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Age related cataract is the leading cause of blindness in the world today,1 with an estimated 17 million individuals bilaterally blind.2 Though surgery may be an effective means to reverse cataract blindness, visual outcomes will be poor where experienced surgeons and appropriate postoperative care, including refraction, are not available.34 Moreover, even where high quality surgery is readily accessible, it may be expensive—cataract extraction is currently the most frequently performed surgical procedure among Medicare beneficiaries in the United States, at an annual cost of over $3 billion.5
It has been estimated that a delay in cataract onset of only 10 years could reduce the need for cataract surgery by as much as half.6 At present, no proved methods exist to effect such a result. This article will review existing and possible future strategies to prevent or delay age related cataract.
An association between nuclear cataract and smoking is one of the most robust findings in cataract epidemiology.7-11 There is also evidence that smoking cessation can reduce the likelihood of cataract,1213 and studies of attributable risk have proposed “quit smoking” campaigns as a major cataract prevention strategy.10 However, it is not clear whether damage to the lens resulting from smoking is indeed reversible, or whether individuals who quit smoking are simply subjected to a lower cumulative risk than those who persist.12
Evidence for an effect of ultraviolet-B (UV-B) light on cataractogenesis in animal models, presumably on the basis of increased oxidative damage, is comparatively plentiful.14-16 Early evidence on chronic exposure from human studies has been from ecological investigations examining some proxy for ultraviolet exposure such as latitude.1718 Another ecological association which has been studied is that between location and severity of cortical opacities in the lens, with the …