Nonsurgical approaches may be attempted to improve visual function in cataract patients who do not desire surgery or for whom surgical management is not feasible. Careful refraction may improve spectacle correction for distance and near vision. Use of specialized tints on spectacles may reduce glare, and brighter illumination can improve the contrast of reading material. Handheld monoculars may facilitate spotting objects at a distance; high-plus spectacles, magnifiers, closed-circuit televisions, and telescopic loupes may be used for reading and close work.
Referral to low vision services may be appropriate. The American Academy of Ophthalmology’s Initiative in Vision Rehabilitation page on the ONE Network (www.aao.org/low-vision-and-vision-rehab) provides resources for low vision management, including patient handouts and information about additional vision rehabilitation opportunities beyond those provided by the ophthalmologist.
In patients with small axial cataracts, dilating the pupils either pharmacologically or by laser pupilloplasty may improve visual function by allowing more light to pass through peripheral portions of the lens. However, there is a risk of inducing additional glare with this approach.
Pharmacologic treatment of cataracts is the subject of ongoing research. No commercially available medication has been proven to delay or reverse cataract formation in humans. Aldose reductase inhibitors, which block the conversion of glucose to sorbitol, have been shown to prevent cataracts in animals with experimentally induced diabetes mellitus. However, studies of the use of these inhibitors in humans show no such effect. Antioxidants such as zinc and beta carotene and vitamins E and C had no significant effect on the development or progression of cataracts on participants in the Age-Related Eye Disease Study (AREDS); the role of vitamins in cataract prevention requires further study.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.