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Not Yet Time To Say Goodbye To Cataract Surgery.

There are three main parts of a fresh egg. The outer shell, the transparent slimy liquid inside the shell and the inner core of thicker yellowish fluid called the egg yolk. The process of boiling (heating or denaturation) changes the nature and colour of the transparent slimy protein liquid into a white solid - the egg white.

Let's ignore the yolk because it is not relevant here! Heat, or any insult (physical or chemical), would cause exactly similar changes in the crystalline lens inside the eye making it to lose its transparent nature, becoming initially cloudy and then finally white. This transformation from a transparent lens to a white lens is what we call cataract. As expected, it's accompanied by an increasing change in its ability to transmit light.

Readers of this page have asked several questions since my last article on cataract. 'What are the causes of cataract? Why do old people develop cataract?' Broadly speaking, anything that will directly or indirectly cause a change in the nature of the crystal line lens can cause cataract.

Thus, any physical or chemical injury to the eye, prolong use of some topical eye drops or systemic medications, inflammations within the eye and changes in the composition of the fluid bathing the lens (called aqueous) as in diabetes can all lead to clumping and cloudiness of the natural lens protein and result in cataract.

Sunlight contains visible light and invisible ultraviolet rays that can tan or burn the skin. Little doses of these over the years added to other little insults above, will with age,denature the lens proteins and result in cataract. We are all exposed to different amounts of sunlight over the years, if we all live to about 120 years of age, we will all develop cataract.

'But why does it happen in some at the age of 50 years and others at 60, 70, or 90?' another reader had asked. The factors mentioned above, in addition to what we eat or do not eat can either slow down or accelerate the development of cataract. Therefore, the commonest cause of cataract worldwide is age.

In Nigeria, over 5 million people (that's the entire population of Oyo State and twice the entire population of Ekiti State) have cataract and are in need of cataract surgery. Cataract surgery is the commonest eye surgery performed all over the world and in Nigeria. Sadly, less than 150, 000 cases are done in a year.

Another 50,000 or probably more are done by quacks, eventually converting a reversible blindness to an irreversible blindness. Many old people blinded by cataracts die blind helping us to clear the backlog.

'Is there an alternative to cataract surgery?' asked an avid reader of this column who had done an extensive search of the web. He added, 'I found an interesting article about an eye drop that can dissolve cataracts so that surgery would not be necessary. What is your opinion about this magic medication?

'I did some little research on this too. The article scored very low in my rating! I consulted a number of my colleagues, locally and internationally. Nearly all confirmed my fears that the claimed success was not real. A few declared the claim as bogus and outrightly fraudulent. A Nigerian colleague of mine sent this response, 'I have it on good authority that NAFDAC has concluded arrangements for mass importation of this wonder drug.'

I tried to reach the Director General of NAFDAC to verify this claim without success. A few days ago, one of my patients provided me Three thousand three hundred naira a visual evidence of the cataract dissolving eye drops she had bought for N3,300.00. She had used it for about six months without any change in her vision.

So this,supposedly eye dissolving, medication is real. But does it work? Will it replace surgery? My personal views are expressed below. Surgery will remain the only cure for cataract in the foreseeable future.

First, the crystalline lens inside the eye, is made up of protein molecules arranged in a special way that make them transparent. Cataract occurs because of the disruption of the structural arrangement of these protein molecules. Dissolving an already formed cataract means causing another alteration in the structure of the damaged lens. It cannot restore it to its previous state.

The optical properties which make it possible for light to pass through the lens to the retina in this new liquid lens can never be the same as those of the lens its natural solid state. Therefore, the altered liquid lens still has to be sucked out and replaced by an artificial intraocular lens. This is what cataract surgery is about! Therefore, no cataract dissolving eye drops can cause an improvement in vision without surgery.

Such eye drops may make the eventual cataract surgery easier or perhaps, even more difficult but surgery is inevitable. I also envisage an increase in cases of glaucoma and severe ocular reaction to the altered lens after using such cataract dissolving eye drops, if indeed they work.
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Publication:Nigerian Tribune (Oyo State, Nigeria)
Date:Feb 28, 2019
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