Therapeutic Interventions for Cataracts and Precautions for People with Diabetes

Therapeutic Interventions for Cataracts and Precautions for People with Diabetes

While there is no scientific proof you can prevent cataracts, there are steps you can take to reduce your risk factors:

  • Reduction/cessation of smoking
  • Reduction of UV light exposure/wear sunglasses
  • Maintaining healthy Body Mass Index
  • Avoid prolonged corticosteroid use

Pre-operative considerations: Patients with pre-existing proliferative diabetes-related retinopathy are more likely to progress rapidly after cataract surgery, therefore panretinal photocoagulation (PRP) is recommended preoperatively. Macular edema should be adequately treated prior to surgery because pre-existing maculopathy may aggravate postoperatively and is strongly associated with a poor visual outcome 3.

Anti-cataract treatment: 

While maintaining good glucose, lipid and blood pressure control, may delay the onset of cataract, additional supplements have shown promise pre-clinically. 

Aldose reductase inhibitors(ARIs): Pre-clinical studies have shown that ARIs can delay diabetes induced cataract in animal models. Certain non-steroidal anti-inflammatory drugs (NSAIDs), acting through an ARI mechanism such as sulindac, aspirin, or naproxen have been reported to delay cataract in diabetic rats1.

Antioxidants: As oxidative damage occurs indirectly as a result of polyol accumulation during diabetes-related cataract formation, the use of antioxidant agents may be beneficial. A number of different antioxidants have been reported to delay cataract formation in animals with diabetes. These include the antioxidant alpha lipoic acid, vitamin E and pyruvate1.

Cataract Surgery and Intravitreal Injections

Intravitreal steroids may be considered during cataract surgery in the eyes with DME without epiretinal membrane or tractional component, particularly if the patient has not been treated previously. Coexistent centre-involving DME at the time of cataract surgery warrants combined phacoemulsification and anti-VEGF injections as treatment for the DME simultaneously. 

Combined cataract surgery and vitrectomy

Patients living with diabetes undergoing vitrectomy often have coexisting cataracts. Furthermore, lens opacities often progress following vitrectomy. Careful patient selection and combining the two procedures can offer more rapid visual rehabilitation, avoid a second operation, and simplify surgical interventions in patients who are likely to require multiple procedures.