|Year : 1989 | Volume
| Issue : 3 | Page : 109
Medical therapy of cataracts, yet again?
R.P. Centre for Oph. Science, All India Institute of Medical science,Ansari Nagar, New Delhi-110 029, India
R.P. Centre for Oph. Science, All India Institute of Medical science,Ansari Nagar, New Delhi-110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:
Azad R. Medical therapy of cataracts, yet again?. Indian J Ophthalmol 1989;37:109
That cataracts are the number one cause of preventable world blindness needs no emphasis. And happily cataract surgery remains one of the most common and successful of all surgical procedures. With the arrival of posterior chamber intraocular lenses although the story is complete, can we comfortably forget the admonitions of Alan C. Woods. And yet, can we ? Who needs medical therapy of cataracts ? If indeed such becomes available, many an ophthalmologists will rue the ready loss of income. But to think so is myopic and out of perspective. The figures on cataract blindness in developing countries and the astronomical sums spent on cataract surgery in developed countries, mitigate a welcome approach to such efforts.
Like for any untreatable disease, innumerable agents have been suggested and marketed as having antictaractogenic effects. Despite this very large and perhaps unethical industry operating in developing countries, no medical treatment has received scientific acceptance. Such suggested medical interventions have varied truly widely and have ranged from ridiculous ox sperm's extract to various shady inorganic and organic combinations. But the prevention of sugar cataracts in animals by the use of aldose reductase inhibitors gave the first real scientific impetus to such studies. Yet, how close are we?
There arc several difficulties. Indeed it has been stated that studies on the medical therapy of cataracts may be all but impossible. In addition, documentation and progression of lens opacities accurately is an expensive sophisticated fare requiring special lens exclusive photo slit-lamp systems. It is these difficulties in studies on medical therapy of cataract by Sharma et al published in this journal that make it interesting and instructive. In 'Cataract-I' the authors report a simple system of cataract classification which is possible to use at any centre which is reasonably equipped. While this does not dispense accurate photodocumentation, where sophisticated equipment, are not available, the suggested classification system would be useful.
In 'Cataract-II' the methodology used in medical therapy of cataract studies is described and this highlights several difficulties inherent in such studies. In Cataract III IV & V ' the authors described their results with use of topical sulindac in diabetic senile cataract, topical glutathione, systemic Aspirin and systemic vitamin E in senile cataracts. The authors guardedly suggest that sulindac and Aspirin should be further studied in large multi-centric, photo-documented studies. While there are several flaws and shortcomings in the reported series, the authors recognise these and have highlighted them well. While such drawbacks in these studies are to be noted, the positive aspects of studies are that data is analysed in great detail, these are prospective studies and further, the authors refrain from drawing any definite conclusions. There has been a lot of controversy on use of Aspirin in senile cataracts but these controversies were all based on retrospective studies. The authors report of their results with aspirin is the first such prospective study on its use in senile cataracts.
Lastly, the prospect of medical therapy of cataracts may yet be far but let us remember the computation that if development of cataracts can be delayed by ten years, the surgical need will be reduced by 45 percent.