Cataract formation represents a serious problem in the elderly, with approximately 25% of the population aged >65 years and about 50% aged >80 years experiencing a serious loss of vision as a result of this condition. Not only do
cataracts diminish quality of life, they also impose a severe strain on global healthcare budgets. In the US, 43% of all visits to ophthalmologists by Medicare patients are associated with
cataract. Surgery represents the standard treatment of this condition, and 1.35 million
cataract operations are performed annually in the US, costing 3.5 billion US dollars (year of costing, 1998). Unfortunately, the costs of surgical treatment and the fact that the number of patients exceeds surgical capacities result in many patients being blinded by
cataracts worldwide. This situation is particularly serious in developing countries; worldwide 17 million people are blind because of
cataract formation, and the problem will grow in parallel with aging of the population. In any event, surgical removal of
cataracts may not represent the optimal
solution. Although generally recognised as being one of the safest operations, there is a significant complication rate associated with this
surgical procedure. Opacification of the posterior lens
capsule occurs in 30-50% of patients within 2 years of
cataract removal and requires
laser treatment, a further 0.8% experience
retinal detachments, approximately 1% are rehospitalised for corneal problems, and about 0.1% develop
endophthalmitis. Although the risks are small, the large number of procedures performed means that 26,000 individuals develop serious complications as a result of
cataract surgery annually in the US alone. Thus, risk and cost factors drive the investigation of
pharmaceutical approaches to the maintenance of lens transparency. The role of
free radical-induced
lipid oxidation in the development of
cataracts has been identified. Initial stages of
cataract are characterised by the accumulation of primary (diene conjugates, cetodienes) lipid peroxidation (LPO) products, while in later stages there is a prevalence of LPO fluorescent end-products. A reliable increase in oxiproducts of fatty acyl content of lenticular
lipids was shown by a direct gas chromatography technique producing
fatty acid fluorine-substituted derivatives. The
lens opacity degree correlates with the level of the LPO fluorescent end-product accumulation in its tissue, accompanied by sulfhydryl group oxidation of
lens proteins due to a decrease of
reduced glutathione concentration in the lens. The injection of LPO products into the vitreous has been shown to induce
cataract. It is concluded that
peroxide damage of the lens fibre membranes may be the initial cause of
cataract development.
N-acetylcarnosine (as the ophthalmic
drug Can-C), has been found to be suitable for the nonsurgical prevention and treatment of age-related
cataracts. This molecule protects the crystalline lens from oxidative stress-induced damage, and in a recent clinical trial it was shown to produce an effective, safe and long-term improvement in sight. When administered topically to the eye in the form of Can-C,
N-acetylcarnosine functions as a time-release
prodrug form of
L-carnosine resistant to hydrolysis with
carnosinase.
N-acetylcarnosine has potential as an in vivo universal
antioxidant because of its ability to protect against oxidative stress in the
lipid phase of
biological cellular membranes and in the aqueous environment by a gradual intraocular turnover into
L-carnosine. In our study the clinical effects of a topical
solution of
N-acetylcarnosine (Can-C) on
lens opacities were examined in patients with
cataracts and in canines with age-related
cataracts. These data showed that
N-acetylcarnosine is effective in the management of age-related
cataract reversal and prevention both in human and in canine eyes.