, India.
alternative to cataract surgery in patients that have moderate forms of
cataracts. NAC Eye Drops have been hailed as a major breakthrough in the treatment of
senile cataracts. They are n-acetylcarnosine eye drops (NAC) – a powerful anti-ageing
oxidant that has proven benefits to cataract suffers. As a leading brand of cataract drops,
NAC Eye Drops offer a tried and tested alternative to surgery in the treatment of senile
cataracts. Homeopathic Cataract Solutions (cineraria maritima) is a comprehensive reference
for maintaining and restoring the health of the crystalline lens and it covers some well-known
and effective eye drops that can help prevent and reverse the development of cataracts.
KEYWORDS: Cataract, Lanosterol, N-Acetyl-Carnosine, Cineraria Maritima.
INTRODUCTION
What Are Cataracts?[1]
A cataract is a clouding or loss of transparency in the natural lens of the eye. The human lens
is composed of crystalline proteins. When young and healthy, these proteins act to keep the
lens clear. Cataracts develop because as we age, these proteins become disrupted, clump
www.wjpps.com Vol 7, Issue 8, 2018. 321

together and break down. Cataracts affect vision and cause images to appear cloudy, fuzzy or
blurry similar to looking through a foggy window. Cataracts are the leading cause of
blindness among people older than 55. Gradual cataract development occurs as a part of the
normal aging process and it is rare to find a complete absence of a cataract in older
individuals.
Cataracts can occur more severely or prematurely in some people. Cataracts can be caused by
taking certain medications, such as prednisone steroids.
Cataracts can also be caused by other types of eye surgery, such as retinal surgery. Health
conditions such as diabetes can cause cataracts to develop at a much earlier age. Habits such
as smoking can cause more severe cataracts than in someone that does not smoke. Also,
babies can be born with congenital cataracts.
New eye drops that dissolve cataracts[2]

A cataract is a cloudy or gray deposit that occurs on the lens of the eye (figure 1). Cataracts
affect millions of people over the age of 40. It is rare to find a child with cataracts,
but sometimes babies are born with them.
Scientists and doctors have been baffled. To this day, no one truly knows what the exact
cause, or causes, of cataracts are. There are theories, of course, one of which is that cataracts
are a result of a crystalline protein build up in the eye. As the eye produces more protein, it
pushes the old protein down, which then becomes gray or cloudy.
When the protein has built up and formed a cataract, it prevents light from entering through
the normally clear lens. The cataract will continue to grow if not treated. Cataracts normally
affect your central vision the most. If allowed to form even more, it could begin to affect your
peripheral vision as well.
The only current cure for cataracts is to surgically remove them. The entire lens is removed
and replaced with an artificial lens. The surgery is non-invasive, but none the less runs risks.
Some patients have reported new cataracts forming on their artificial lens after surgery.

[Figure: 1]
Classification[2]
Cataracts may be partial or complete, stationary or progressive, or hard or soft. The main
types of age-related cataracts are nuclear sclerosis, cortical, and posterior subcapsular
(figure: 2).
Nuclear sclerosis is the most common type of cataract, and involves the central or 'nuclear'
part of the lens (figure: 3). this eventually becomes hard, or 'sclerotic', due to condensation on
the lens nucleus and the deposition of brown pigment within the lens. In its advanced stages it
is called a brunescent cataract. In early stages, an increase in sclerosis cause an increase in
refractive index of the lens. This causes a myopic shift (lenticular shift) that decreases
hyperopia and enables presbyopic patients to see at near without reading glasses. This is only
temporary and is called second sight. Nuclear cataracts are formed deep in the nucleus of the
lens. This is the type of cataract most associated with aging.
Cortical cataracts are due to the lens cortex (outer layer) becoming opaque. They occur when
changes in the fluid contained in the periphery of the lens causes fissuring. When these
cataracts are viewed through an ophthalmoscope, or other magnification system, the
appearance is similar to white spokes of a wheel. Symptoms often include problems with
glare and light scatter at night. Cortical cataracts are cataracts that form on the side or
periphery of the lens. Over time, the cataract will spread towards the centre of the eye and
affect the central vision.
Posterior subcapsular cataracts are cloudy at the back of the lens adjacent to the capsule
(or bag) in which the lens sits (figure: 4). because light becomes more focused toward the
back of the lens, they can cause disproportionate symptoms for their size.

An immature cataract has some transparent protein, but with a mature cataract, all the lens
protein is opaque. In a hyper mature or Morgagnian cataract, the lens proteins have become
liquid. Congenital cataract, which may be detected in adulthood, has a different classification
and includes lamellar, polar, and sutural cataracts.
Cataracts can be classified by using the lens opacities classification system LOCS III. In this
system, cataracts are classified based on type as nuclear, cortical, or posterior. The cataracts
are further classified based on severity on a scale from 1 to 5. The LOCS III system is highly
reproducible.
 Subcapsular Cataracts: These cataracts form at the back of the lens. Those with diabetes
are at a high risk of developing subcapsular cataracts.
 Congenital Cataracts: Congenital cataracts are found in newly born babies. This type of
cataract normally forms while the child is in the womb. It is a rare condition.
[Figure: 2][3]
[Figure: 3] Nuclear sclerosis cataract [Figure: 4] Nuclear sclerosis and posterior

polar cataract

Cataract Causes[4,6]
Cataract forms in a myriad of different patterns due to many different causes, and oxidation
of cell membrane lipids plays a fundamental role in cataractogenesis. Because free radical
pathology that affects most age related and degenerative process causes cataracts too. That
apart Cataract can be found in birth due to toxic conditions in the prenatal environment, it can
be caused due to trauma. Posterior subcapsular cataracts can advance rapidly in middle age
and are related to digestion and immune function. Poor regulation of sugar metabolism causes
many cataracts as does impaired liver function. Most cataracts change slowly over time
eventually disturbing vision so much so that surgery is needed to remove the entire lens from
the eye.
As a person ages changes in the protein of the lens develop. Oxidative reactions develop
which form abnormal disulphide and other covalent linkages. This causes the lens fibers to
lose their transparency. Penetrating trauma from injury or ocular surgery usually results in
rapidly progressive cataract, with lens fiber swelling, fragmentation, and opacification.
Concussive injury can infrequently cause a rupture of the lens capsule with the development
of a cataract or more commonly a contusion cataract forms in the anterior or posterior cortex.
These traumatic cataracts may be transitory, or they can remain if the lens fibers are damaged
sufficiently. Ionizing radiation has a very high cataract producing affect, and the lens is its
most sensitive target within the adult eye. Its damage is dose related and cumulative. The
sources of electromagnetic radiation energy most important in damage to the lens are ionizing
radiation (x-rays, gamma rays, and neutrons), emission of infrared or ultraviolet rays from
various hot bodies, and microwave. Copper, iron and mercury poisoning can lead to the
development of cataracts. Copper deposition in Wilson‘s disease produces a characteristic
sunflower cataract. In this inherited disease there is copper deposition in tissues, especially
the liver, causing cirrhosis, and in the basal ganglia of the brain. Galactosemia and diabetes
are two hereditary diseases which are related to the development of cataracts. Galactosemia is
an uncommon hereditary disease of the new-born producing bilateral cataracts, mental
retardation and enlargement of the liver. In diabetes mellitus, the usual cataract in these
patients does not differ from senile cataract but occurs 20 to 30 years earlier than in a non-
diabetic. . Oxidative damage contributes to the decrease natural antioxidants in the lens, such
as Glutathione, inositol, and ascorbic acid. Aging, diet, and other disease also play roles in
deficiency of antioxidants.

Vitamins and Nutrients for Vision[5,6]

Good nutrition is a key element of effective prevention for most age-related diseases, and
cataracts are no exception. A number of nutrients can benefit our eyes, and may help prevent
diseases such as cataracts, glaucoma, and macular degeneration. These nutrients include the
tripeptide glutathione (the most abundant and important antioxidant in the human body,
critical for protecting the lens from free radical damage); vitamins A and C; vitamin E and
some of the B vitamins; various bioflavonoids (especially quercetin and hesperidin) and
carotenoids (especially lutein and zeaxanthin); the amino acids taurine, N-acetylcysteine (a
precursor of glutathione), and acetyl L-carnitine; the hormone melatonin; the alkaloid
vinpocetine; the herbs bilberry, ginkgo, and garlic; the minerals zinc and selenium; and, last
but certainly not least, the saturated fatty acid, lipoic acid (―the antioxidant‘s antioxidant‖),
which plays a central role in maintaining the body‘s antioxidant network.
There have been many large scale studies to show the effectiveness of vitamins on reducing
the incidence of cataracts. A Canadian studied showed that patients over the age of 55 who
consumed vitamin C and E supplements reduced their risk of developing cataracts by over
50%. A double blind study involving 30,000 patients performed at the University of Helsinki
also demonstrated the beneficial effects of vitamins. Glutathione Loss of Glutathione occurs
in all forms of cataracts. Since 1912, researches have shown that reduced levels of
Glutathione precedes the development of cataracts. With increasing age the levels of
Glutathione content of the human lens decreases by 4 to 14 times. Glutathione supplements
are available but it is questioned whether this large molecule can pass through the digestive
tract. N-acetyl-cysteine, a stable amino acid, has been shown to raise the levels of
Glutathione. Cysteine is found in protein rich eggs. Completely avoiding eggs may rob the
body of this amino acid which may have anti cataract properties. The lens of the human eye is
bathed in a vitamin C rich aqueous solution which is 30 times more concentrated than the
human blood. It appears that this vitamin C acts as an ultraviolet filter preventing the harmful
effects of ultraviolet light. With age the levels of vitamin C begin to decrease and this may
contribute to the formation of the senile cataract. There are several studies which have shown
that high dosages of vitamin C (1000 mg/ day) will reverse the development of some
cataracts. Riboflavin helps to make a substance called flavine adenine dinucleotide which is
necessary for the production of Glutathione. High levels of Glutathione have been shown to
keep the human lens clear and prevent the development of cataracts. In one study, 81 percent
of patients with cataracts were deficient in riboflavin.

Daily vitamin and mineral recommendations for the treatment of cataracts Vitamin A 5,000 I.
U. N-acetyl-cysteine 250 mg. Vitamin C 1000 mg. Vitamin E (dl-alpha Tocopheryl) 800 I.U.
Beta Carotene 25,000 I.U. Chromium 200 mcg. Zinc (Picolinate) 15 mg. Rutin 250 mg.
Quercetin Bioflavonoid 300 mg. Vitamin B-2 (Riboflavin HCL) 50 mg. The vitamin
supplement that I recommend is a Cataract Nutritional Formula manufactured by Nutritional
Research. Information can be obtained from 877-341-2703 or the web page is
www.nutritionalresearch.net
Signs and symptoms[7]

Signs and symptoms vary depending on the type of cataract, though considerable overlap
occurs. People with nuclear sclerotic or brunscent cataracts often notice a reduction of vision.
Those with posterior subscapular cataracts usually complain of glare as their major symptom.
The severity of cataract formation, assuming no other eye disease is present, is judged
primarily by a visual acuity test. Other symptoms include frequent changes of glasses and
colored halos due to hydration of lens.
 Blurry vision
 Colors that seem faded
 Glare - headlights, lamps or sunlight may seem too bright. You may also see a halo around
lights.
 Not being able to see well at night
 Double vision
 Frequent prescription changes in your eye wear.[8]
Cataracts can often begin to form with no warning. You may experience some abnormally
blurry vision, but more times than not, people see this as a sign for new glasses. Sometimes
people https://medlineplus.gov/cataract.html don‘t recognize the signs before it is too late and
their vision can no longer be helped. This is why an annual eye exam is very important. With
a comprehensive eye exam, your doctor will be able to catch a cataract early and hopefully
slow down its formation in the lens.
An obvious symptom to look for is blurred vision. If your eyesight is suddenly cloudy and
seems as though you‘re looking through a dirty window, it may be time to visit your doctor.
If you look at your eyes in a mirror and notice clouding on the lens, you may have a cataract
forming (figure: 5 show cataract in eye).

Another symptom is glare. Sometimes cataracts can cause glare from bright lights. This is
especially true at night. Headlights and street lights against a dark sky may see more bright
than usual and can be very dangerous. If you experience this while driving at night, stop
driving and consult your doctor immediately.[2]
[Figure: 5]
Cataract Surgery[2]
Cataracts are usually treated by cataract surgery. Cataract surgery involves extracting the
cataract and inserting a new, clear lens implant in its place. The procedure is usually
performed under local anaesthesia on an outpatient basis, taking less than an hour in most
cases. During cataract surgery, an ophthalmologist removes the cataract by ultrasound or
laser and inserts a new intraocular lens implant. Recovery from cataract surgery normally
takes around 8 weeks. During this recovery period, you will need to return to your surgeon
for a series of follow up visits. During the follow up appointments, your doctor will check
your eyes for possible infection and make sure your eyes are healing properly.
Cataract Prevention[2,6]: Though the exact cause of cataracts is not known, there are some
methods you can use to slow the progression and hopefully prevent cataracts from forming.
 Moderate the Sunglasses: Yes, we often talk about how harmful UV rays and sunlight can
be to our eyes. But sometimes, it can be beneficial to allow some sun to waft over your eyes.
Sunlight nourishes our bodies and that includes our eyes. Moderation is key.
 The Right Nutrients: Getting the right eye nutrients is crucial to your overall eye health.
Getting enough vitamin A, bilberry, and lutein in your eyes will help them stay strong and
slow down the signs of aging. Don‘t have the time of resources to acquire all these nutrients?
The Ocu-Plus Formula is an herbal supplement that contains all the necessary eye nutrients in
one simple pill.

 Get Eye Exams Regularly: The reason we stress this point so much is because we often
don‘t think to visit the eye doctor every year unless something is wrong. Unfortunately, if
something is wrong in the eye, it is sometimes too late to reverse the damage. That‘s why,
even if you don‘t have any potential cataract symptoms, you should still get regular eye
exams done. Once a year is often enough, but if you have an existing condition, consider
going twice a year.
Sunlight UV and Blue Violet sun rays increase the risk of developing cataracts. There are
over 951 different references to back up the claim that sun light is the primary cause of
cataracts. Studies have shown that people who spend a great deal of time outdoors are three
times as likely to develop cataracts. A good pair of sunglasses which block 100% of UVA
and UVB and block at least 85% of blue violet sun rays are essential to protect the eyes from
the harmful effects of the sun. On sunny days a wide brim hat should also be worn.
If you smoke please do everything possible to stop. Smoking tobacco, especially more than
20 cigarettes per day, increases the risk of cataracts by more than 2 times. The risk in ex-
smokers is 50 percent higher compared to non-smokers. Each cigarette also robs the body of
25 mg of vitamin C. Smokers have an increase in lipids (both fat and cholesterol) which
increase the risk of severe cardiovascular disease. These factors produce narrowing of the
retina blood vessels that carry valuable nutrients to the eye.
High intake of alcohol more than doubles the risk of developing cataracts. More than 7 drinks
per week will increase the risk, while moderate use does not seem to increase the risk.
Diabetics develop cataracts at an earlier age than non- diabetics. An accumulation of sorbitol
and fructose in the lens can induce osmotic swelling of the lens, which will lead to the
development of a cataract. A significant number of adults who develop cataracts have
undiagnosed diabetes. If you have diabetes, every effort should be made to keep your blood
sugar under control. There have been several studies to show that vitamin C can help reduce
the level of sorbitol and reduce the incidence of cataracts formation.
Mechanism[9]
This hardening and discoloration of the lens is the result of lifelong cross-linking (or
glycosylation) of the lens proteins with ascorbate. This persists in the aqueous humour at high
concentrations, due to the kynurenine derivatives, and takes place due to the low availability
of natural defences in the form of anti-oxidants, (which decline with advancing age).

Also, populations that consume large amounts of milk and dairy products have a much higher
incidence of cataracts. The problem appears to be the milk sugar, lactose. In the digestive
tract, lactose breaks apart, yielding two simple sugar molecules, glucose and galactose. When
blood concentration of galactose increase, it can pass into the lens of the eye. There, galactose
degrades into various molecular waste products that can lead to opacities of the lens. Nursing
children can generally handle galactose. But as we age, many of us lose much of the capacity
to break down galactose. There are even some rare cases of genetic defects in which children
cannot break down galactose. These children can form cataracts within the first year of life.
[Figure: 6]
Cataract treatment without surgery may lie in activating protective protein[10]

The ability of the lens in the human eye to change focus relies on a dense formation of
proteins that can result in clumps that cloud the lens and lead to cataracts - except for special
protective proteins that prevent this.
They suggest the discovery may lead to alternative treatments for cataracts that do not
require surgery
Lens cells perform a remarkable feat. They produce a dense mix of proteins that give the lens
its refractive power - its ability to change focus so we can see distant and close objects - yet
at the same time keep the lens clear.
To overcome the problem of cloudiness, the lens cells produce and eliminate proteins in a
completely different way to other cells - they make them once in the embryonic stage and
preserve them for life. Unlike the proteins in the rest of our body, those in our lenses are as
old as we are.

But to make the proteins last a lifetime, the lens cells have to keep them in a dissolved state,
or they clump together and produce the cloudiness that is characteristic of cataracts.
And herein lies the clue to the German team's discovery - they have found one of the
mechanisms the cell uses to keep the proteins in a dissolved state for so long.
Two crystallin proteins stop other proteins clumping together.[10]

Scientists already knew that two related "heat shock" proteins, αA-crystallin and αB-
crystallin, were involved. Heat shock proteins are present in all human cells and help stop
other proteins clumping when the cell experiences strong heat or stress.
But until this study, little was known about the structure and behaviour of the two crystallins
are,
"The great challenge in the analysis of these two crystallin types lies in their inordinate
variety. These proteins exist as a mixture of very different forms, each comprising a variable
number of subunits. This makes it very difficult to distinguish the individual structures from
one another."
Molecular switch triggers the protective protein.[10]

A few years ago, scientists at Technische Universitaet Muenchen (TUM) solved the mystery
of one of the crystallin proteins - they decoded the molecular structure of one of the most
important forms of αB-crystallin. The protein is made of 24 subunits.
Under normal conditions, when a lens cell is not stressed, the protein exists in the form that
the scientists decoded. But they realized this is just a resting form, and not the form that helps
prevent other proteins clumping. So they reasoned there must a switching mechanism that
triggers the formation of active forms of the protein.
In the study they describe how they found the trigger - when the cell is exposed to stress,
such as heat, phosphate groups attach to the crystallin protein causing it to break up into its
subunits. The protein subunits each bind to other proteins and stop them clumping. This is the
active form of the crystallin.
The main challenge the team faced was resolving the structure of the protein, as co-author
Sevil Weinkauf, professor for electron microscopy at TUM, explains:

"Imagine you only have a few pictures of a coffee cup's shadow cast and want to infer the
shape of the cup from that. Now, if you think that sounds difficult, try to imagine you have
not just a single cup, but a cupboard full of china that you want to deduce from the shadow
casts. It is precisely this daunting challenge that we met for αB-crystallin."
The team believes their discovery of how the crystallin behaves could lead to new treatments
for cataracts that do not require surgery. It may be possible to develop a drug that activates
the αB-crystallin mechanism to clear up clouded lenses.
There could also be other applications, because the protein also plays a role in other cells. For
instance it is too active in cancer cells and can stop them committing suicide. In that example,
a drug could be developed to deactivate the protein.
In 2012, researchers at the Missouri University of Science and Technology in the US, found
that eye drops containing an antioxidant can prevent or heal cataracts and other degenerative
eye disorders.
Lanosterol decreased clumping in cataract-forming proteins[11]

The researchers ran three sets of experiments, starting with lab cells and progressing to
animals. First, in human lens cells, the team found lanosterol decreased clumping in cataract-
forming proteins. They then showed treatment with lanosterol reduced cataracts and
increased lens transparency in rabbits.
Lanosterol [Figure: 7][12]
Fast facts about cataracts.[7]

 Cataracts account for 51% of world blindness
 Most cataracts develop later in life

 Risk factors include too much sun, diabetes, tobacco and alcohol.
Learn more about cataracts

And, finally, when they tested the lanosterol solution - both in injected and eye drop form - in
live dogs with cataracts, it had the same effect in reducing protein clumping as in the human
lens cells and the rabbits' lenses: the cataracts reduced and lens transparency improved.
The researchers conclude

"Our study identifies lanosterol as a key molecule in the prevention of lens protein
aggregation and points to a novel strategy for cataract prevention and treatment."
Should lanosterol in the form of eye drops prove to be an effective treatment for cataracts in
humans, it could be a game changer.
Currently, the only way to treat cataracts is with surgery. But this is not an option that is
available to everyone. According to the World Health Organization (WHO), in many
countries there are barriers that prevent patients accessing surgery, and so cataract remains
the leading cause of blindness.
The new study follows another recent success story reported by Medical News Today where,
after receiving an implanted bionic eye, an 80-year-old man with age-related macular
degeneration regained some visual function.
Potential lanosterol use for human cataract treatment[13]

While the lanosterol-based eye drops have yet to be tested on humans, the success of the
studies on animals has prompted J Fielding Hejtmancik of the Ophthalmic Genetics and
Visual Function Branch of the National Eye Institute to emphasise the potential of the new
eye drops in future eye care use for humans. Hejtmancik suggested the research could lead to
non-surgical prevention and treatment of cataracts, with his praise of the new lanosterol-
based eye drops featuring in commentary which accompanied the study published in Nature.
―The potential for this finding to be translated into the first practical pharmacological
prevention, or even treatment, of human cataracts could not come at a more opportune time.‖
One of the authors of the study which produced the ground-breaking eye drop, Professor of
Ophthalmology and Chief of Ophthalmic genetics at University of California, Dr Kang
Zhang, said that before testing could begin on humans the research team will need to check

the toxicity of lanosterol, even though it is a product of our own body, and subsequently
formulate the lanosterol-based drug as the most efficient eye drop for a human trial.
Addressing the potential for the eye drops use in human eye care during a Nature podcast,
Zhang said he and his colleagues hope to begin human trials within a year.
Now, for the treatment of cataract lanosterol contain formulation lanomax available in market
(Figure: 8).
[Figure: 8].
Cataract treatment study without surgery.[7]
[Figure: 9]

Lanosterol re-dissolved pre-formed amyloid-like fibrils of crystallin proteins – effectively

dissolving the cataracts – image courtesy of Nature.
The University of California, San Diego, researchers began their work by focusing on the
cases of three children who had a severe cataract condition that ran in their family.
The scientists sequenced the children‘s genomes and identified a genetic mutation that
interfered with the production of lanosterol, a steroid which occurs naturally in the body.
From this identification the researchers decided to test whether lanosterol might have the
ability to prevent or even eliminate cataracts. The university researchers first tested the new
drug in lab cultures, then in the cataract lenses of rabbits, and finally on 7 dogs from 3
different breeds who were suffering from adult-onset cataracts.
The dog‘s treatment involved each of the 7 animals being seated and injected with lanosterol
(100mg) loaded nanoparticles into the vitreous cavity of their eyes. The treatment eyes then
received lanosterol in topical eye drops, one drop three times a day for 6 weeks.
The dogs who received the treatment showed notable improvement in their cataracts, graded
on a scale from 0 (no cataract) to 3 (extensive opacity of the entire lens).
Before testing on the dogs, the University of California researchers tested their lanosterol-
based eye drops on rabbits, and after six days all but two of the 13 animals had gone from
having severe cataracts to mild cataracts or no cataracts at all.
Antioxidant Can Prevent or Heal Cataracts and Other Degenerative Eye Disorders.[14]
Eye drops, prepared with the antioxidant N-acetylcysteine amide (NACA), have been used as
treatment for the prevention or healing of cataracts, macular degeneration, and other
degenerative eye disorders.
"NACA's characteristics as a drug were improved over NAC by neutralizing the carboxylic
group of NAC, which makes the NACA pass cellular membranes easily. And because NACA
can be administered at a lower dose, the drug has a greater therapeutic index and lowers the
risk of side effects traditionally associated with NAC. NACA is also an excellent source of
glutathione, a cell's main antioxidant power, which is diminished during degenerative eye
disorders.‖

Age-related eye disorders that induce vision loss are common, affecting over 30 million
people in the United States, and are projected to double in the coming years. It has been noted
in previous studies that a lack of anti-oxidants can put you at a higher risk for eye diseases
such as macular degeneration.
"NACA eye drops could drastically reduce these costs and represent an alternative to costly
surgery, while greatly improving the quality of life for those afflicted."
Ercal and her investigators have long been experimenting with NACA regarding lead
poisoning, HIV-related issues and other toxicities and have just recently started testing it on
eye disorders.
Building upon previous research by her colleagues that questions if growth of cataracts can
slow in rats by treatment with NACA, rats were first given L-buthionine-S, R-sulfoximine
(BSO), a solution that causes cataracts to form. The NACA solution prevented cataracts from
forming and will now be tested further to see if degeneration reversal is possible.
Eliminate cataract without surgery:[7]

Essentially, N-acetylcarnosine is a "carrier" for the di-peptide L-carnosine into the aqueous
humour of the eye (this is the fluid area surrounding the lens).
It is here that the substance becomes most active in its ability to basically act as a natural and
comprehensive anti-oxidant. Once N-acetylcarnosine has delivered L-carnosine safely
through the aqueous humour into the lens, the L-carnosine itself is flushed out of the eye via
the canal of schlemm, and once into the bloodstream it is broken down by carnosinase and
excreted. N-acetylcarnosine is acting as a time release version of carnosine resistant to
hydrolysis with carnosinase.
The major role of N-acetylcarnosine and L-carnosine is their facility to act in the biological
system as universal antioxidants. They possess the ability to protect cells from oxidative
stress, both in the lipid phase of cellular membranes and in the aqueous environment. L-
carnosine is able to reduce the content of lipid peroxidation products in the peroxidized lens
fiber cells plasma membranes, and to repair their structure accordingly. It is the only known
anti-oxidant able to protect structural proteins of the lens/alpha-crystalline, from the free-
radical induced oxidation process.

The statistics in the human trials in Russia show that Can-C eye-drops, applied for 6-months
(twice daily into the eye) in patients all suffering from senile cataract, had the following
results:
 88.9% had an improvement of glare sensitivity.
 41.5% had an improvement of the transmissivity of the lens.
 90% had an improvement in visual acuity.
The below figure: 10 show the treatment of human cataract with the eye drops of 1% Can-C
for the period of 5 months. The left image shows the appearance of cataract which resembles
a bat in its form and the right image shows that this opacity has disappeared after the cited
period, after treatment with n-acetylcarnosine is completed. The lens has become clearer. The
action has been described as a snow melting effect.
[Figure: 10].
BENEFITS of NAC drops[15]

•Overall eye health support.
•Improved visual performance.
•Improved colour perception.
•Helps defend against age related eye conditions (anti-aging).
•Helps aid recovery of compromised eye tissue (after injury/surgery).
•Relief from irritation, dryness, watery discharge and sensation of grittiness.
•Refreshed feeling (less stickiness).
• Brighter-looking eyes (less discoloration and redness).

Science Behind Nacdrops[12]
[Figure: 11].
Oxidation inhibition is the mechanism that NACDrops performs in the eye tissue to allow
anti-aging, preventative and even regenerative effects to take place.
NACDrops neutralizes the effects of free radicals that lead to the chain reactions that damage
the cells in the eye. At the same time, it allows the current state of health in the eye tissues to
improve by eliminating exposure to any harmful free radical activity. The key ingredient in
NACDrops is the antioxidant (figure: 12), a naturally occurring compound chemically related
to the amino acid carnosine.
N-Acetyl-Carnosine [Figure: 12].
The NAC molecular structure is identical to carnosine with the exception that it carries an
additional acetyl group. The acetylation is what makes it effective in the eye tissue. Carnosine
is found naturally in foods and in human cells.
NACDrops protects the eyes against potential eye problems that many of us might experience
during the aging process. Our levels of carnosine decline as we age, which results in the eyes
being susceptible to many common eye disorders.

NAC Eye Drops have been hailed as a major breakthrough in the treatment of senile
cataracts. They are n-acetylcarnosine eye drops (NAC) a powerful anti-ageing oxidant that
has proven benefits to cataract suffers. As a leading brand of cataract drops, NAC Eye Drops
offer a tried and tested alternative to surgery in the treatment of, senile cataracts.
How Does NAC Work?[16]

NAC contains a synthesised formulation of the anti-oxidant carnosine known as n-
acetylcarnosine (NAC). NAC is based on the naturally occurring nutrient di-peptide
carnosine (a combination of two amino-acids, or protein fragments). It is the key ingredient in
NAC cataract eye drops due to NAC‘s potency at ‗mopping up‘ free radicals. As the root of
tissue damage and accelerated ageing in our bodies, free radicals are the main culprit behind
the cataract condition. NAC eye drops for cataracts contain NAC due to its robust
characteristics. This is because carnosine‘s ability to tackle free radicals and cataracts is
blunted by the natural enzymes in the eye breaking carnosine down. However, NAC is highly
resistant to this breakdown which, combined with the slow release characteristics of NAC n-
acetylcarnosine eye drops, makes them highly effective in the treatment of cataracts. NAC
carnosine eye drops also tackle the bodily process of glycation (also known as cross-linking)
another key factor behind ageing and the development of cataracts. This is where glucose
leads to changes and a hardening of tissues over time. NAC cataract eye drops deliver a
powerful anti-oxidant boost to the eye counteracting the natural decline of anti-oxidants as
we grow older to protect the eye lens proteins from free-radical induced deterioration.
Dosage: As a preventative measure, two drops into both eyes once a day may be a suitable
on-going regime. As for treatment, two drops into the affected twice daily is the ideal regime-
there is no benefit in exceeding this dose. It is recommended that occasional use of N-
acetylcarnosine eye-drops continue even after the reduction/reversal of the cataract to prevent
any re-occurrence.
Side effects: To date, no serious side effects or contraindications have been noted in any of
the clinical trials.
Cataract-Dissolving Analog: N-Acetylcarnosine (NAC)[17,18,19]

N-acetylcarnosine (NAC), like its parent compound, carnosine, occurs naturally throughout
the human body. Both compounds are found primarily in the heart and skeletal muscles (the
word carnosine is derived from the Latin word for flesh) and in the brain. Carnosine was

discovered in 1900 in Russia, and it is in Russia that most of the recent research on the N-
acetylcarnosine derivative has been carried out. (13-15) Research with N-acetylcarnosine, as
with carnosine, demonstrates that it is effective not only in preventing cataracts but also in
treating them. NAC has been shown to improve vision by partially reversing the development
of the cataract, thus increasing the transmissivity of the lens to light.
The structural difference between NAC and carnosine is that one hydrogen atom in carnosine
replaces an acetyl group (CH3CO-), and this substitution occurs at a nitrogen atom. An
important chemical difference between carnosine and N-acetylcarnosine is that carnosine is
relatively insoluble in lipids (fats and fatty compounds), whereas N-acetylcarnosine is
relatively soluble in lipids (as well as in water). This means that N-acetylcarnosine may pass
through the lipid membranes of the corneal and lens cells more easily than carnosine, and
may thereby gain access more readily to the cells‘ interior, which is primarily aqueous.
There, the N-acetylcarnosine is gradually broken down to carnosine (and, perhaps, to
histidine), which then exerts its beneficial effects.
N-acetylcarnosine eye drops dissolve cataracts?[20]

A: Some animal studies and a few human trials suggest the drops may help reverse lens
cloudiness, the hallmark feature of cataracts—but claims that they are a cataract cure are
overstated, at best. The Food and Drug Administration (FDA) has not approved any form of
carnosine for the treatment of cataracts. (Carnosine is also sold as a dietary supplement,
promoted for eye health and many other disorders.)
Various carnosine-related compounds, including N-acetylcarnosine (NAC), occur naturally in

the body. When applied in eye drops, NAC makes its way to the interior of the eye, where it
may have antioxidant effects. Oxidation of lipids in the lens of the eye is thought to
contribute to cataracts. NAC may also help prevent ―cross-linking‖\\ of proteins, another
factor behind cataracts.
In a study published in Clinical Interventions in Aging in 2009, people with cataracts who
used NAC drops for nine months appeared to have an improvement in visual acuity and
sensitivity to glare (a problem with cataracts), compared to those using placebo drops. But as
with prior studies, this one was relatively small—and there are no data on long-term use.
Moreover, nearly all of the research has been done by a Russian scientist who developed and
holds a patent for a brand of NAC eye drops, called Can-C. Larger, better—and

independent—studies are needed. According to the Royal College of Ophthalmologists in

England, the evidence so far does not support the claims or establish safety of NAC drops.
The best ways to reduce the risk of cataracts are to get plenty of antioxidants from fruits and
vegetables, wear sunglasses and a hat to protect your eyes from ultraviolet light and not
smoke. Studies on antioxidant supplements have mostly had disappointing results. The only
sure cataract cure is surgical removal and replacement of the lens. Still, if you want to try the
drops for mild cataracts, talk to your eye-care professional first.
Now, for the treatment of cataract N-acetylcarnosine (NAC) contain Can-C formulation are
available in market (figure: 13).
[Figure: 13].
Herbal Treatment[4]: Cineraria maritima (Dusty Miller) the government of India‘s Central
Council for Research in Homeopathy, Ministry of Health and Family Welfare have stated that
tincture of Cineraria Maritima Succus is the drug of choice which prevents the development
of cataract. The recommended therapy is 1 to 2 drops in the eye, 3 to 6 times daily. Boericke
describes that it is most effective in traumatic cases and should be instilled into the eye one
drop four or five times a day for several. Clarke states that patients should be receiving
specific homeopathic treatment internally at the same time.
Cineraria maritima for Cataract[4]

 Cineraria Maritima has been widely used in homeopathy medicines especially as Eye drops
because it has been clinically proven to have the potential to significantly improve the
condition of cataract at early stage. It has the potential to arrest further degeneration in later

stages of cataract and the extent of improvement vary from individual to individual. People
visiting ophthalmologist‘s office for an exam and visual field test have confirmed in product
reviews that the tests after Cineraria treatment reveal ―not progressing, in fact, are better‖.
 Pharmacologically meets the high quality demands from an eye remedy namely
effectiveness and physiological compatibility
 It provides for nutrition of the cornea, lens and vitreous body thus arresting the
degenerative process in the eye that leads to myopia, poor vision
 It promotes better osmotic process of those ocular components which are not directly
supplied by the blood vessel
 Cineraria helps in circulation (including the outer region of eye) and supports general
metabolic process that promotes normal vision. All these is useful for people suffering from
age related deficiencies. In fact old age people with Cataracts have reported significant
improvement so much so that they are able to perform functions like car driving which they
could not do earlier
 Pet owners especially dog lovers have been regularly using Cineraria Maritima eye drops
and have reported cases (through product reviews) where Canines with completely cloudy
eyes (90% Cataract blockage leading to dim vision) have shown great improvement (only
white speckles left ) in a few months.
Table: 1: Top 5 cineraria maritima eye drops available in market.

Table. 1: Top 5 cineraria maritima eye drops.[4]
Sr. No. Product name Description Homeopathy eye drops
Original German formula to treat
Cataract & Corneal opacities.
Trusted for more than 100 years and
Schwabe cineraria
1. widely used by physicians
maritima eye drops
worldwide with good reviews from
customers. Contains Succus (juice of
a Cineraria plant, for medicinal use).
India‘s best selling cineraria that
treats Cataract, conjunctivitis,
corneal opacity, blepharitis etc
without any irritation. Contains
Dr. Reckeweg cineraria
Senecio Bicolor (Cineraria
2. eye drops without
Maritima) D2 2.5 gms,
alcohol
Benzalkonium Chloratum 0.001g
and excipients. Product well
reviewed for irritation free
treatment.
3. Adel 18 glutaract drops German Homeopathic formula from

for cararact,glaucoma Pekana that addresses metabolic

and poor vision processes connected with
deteriorating eye conditions. It
contains Aurum chloratum that treats
degenerative eye conditions
(blocked aqueous
humour), Euphrasia stimulates
excretion process & lymphatic
conditions, Glonoinum addresses
Glaucoma, Ruta graveolens
stimulates circulation and treats
vision weakness.
Indicated for first sign of cataract,

early cataract in patients suffering
from Diabetes, clouding of vision
SBL cineraria maritima
4. (blurred eye sight). Contains
10% eye drops
Cineraria Maritima Q 10% w/w,
Glycerinum 2 % w/w, MRP Rs.110,
Size: 10ml
Indicated for symptoms of incipient

cataract especially blurring of vision,
Bakson cineraria
5. Myopia and other eye affections like
maritima eye drops
corneal opacities. MRP Rs.110,
Size: 10ml
CONCLUSION
This review suggest that lanosterol, N-acetylcarnosine and cineraria maritima eye
drops appear to be a safe and effective means to prevent cataracts, and to possibly even treat
cataracts that are forming. Although cataract surgery is safe and highly effective, the use of
lanosterol or NAC eye drops or cineraria maritima eye drops may give many people another
option. Therefore, lanosterol, NAC eyes drops and cineraria maritima eye drops formulation
are used for the healing the cataract.
REFERENCES
1. Eye Drops for Cataracts, A Future Alternative to Cataract Surgery,
https://www.verywellhealth.com/eye-drops-for-cataracts-3421711.
2. New Eye Drops That Dissolve Cataracts, https://www.rebuildyourvision.com/blog/vision-
conditions/cataracts/new-eye-drops-dissolve-cataracts/,,

https://www.rebuildyourvision.com/blog/vision-conditions/cataracts/june-is-cataract-
awareness-month/.
3. The 'lanosterol eye drops' that claim to dissolve cataracts have appeared,
https://www.lanomax.com/lanomax.html.
4. Cataract Treatment without Surgery – Homeopathy Eye Drops & Tips,
https://homeomart.net/2016/11/01/cataract-treatment-without-surgery-homeopathy-eye-
drops-tips/.
5. New Hope for Cataracts: NAC (N-Acetylcarnosine) Eye Drops, Block, W. N-
Acetylcarnosine May Help with Cataracts. NAC eye drops show benefits in both
preventing and treating this age-related condition. LE Magazine, Aug, 2003.
6. Treatment of Cataracts, Dr. Kondrot, https://www.healingtheeye.com/cataracts.html.
7. https://en.wikipedia.org/wiki/Cataract#Signs_and_symptoms.
8. Cataract Surgery - Eye M.D.-approved information from Eye Smart. 2015. Cataract
Surgery - Eye M.D.-approved information from Eye Smart.[ONLINE]Available
at:http://www.geteyesmart.org/eyesmart/diseases/cataracts/cataract-
surgery.cfm.[Accessed 03 June 2015], https://www.ncordhealth.com/wp-
content/uploads/Diseases-A-to-Z/Cataract.pdf.
9. Eliminate cataracts without surgery, www.preventcataract.org,
http://www.preventcataract.org/.
10. Cataract treatment without surgery may lie in activating protective protein, Published
Thursday 24 October 2013,By Catharine Paddock PhD,
https://www.medicalnewstoday.com/articles/267835.php?sr.
11. Cataracts may be treatable with eye drops instead of surgery ,
https://www.medicalnewstoday.com/articles/297240.php.
12. https://www.google.co.in/imgres?imgurl=https%3A%2F%2Fpubchem.ncbi.nlm.nih.gov
%2Fimage%2Fimgsrv.fcgi%3Fcid%3D246983%26t%3Dl&imgrefurl=https%3A%2F%2
Fpubchem.ncbi.nlm.nih.gov%2Fcompound%2Flanosterol&docid=NeNBe9LBt8kQkM&t
bnid=6GSKt8thh7cvBM%3A&vet=10ahUKEwiQyfertvjbAhXIf7wKHTxkCFgQMwg8K
AEwAQ..i&w=300&h=300&bih=877&biw=1709&q=lanosterol%20structure&ved=0ah
UKEwiQyfertvjbAhXIf7wKHTxkCFgQMwg8KAEwAQ&iact=mrc&uact=8.
13. US researchers develop a new eye drop cataract treatment, Posted on 17 Aug 2016, by
Tim Brown, https://www.themanufacturer.com/articles/us-researchers-develop-a-new-
eye-drop-cataract-treatment/.

14. Antioxidant Can Prevent Or Heal Cataracts And Other Degenerative Eye Disorders,
Published Wednesday 10 October 2012,By Kelly Fitzgerald,
https://www.medicalnewstoday.com/articles/251298.php?sr.
15. Nac drops, http://www.nacdrops.com/.
16. NAC – (Replaces Can-C eye drops), http://drfitt.com/nac-eye-drops/.
17. Babizhayev MA, Yermakova VN, Sakina NL, Evstigneeva RP, Rozhkova EA,
Zheltukhina GA. N-Acetylcarnosine is a prodrug of L-carnosine in ophthalmic
application as antioxidant. Clin. Chim. Acta, 1996; 254: 1-21.
18. Babizhayev MA, Yermakova VN, Deyev Al, Seguin M-C. Imidazole-containing
peptiomimetic NAC as a potent drug for the medicinal treatment of age-related cataract in
humans. J. Anti-Aging Medicine 2000a; 2: 43-62.
19. Babizhayev MA, Yermakova VN, Semiletov yu A, Deyev A. The natural histidine-
containing di-peptide N-acetylcarnosine as an antioxidant for ophthalmic use.
Biochemistry (Moscow), 2000b; 65: 588-598.
20. N-acetylcarnosine eye drops dissolve cataracts, http://www.berkeleywellness.com/self-
care/over-counter-products/article/cataract-drops.

Article Wjpps 1533027420

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Article Wjpps 1533027420

Uploaded by

Copyright:

Available Formats

WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

Rajashree et al. World Journal of Pharmacy and Pharmaceutical Sciences

Volume 7, Issue 8, 321-345 Review Article ISSN 2278 – 4357

SAY NO TO CATARACT SURGERY: HEAL BY EYE DROPS

Krishna Jadav, Charmi Panchal, Riddhi Patel and Rajashree Mashru*

KEYWORDS: Cataract, Lanosterol, N-Acetyl-Carnosine, Cineraria Maritima.

www.wjpps.com Vol 7, Issue 8, 2018. 321

New eye drops that dissolve cataracts[2]

www.wjpps.com Vol 7, Issue 8, 2018. 322

www.wjpps.com Vol 7, Issue 8, 2018. 323

[Figure: 3] Nuclear sclerosis cataract [Figure: 4] Nuclear sclerosis and posterior

www.wjpps.com Vol 7, Issue 8, 2018. 324

www.wjpps.com Vol 7, Issue 8, 2018. 325

Vitamins and Nutrients for Vision[5,6]

www.wjpps.com Vol 7, Issue 8, 2018. 326

Signs and symptoms[7]

www.wjpps.com Vol 7, Issue 8, 2018. 327

www.wjpps.com Vol 7, Issue 8, 2018. 328

www.wjpps.com Vol 7, Issue 8, 2018. 329

Cataract treatment without surgery may lie in activating protective protein[10]

www.wjpps.com Vol 7, Issue 8, 2018. 330

Two crystallin proteins stop other proteins clumping together.[10]

Molecular switch triggers the protective protein.[10]

www.wjpps.com Vol 7, Issue 8, 2018. 331

Lanosterol decreased clumping in cataract-forming proteins[11]

Lanosterol [Figure: 7][12]

Fast facts about cataracts.[7]

www.wjpps.com Vol 7, Issue 8, 2018. 332

Learn more about cataracts

The researchers conclude

Potential lanosterol use for human cataract treatment[13]

www.wjpps.com Vol 7, Issue 8, 2018. 333

Cataract treatment study without surgery.[7]

www.wjpps.com Vol 7, Issue 8, 2018. 334

Lanosterol re-dissolved pre-formed amyloid-like fibrils of crystallin proteins – effectively

www.wjpps.com Vol 7, Issue 8, 2018. 335

Eliminate cataract without surgery:[7]

www.wjpps.com Vol 7, Issue 8, 2018. 336

BENEFITS of NAC drops[15]

www.wjpps.com Vol 7, Issue 8, 2018. 337

Science Behind Nacdrops[12]

N-Acetyl-Carnosine [Figure: 12].

www.wjpps.com Vol 7, Issue 8, 2018. 338

How Does NAC Work?[16]

Cataract-Dissolving Analog: N-Acetylcarnosine (NAC)[17,18,19]

www.wjpps.com Vol 7, Issue 8, 2018. 339

N-acetylcarnosine eye drops dissolve cataracts?[20]

Various carnosine-related compounds, including N-acetylcarnosine (NAC), occur naturally in

www.wjpps.com Vol 7, Issue 8, 2018. 340

independent—studies are needed. According to the Royal College of Ophthalmologists in

Cineraria maritima for Cataract[4]

www.wjpps.com Vol 7, Issue 8, 2018. 341

Table: 1: Top 5 cineraria maritima eye drops available in market.

www.wjpps.com Vol 7, Issue 8, 2018. 342

for cararact,glaucoma Pekana that addresses metabolic

Indicated for first sign of cataract,

Indicated for symptoms of incipient

www.wjpps.com Vol 7, Issue 8, 2018. 343

www.wjpps.com Vol 7, Issue 8, 2018. 344

www.wjpps.com Vol 7, Issue 8, 2018. 345

You might also like