Cataracts

The Problem

No medical treatment for cataracts (numerous eye drops and medications investigated—none proven to dissolve or reverse cataracts, N-acetyl-carnosine (NAC) drops heavily marketed—mixed evidence, not FDA-approved, expensive, surgery only definitive treatment), Surgery delayed too long: some ophthalmologists wait until cataracts 'ripe' or vision very poor (outdated approach—modern surgery safer, earlier intervention improves quality of life, no benefit to waiting, hypermature cataracts harder to remove, higher complication risk), or Surgery done too early: some surgeons push surgery before significantly affecting function (financial incentives—surgery profitable, balance needed—patient-centered decision based on functional impairment, not pressure), Generic 'wear sunglasses' advice: insufficient emphasis on UV protection starting in childhood (lifetime cumulative exposure matters, most cataract damage preventable with consistent UV protection), Antioxidant supplementation not routinely recommended: despite evidence vitamins C, E, lutein/zeaxanthin reduce cataract risk 10-30% (safe, inexpensive, potential benefit—worth considering), concerns about vitamin E and cancer in some trials (mixed data), Smoking cessation: critical but often not emphasized strongly enough (smoking doubles cataract risk—more important than supplements), Diabetes control: ophthalmologists may not emphasize glycemic control impact on cataracts (focus on retinopathy—cataracts also accelerate with poor control, HbA1c <7% slows progression), IOL selection: many patients don't understand options (monofocal vs multifocal, out-of-pocket costs, tradeoffs—glare with multifocal, most need reading glasses with monofocal, informed decision-making critical), Posterior Capsule Opacification (PCO—'secondary cataract'): patients often think cataract came back (misunderstanding—capsule cloudy, not new cataract, easily treated with YAG laser), 20-40% develop PCO but simple laser treatment restores vision—should be explained pre-operatively, Many people delay cataract surgery: fear (eye surgery sounds scary but actually very safe, quick, painless), cost (if choosing premium IOL—$3,000-5,000 out-of-pocket both eyes, standard monofocal covered by Medicare/insurance), don't realize how impaired vision is (gradual decline, adapt—until after surgery realize how much was missing), Cataract surgery one of most successful, cost-effective surgeries in medicine (improves quality of life dramatically, restores independence, prevents falls, $2,500-3,500 per eye—reasonable cost for life-changing improvement), Gabriel's integrative approach: prevention focus (UV protection lifelong, antioxidant supplementation, smoking cessation, diabetes control—delay onset 10 years = 50% fewer surgeries needed), surgery when functionally indicated (patient-centered decision, not too early or too late), optimize surgical outcomes (choose experienced surgeon, appropriate IOL for lifestyle, manage expectations—realistic about multifocal glare, reading glasses with monofocal), post-op care (omega-3, antioxidants support healing, address inflammation, prevent infection).