EDUCATIONAL
NUMBER
Glasgow Medical Journal
New (7th) Series
September,
ORIGINAL
1938
Vol. XII
No. Ill
ARTICLES
THE NON-SURGICAL TREATMENT OF CATARACT
By J.
*
BURDON-COOPER, M.D., F.R.C.S.Ed., D.O., Bath.
Operation has for long held sway as the one and only
treatment for cataract, but cataract is rapidly becoming one of
the preventable diseases.
Spontaneous
Cataract
1908).
occur
cure
is not
uncommon
at all in the
other,
(Encyclopedia Frangaise,
eye may be arrested or not
and there are numerous cases of 70
occurring
in
one
years of age, and upwards, in which no opacity is discoverable
in either lens. Such cases are enough in themselves to scrap
for
old
ever
the idea that cataract is the inevitable outcome of
age.
Incipient opacities in the lens can be removed, as we have
found from drawings and entoptic examination, and I say this
with all the weight of thirty-three years experience of the lens.
Futhermore,
cataract is
meet with in
of the commonest conditions
we
and at 62
practice,
incipient
commencement of
all
one
(the average age for the
cataract) it constitutes one-third of
cases.
cases of all ages in my private practice I found
in 6 per cent (Gerok 1903, Tubingen Clinic
cataract
incipient
I do not think it is
it is on the increase.
and
6*9 per cent)
In
*
2,808
Post-Graduate
Ophthalmology,
VOL. cxxx.
Lecture delivered
Western
in the
Infirmary, Glasgow,
NO. ?l.
109
Tennent Memorial
on
12th
April,
Institute of
1938.
Q
J. Burdon-Cooper
legacy
a
of the late
breeding
whose
race
a
war.
My opinion is that we are rapidly
crystalline lenses break down from
hereditary predisposition, long
and this is
one
before those of
our
forefathers,
of the main factors to be reckoned with
to-day in
of
connexion with the
subject prophylaxis.
undoubtedly a chemical decomposition of the
lento-proteid, and the trend of opinion now is that it is more
acceptable to regard it as due to alterations in the whole
organism, than to any mechanical explanation based on local
Senile cataract is
causes.
justify
But
such
whose vision
may ask?Do the results of treatment
attitude ? They do. I have a patient to-day
someone
an
eight
treatment, and it is
cripple
years ago was 50 per cent when I began
100 per cent notwithstanding she is a
now
from rheumatoid arthritis.
I have
40 per cent in six
of
improved
the vision
form of treatment I
weeks, by
another,
I have seen opacities
at present experimenting with.
entirely clear up after removal of septic foci, and the rectification
a
am
of metabolic errors; and the process be stopped, after attending
kidney trouble, the cause in one case, and the removal of
an abdominal tumour in another.
to the
My concern in this paper is the elaboration of scientific
principles, on which a sound scheme of non-operative treatment
of cataract can be based. I have no intention of providing
cures, or of suggesting anything on purely
press the button
empirical grounds. Our knowledge of the lens to-day demands
something better. The subject is still in its infancy, and we
need help. For those who are interested, may I suggest that
future reports should not only state the visual acuity, but have
regard to the fundus, and any other ocular condition present, and
be accompanied by drawings of the appearance both before and
"
"
after treatment.
Pathogenesis.
therefore, considering the lens itself, largely from
a bio-chemical aspect, as being most conducive to the object I
have in view, and I shall refer to pathogenesis, aetiology, and
I propose,
finally,
treatment.
The lens fibres
older become
dehydrated, sclerosed,
by a lipoid membrane in which
Their surface
cholesterol and calcium play important parts.
becomes irregular; colour, pigmentation, and refractive index
and
as
progressively
they get
surrounded
110
The
Non-Surgical Treatment of Cataract
increases 50 per
cent between the ages of 30 and 80 years, and the ash in
proportion. The ratio of soluble to insoluble protein gets less,
while the albumenoid, electrolytes (calcium and phosphorous)
increase,
lipoids
and
and
general
haze
develops.
and free water increase.
relative decrease
both
Weight
There is
in water
an
and
absolute increase
protein
content.
and
fatty acids increase, though there is a
relative decrease in unsaturated fatty acids.
The potassium
Calcium, sterols,
calcium ratio
less.
The water binding and
of
the
solvating power
proteins diminishes and there is a
lessened permeability of the capsule. Diffusion diminishes and
probably gets
metabolism is
depressed, and there is accumulation of waste
and slower recovery from fatigue.
There is also a
relative diminution of the lipide-lipoid ratio. The lipides are
material,
colloids
possessing great swelling capacity, act as
respiration. The lipoids, of
are
types, are hydrophobic,
and increase in the lens with age. They are adsorbed on the
fibre, isolate it electrically, and depress cellular respiration and
metabolism, though their effect is much less than the lipides
oxygen-loving
oxygen carriers and stimulate cell
which cholesterin and the sterols
such
as
lecithin.
The whole lens may be regarded as a protein lipoid membrane
through which water and salines diffuse, diffusion being governed
the protein content and the hydrophilic colloids. Calcium is
necessary to the maintenance of this membrane (Chambers) and
potassium increases its permeability. With increase in calcium
by
and cholesterin with age, the membrane becomes more static,
interchange becomes less, products accumulate until metabolism
finally
are
ceases.
Adequate nutrition, assimilation,
essential to the life of the lens
diffusion which is
more
fibre,
and
excretion,
and this is secured
active in the cortex.
The lens lives
by
by
respiration and has an oxidation system of its own,
by its glutathione and its enzymes, of which oxydase,
peroxydase and catalase are the most important (La Coscia). As
haemoglobin may be termed a respiratory pigment, glutathione
may be styled a respiratory catalyst. Glutathione is probably
not the only catalyst: others are to be found in the small
quantities of metals such as lead, silver, iron, zinc, &c., which
I have shown spectstroscopically to exist in the normal
lens (Burdon-Cooper and Lewis, 1929).
a
form of
constituted
Ill
J. Burdon-Cooper
glutamyl cysteil glycine which in its reduced
form contains the monosulphide group S.H. It becomes oxydized
to the disulphide state S.S. in the presence of molecular oxygen.
The disulphide in the presence of reducing substances is
converted again into the monosulphide and this can only occur
with normal alkalinity of lens protein and normal fluids. The
disulphide state may bring about oxydation by acting as a
hydrogen acceptor, but it never provides oxygen for combustion.
It conserves oxygen by acting its part in removing hydrogen.
Where oxygen is limited therefore, its importance is manifest.
Glutathione gets less with age and is enormously reduced in
Glutathione is
a
cataract.
changes, while they are manifestly retrograde, are far
from being evidence of disease, and they are not cataract. They
are, I consider, expressive of nature's method of preserving the
structure. When this is upset, as by some extraneous toxin,
These
the tissue breaks down.
for
instance, by
Evidence in favour of this is
the cholesterin
curve.
Goldschmidt
furnished,
(1922) has
shown that the cholesterol of the lens increases up to the second
decade when it drops till about 60 and rises again to extreme
old age.
the
It is
just
when it is lowest at about
incidence of cataract,
62,
that
we
find
that in
some way
indicating
preservative. Dehydration, lowered lipide-lipoid
ratio, diminished permeability of the capsule, all lead me to this
conclusion. They are all in keeping with, and necessary to
a retarded general metabolism, and when this
protection which
nature has designed to serve her own ends is upset, as may be
done by, say, the ingestion of dinitrophenol (which increases
metabolism) cataract ensues. The normal lens contains glucose
derived from reduced glutathione or autolysis of cellular carbohydrate (O'Brien and Salit), and it can oxydize glucose under
aerobic conditions (Michail and Vancia, 1932); this power is
greatest in the cortex (Kromfeld and Bothman, 1928). The
eye itself contains more glucose than it has oxygen to
greatest
cholesterin is
combust it.
is
greater
The remainder is converted into lactic acid which
in amount in the aqueous than in
serum.
This
incidentally constitutes an argument against the aqueous being
purely a dialysate. The oxygen supply of the lens depends on
diffusion. The amino acid Cystein is normally associated with
glutathione and in the lens closely follows its variation. It is
112
The Non-Surgical Treatment of Cataract
this amino acid in the lens which
reaction,
negative
The
gives
the
but when combined with oxygen yields
to nitro-prusside (Tassman, 1928).
pathological changes
imbibition of aqueous
position of the lento
in cataract
seen
nitro-prusside
cystin which is
are
the result of
and chemical decom-
the
capsule,
proteid. The imbibition gives rise to
splitting of sutures, separation of lamellae and cortical haze,
resulting from cloudy swelling and lysis of the fibre, with
a
laking
through
of the resultant fluid.
it may be a simple oedema without denaturation and
the lens may clear from this as is seen in an opacity produced
by sugar. While denaturation may be progressive, it is not
reversible (Duke-Elder, 1938).
Changes in the visual acuity
Initially
probably due to this initial oedema and its variation. I have
droplets of fluid appear and disappear in the cortex by the
slit lamp.
As the condition advances, the above changes are intensified
owing to reduced oxidation and enzyme action, and finally,
autolysis and death of the lens fibre takes place. Cataract is
are
seen
synonomous with death of the lens.
^Etiology.
I feel certain that the
resident in the lens
heredity,
the
or
its
of cataract
causes
capsule,
changes normally
are
not
primarily
but in this statement I
except
found in all colloid membranes
with age, the effects of radiant energy, and undue stress on the
capsule occasioned by irregular accommodation, in uncorrected
refraction,
for
a
refraction cataract
is,
I
believe,
a
definite clinical
entity. It is more than likely that the capsule is affected by
cytotoxins in the aqueous, for on that fluid the lens relies solely
for its food supply and metabolism.
Toxins in the aqueous increase the permeability of the capsule
by their effect on the epithelium, and even cataractous cortex
has the
which
same
Their concentration in that fluid
effect.
probably explains
the
intermittent
varies,
development
of
cataract.
There
are
cataract is
a
many factors which lead
toxic manifestation. For
tomized animals
can
be fed in such
tetany develop, though
us
to think that senile
instance, parathyroidec-
way that no symptoms of
in five out of seven cataract Occurs and
113
a
J. Burdon-Cooper
the
rises to 10 mgm. per cent
and in naphthaline cataract, serum
inorganic phosphorus
1934).
In this
type,
and
glutathione
cystein
are
available for detoxication in
all three reduced.
man
are
(Evans,
calcium,
The
only acids
glycine, glutamic acid and
cystein, those from which glutathione is formed, and the latter
definitely reduced in senile cataract (Brand and Harris,
is
Such facts constitute
1934).
toxic
origin
cataract,
is
one
definitely
been shown
of
senile
cataract.
of the most
a
an
argument in favour of the
Furthermore, naphthaline
important experimental cataracts,
manifestation.
toxic
It
has
only recently
Bourne and
Young (1934) that naphthaline
can be metabolized, and, conjugated with cystein, it is secreted
in the urine as a naphthaline mercapturic acid. Naphthaline
cataract does not give the cystein reaction (Tsugi, 1932), and
may be caused by depletion of that body.
Cytotoxins of systemic diseases such as arthritis, rheumatism,
focal infections, the abnormal metabolism of naphthaline
poisoning and parathyroid disease, arteriosclerosis, together with
by
the constitutional effects of
electroytes (O'Brien
potassium) coupled
influences,
and
deficient
Salit, 1934) (such
with
as
contents, and
calcium
and
abnormal
all have their effect
from the blood
mineral
hormone and enzyme
the aqueous, derived as it is
diffusion from the ciliary body
on
through
epithelium.
Cataract is undoubtedly a specific metabolic disease having its
primary cause in the body, and its immediate cause in the
serum
and
aqueous humour which reflects its disturbances. Cataract has
been attributed to such biological causes as unequal sclerosis,
separation of fibre layers, decrease in regenerative processes in
the lens epithelium, and to general dehydration and shrinkage,
but such changes are not normal to the healthy ageing lens and
must have some external cause to initiate them. The absorption
of radiant energy and its conversion into heat in the lens,
together with the effect of such radiation on the eapsule, is of
undoubted
The influence of
light is shown in
deeply pigmented than European.
The influence of heredity is marked in cataract, and it usually
anticipates in point of time the occurrence in a previous
generation. There are those who believe that it is germ
plasmodically determined (O'Brien and Weiner, 1934), and that
Indian
importance.
lenses,
which
are
more
114
The Non-Surgical Treatment of Cataract
the influence shows itself in
a
weakened cellular resistance from
the
pathological changes in the structural configuration of
proteid molecule, rendering it susceptible to the pathological
chemical phenomena concerned in cataract production.
and
To make cataract
an
expression of pure senescence is not
for
at
the
most
it
can
correct,
only be described as heterochronic,
whereas pure senility is homochronic.
It is
to limit the
impossible
aBtiology
of cataract to any
single
factor.
Starvation, insufficient oxygen supply, abnormal nervous
influences, toxins, enzymes, may all initiate a change which ends
in final destruction of the fibres.
of the
capsule,
in the lens fibre
Changes
in the
membrane,
permeability
in the diffusion in
the fibres and interfibrillar spaces, loss of water-binding capacity
of the proteins and of the cell nuclei, together with abnormal
infiltration of
fat,
and
inorganic material,
all
play
their
part
in
process of which for complexity it is difficult to find a
counterpart in any other part of the human body. The
a
vitamins,
attention
as
we
should
expect,
have received
considerable
act
of cataract.
by altering
They probably
calcium-phosphorous balance. Deficiency in vitamins, excess
of sugar, abnormal dietry, loss of cystein and abnormal calcium
metabolism are the factors in the SBtiology of cataract that have
as a cause
the
received
more
immediate consideration.
Cholesterol, sugar and salts, have been repeatedly estimated
without any significant difference being found in cataract, but
there is evidence that the blood calcium may vary especially in
endocrine cataract (Alajmo and Rubino, 1935).
regards sulphur metabolism and its relation to glutathione
cystein in the normal, and in cataract, little is known.
A good illustration of the effect of cytotoxins on the capsule
was afforded in an eye I had to remove recently for detachment
of the retina. Microscopically the lens showed layers of fluid
droplets under the capsule, and these got smaller and smaller in
Underneath the
diameter the deeper they were in the lens.
a
is
of
lens
there
in
normal
the
layer fluid, the secretion
capsule
of the capsular epithelium, and I am not aware that this has
been noticed before. In this could be seen globules of aqueous
As
and
(as
the two fluids
with
slighlest
stationary. It
are
not
miscible)
which could be moved about
ones in the lens were
pressure.
is in this way that cataract begins in detached
115
The
deeper
J. Burdon-Cooper
cytotoxins and possibly antibodies developed as a
result of degeneration of the retina, must have altered the
premeability of the capsule, and led to imbibition of acqueous.
One of the great points in the treatment of cataract is to keep
the lens dry and seek to follow nature in her protective
The
retina.
when the lens ages, its water content
as
measures,
gets
less.
Treatment.
capsule toxins and antibodies I
antigen treatment. There are
those who think the capsule is impervious to antibodies because
they belong to the class of globuline (Waado and Burky, 1933),
and that specific treatment of this nature is impossible or has
With this reference to the
would like to refer to Davis'
effect
no
on
the lens.
I think there
Roemer.
is increased where the
1930),
and the
because not
must be
Davis does not think so, neither does
be no doubt that the permeability
can
epithelium
is
damaged (Kirby
I have referred to
and
Giles,
to prove the point
toxins but material of the nature of antibodies
case
only
produced
seems
within the eye when the retina is
disorganized.
specific because it incites
antibody production. It creates a mild leucocytosis by means
of which necrotic material is removed, and cell proliferation
While I have had little experience with Davis'
stimulated.
Davis
method,
considers his treatment
I think there is much that
is difficult at the
it
consists
can
be said for
judge
its value.
it,
but it
Briefly,
injecting subcutaneously bovine lens material
as he calls it) prepared by the Mulford Co.
After
in
(lens antigen
a
present
moment to
careful examination, removal of all foci of infection, and
performance of basal metabolic tests, he takes the visual
the
acuity with and without glasses, dilates the pupil, and makes a
A sensitizing test is then made by
drawing of the opacities.
injecting into the forearm 2 drops of antigen. In from two
to twenty-four hours a red swelling develops, and the dose is
governed by this reaction. The day after, he begins by injecting
half a cubic centimetre, raising this by a similar amount daily,
till the dose is 8 cc., and he holds it at this till fifty injections
have been given. If there is much disturbance, pain, nausea,
giddiness, the dose should be reduced for ten days and then
Ten to fifteen drops of a saturated solution of
raised again.
are given daily (with tonics in feeble
iodide
potassium
cases)
116
The Non-Surgical Treatment of Cataract
and the eyes are bathed with hot water.
If for any reason
the treatment should be diseontinued for a time, a sensitizing
test should be done again before recommencing the treatment.
After the course is finished he keeps the patient on dionin 2 per
cent every other
loses its effect, he
night
uses
on
alternate weeks, and if the dionin
My experience of this
Weeks' solution.
limited, but we made one case a test case and did
thoroughly. We found that 3 to 4 cc. were best borne; 7 cc.
The general health was greatly improved and
was too much.
treatment is
it
the
no
as
near
vision bettered.
The lenses
kept dry,
and there
was
deterioration in distant vision, though the opacities remained
before. Those interested should read Davis' report on his
I would like to say here that absorption of opacities is
not everything in the treatment of cataract?our great object
cases.
should be to
to
get
the
the chemical
stop
cases
early
for the
change going
simple reason
It is
on.
that the
important
respiratory
capacity of the lens gets less and less with the progress and
density of the opacity. The analogy I always give is that a
man
may live with one lung, but he cannot with three quarters,
if
and
the glutathione content of the lens is reduced below a
given amount, no treatment whatever will stop the process
from going on to complete destruction of the lens.
I think the visual acuity and density of the opacity should
be determining factors in the consideration of medical treatment
in any particular case. What the degree of visual acuity should
be, I am not at present prepared to state, but personally I
prefer it should not be less that 50 per cent, and I think
the lowest limit is 30 per cent, or near it. Treatment should
be made mandatory in the one-eyed, young diabetics and
diabetics generally, and in complicated cataracts, or where there
is chronic inflammation of the uveal tract.
desensitization
avoiding
and
is
useful
such eventualities
the
reactions
the
as
following
solution of lens
general
protein
and if there is
focal
a
reaction is lessened.
to 4
or
5
cc.
and
for
operations with a view to
ophthalmitis, phakoanaphylactica
residuum
the
great
of soft
care
and
cortex.
injections
and local reaction.
is used.
reaction,
Two per cent
Start with 0*1 or 0*2 cc.,
decrease it
or
repeat
it until
increase till 1 cc., then go on
the flexor surface of the forearm. In
Cautiously
use
a course
before
Desensitization should be done with
governed by
I think
117
J. Burdon-Cooper
desensitization my results have been excellent. I prepare my
antigen, which is a 2 per cent solution of the soluable lens
own
in normal saline
proteins
(mainly alpha crystalline)
rendered
preserved in -05 per cent carbolic acid.
now in our
study of the lens to a consideration of such
sterile and
I
come
immediate factors
and I should
calcium and
as
would
seem
to
essential to its
us
well-being
electrolytes?
first and foremost the mineral
place
potassium.
Calcium is essential to the life of the lens.
It is inhibitory
capsule (Campbell, 1933), is adsorbed
on the lens fibre, lessens its
permeability, and protects the lens
from deleterious influences (Chambers). Deductions from estiin its action
mations of
the lens
on
calcium are
serum
apt
to lead us
Ionized
astray.
"
calcium is my solution of the so-called
calcium riddle" in
cataract. It is the ionized calcium that matters. In serum at
a
pH.
of 7*35 and
a
total calcium content of 10 mgm. per cent,
hydrogen phosphate, 5*6 mgm. in
as
protein calcium (Nitschke, 1928),
24 mgm. exist as calcium
ionized form and 2 mgm.
showing
that
calcium in
level is
by
requirements
calcium
only
too
serves
only
serum
as
no
a
means a
of the
an
little
more
exists in
reliable
The
body.
index to the
apparent
than half of the estimated
ionized form.
an
guide
unreliability
calcium
needs
of
the
of the
serum
body is
only
when it is remembered that the blood
for its transference.
Chemical estimations of the total
show that there is
calcium, however,
rapidly growing cataract (Jirman, 1929),
a
and this indicates
calcium metabolism in cataract.
a
marked decrease in
and in
variations
parathyroidism corresponding
(Matthieu, 1936),
Blood calcium
to the actual calcium
hypo- and hyper-
occur
in the aqueous
instability of
marked
Spectroscopically
I have found
it both normal and lowered in both blood and aqueous. The
huge amount found in the lens itself is the result of degeneration
and not the
cause
of cataract.
has too much.
Nor does it indicate that the
It is the ionic calcium
that is of
organism
the
and
I
am
to
of
the
that
this is not
lens,
importance
opinion
only reduced in cataract but in advancing age generally. The
extra amount in the lens can be explained by its affinity for
protein, alteration in the pH. of the aqueous, the result of the
Donnon eqilibrium between lens and aqueous, and diminished
crystallin content of the aqueous.
?
118
The Non-Surgical Treatment of Cataract
deal of variation, and the
organism to change un-ionized into ionized
with its power to hold calcium, and its control on the
Ionic calcium is
capacity
together
subject
to
a
good
of the
retention of the normal constituents of the
depends
on
body generally,
endocrine influence and the vitamins.
A normal
that there is
calcium metabolism does not
necessarily imply
available, and I am certain from
both clinical and experimental observations that cataract patients
have not enough. Campbell's findings in naphthaline cataract
suggest that a deficiency may favour development, and that
the maintenance of a high blood calcium is a protection against
sufficient diffusible calcium
it
(Campbell, 1933).
Dentists tell
me
that lowered
serum
calcium is found with
we find
precisely
certainly protective against naphthaline
poisoning, and probably against those poisons arising from
pathological changes. Rabbits fed on cabbage which contains
a
high proportion of calcium, never develop naphthaline cataract
(Bourne and Campbell, 1936). I give all my patients some
time during their treatment, calcium with vitamins A and D
and prefer the preparations adexolin and kalzana, with cod
oil, and I have found the progress of the opacities slowed
down, and in three recent cases, by this treatment alone, have
the opacities entirely disappeared.
Calcium retention is
allied to blood alkalinity, the less the alkalinity of the
blood, the greater the acidity of the urine and the greater the
calcium loss. Urine acidity should be watched in cataract
It is best
cases, and if high, calcium should always be pushed.
given as chloride or acetate as neither causes alkali retention
and the oedema peculiar to bi-carbonate of soda.
Potassium is, I consider, definitely related to cataract. Burge
hyper-calcinosis
in cataract.
of the teeth
similar to what
Calcium is
found it reduced from 38*8 to 9*8 per cent in the ash of massed
lenses, and I have found it reduced spectroscopically in the
and aqueous, two specimens of
which showed very little potassium. We also made the K/Ca
ratio a special enquiry, the results of which were published at
the International Congress in Holland in 1929.
From that
lens and in the
single
work
as
related
a
whole,
to the
between 4 and 5.
we
serum
concluded that
development
In
potassium
of cataract.
one case, a
black
119
was
definitely
The ratio varied
cataract,
it
was
11.
J. Burdon-Cooper
Sclerosis of the lens
potassium
progressive
is,
calcium ratio.
I
think, definitely
related to
Potassium loss which is
high
definitely
in cataract, is due to deficient supply. It is a cell
life, and very small quantities have a marked
is seen in the perfused heart which will beat for
food and vital to
effect,
as
twenty-four hours with the merest trace in the Ringers solution
undectable by chemical analysis, and will not beat for one hour
if it is not
exerts
present.
It
seems
connected with oxidation and it
restraining effect on denaturation of lens proteid (Clarke,
1935). My opinion is that it stands more in a primary eetiological
relation to cataract than does calcium, important as that is. It
a
decreases with age and its loss becomes acute in cataract.
essential in the treatment of cataract, but it should not be
It is
given
large doses, or for that matter any drug such as sodium
chloride or potassium iodide which are hygroscopic, as we have
to avoid imbition of water by the lens. That is why I give it
by electrolysis locally, and in citronic fruits and green vegetables
in the diet, rather than iodide of potassium.
in
Potassium and calcium are my sheet anchors in the treatment
of cataract, but iodide of potassium needs to be used with care,
(small doses infrequently), otherwise the condition may be made
worse.
For the treatment
by electrolysis, I use pads soaked in 2 per
potassium with fine copper mesh as the positive
pole on the eye, and a zinc plate on the back of the neck, using
a current of 2 to 5
milliamperes for about twenty minutes each
The
should be well covered with several layers
electrodes
eye.
of lint and it is the negative pole that burns.
With ionization, the interspaces, between the opacities, become
clearer. Diffuse thin opacities break up and leave a number of
fine dark spots like black pepper grains, through which the
patient sees more clearly.
As a collyrium, I use iodide of potassium, five grains, ten
minims of glycerine, succus cineraria maritima for its organic
potassium, and distilled water to the ounce, once or twice a day
kept up unless slight conjunctivitis occurs, when it can be
discontinued for a few days.
cent iodide of
Sodium.?The sodium content of vitreous and aqueous is
little altered with age, and is higher than in serum.
The
chlorides follow the sodium closely, The amount in the aqueous
120
The
Treatment of Cataract
Non-Surgical
and vitreous is about twice that of the lens as the cholesterin
of the latter decreases its ability to hold chlorides. Here is
further evidence of the protective character of the changes
which
potassium
this is
in
occur
ageing
only approximate.
I would
suggest
the chlorides be made
anyone interested in lental
Sodium chloride should be
by
the
The ratio of sodium to
of the lens.
in the aqueous varies between 15 and 20 to 1, but
commencement
much salt.
It
of
hampers
kidney
increased imbibition of water
special enquiry
largely forbidden, especially
treatment
the
a
pathology.
by
most
as
eat
people
at
too
in its work and makes for
the lens.
There is
a
constant
ratio maintained between the salt content of the tissues and of
Chlorides and fluid pass to and fro in order to
If the chloride excretory apparatus
maintain this balance.
the blood.
of the
kidney
is
damaged
as
in renal
unable to excrete chlorides in sufficient
the
disease,
quantity.
As
kidney is
they are
retained the tissue draws fluid from the blood to establish
the osmotic
balance and
lessen the salt
intake
they
we
I allow salt in the diet after
in
became
oedematous.
reduce the fluid
some
in
If
we
the tissues.
weeks rest and for eggs and
cooking.
Hormones,
Thyroid Extract, Thyroxin,
Phakolysin,
Euphakin.?My experience with hormones and gland treatment
though not extensive has been uniformly bad. In every case
where such material has been used indiscriminately the cataract
has progressed. I do not think they should be used unless there
is a very definite indication for them, such as myxcedema and
tetany or parathyroid deficiency. Where the condition of the
lens has improved, it has been coincidental with improvement
in the general condition. My opinion is that they should be
used with the
greatest
care
and this would
of those who have
seem
to be the
sponsored them, for they insist
general examination of each case before undertaking
such treatment.
Together with the vitamins, gland extracts
control the mineral content of the body and a sharp watch
should in every case be kept on the blood calcium and potassium
during their administration.
Phakolysin, used by Meyer Steinegg, consists of sodium and
potassium iodide and lens albumin. This and thyroxin act
opinion
on a
careful
121
J. Burdon-Cooper
mainly
as
iodide is
of
local metabolic stimulants and alternatives.
no use
iodine;
cally
in cataract
I have
never
once
in either the normal
the lens has
as
or
Sodium
enough sodium,
found that element
and
spectroscopi-
diseased lens.
I may be wrong (and there are those of extensive experience
who would not agree with me) when I say that I do not consider
the endocrines directly instrumental in the cause of cataract
unless there is
this is
rarely
indications.
the
some
case
gross disturbance in their function, and
without there being definite symptomatic
There functions must
concurrently with
general depressed
advancing age, and it seems
to me a pitfall to upset their normal balance (and it is easily
done) unless there are very definite indications for it. Euphakin
contains lens protein, thyroid, parathyroid and genital glands,
and has been used by Siegrist. Those interested should consult
wane
metabolism of
a
his book
on
the treatment of cataract.
Potassium iodide has been used
immemorial, and
iodine, as may be
from time
not its
owes
as a
collyrium for cataract
potassium and
its virtue to its
inferred from what I have said in
connexion with that element and its value to the lens.
Dor of
Lyons thought
cataract
was
due to
hydration,
eye baths of sodium iodide and calcium chloride, 4
each to 200 cc. of water, twenty to thirty minutes a
Henri
and used
grains of
day, kept
up for several months. An ointment based on Dor's formula is
prepared by the Blache Laboratories, and is widely used.
I
have,
experience
administered generally,
no
of
not
it,
as
I believe calcium should be
Dor believed it
helped to
lnglis Taylor thought
early cases.
dry
Iodine internally in different forms, notably the peptonized
iodine, and by electrolysis, is largely used in Italy in the
Professor Marri, following Angelucci
treatment of cataract.
with a current of 5 m.a.
uses
iodine
electrolytically
(Naples),
Pads are soaked in the solution and the current is kept up for
half-an-hour. Sixty applications constitute the treatment, but
the patient is given a preliminary course of iodine for two
weeks before the ionization is attempted, so as to saturate the
system with the drug.
Angelucci uses drops composed of rubidium iodide, which is
said to help oxidation, formate of soda and glycerophosphate of
strychnine, Five drops of peptonized iodine is given every
locally.
it of value in
the lens,
122
The Non-Surgical Treatment of Cataract
1
morning, increasing by
drop daily
used three times
eye drops
consider cataract related to arthritis.
are
Errors in
refraction
certain, may be due
attempt
an
on
disability.
of twelve
the
I have
a
an
part
come
error
The rubidium
drops.
day.
The Italian school
of Cataract.?Cataract,
as a cause
to
to 15
in
refraction, and,
of nature to
secure
as
vision
to this conclusion from
a
I
am
such, is
against
careful
a
study
observed over a period of some years. All the
below 50 years of age, the average being 40 when
developed. There was no hereditary influence,
cases
patients
opacity
were
the
systemic disease, or local eye trouble, as far as I could ascertain
to which the cataract could be attributed, and all were free from
opacity initially.
I
speaking of errors occasioned by cataract or
changes
preceding its development, but errors as
a direct cause of
opacity in the lens. I am certain that a
refraction cataract is a definite clinical entity, and am prepared
to wait the proof of it.
I have seen an error of + 4 D sph. with + 325 D cyl. as
determined by the keratometer, and subjectively reduced to
+ 3 D. sph. + 0 75 D cyl. by the development of an opacity in
the lens, and the vision even improved thereby. We know that
variations in both axis and amount of astigmatism are largely
due to alteration in the shape of the lens. And accommodation
and lens form are controlled by a sphincter muscle, as it is well
nigh impossible for every muscle radius to act uniformly and
consistently. Any alteration in the tonicity of one set of fibres
am
not
now
in refraction
over
the other would result in undue traction
on
the lens
capsule.
thinning, minute tears, and structural alterations
capsule might be brought about which would lead to an
increased permeability to the electrolytes of the aqueous and
Schoen (1897) promulgated
the development of cataract.
a somewhat similar theory and, though it was turned down
then, I think he was perfectly right. Shastid believes pressure
of the swollen ciliary processes on the equator of the lens leads
to cataract, and he adds + 0 75 D sph. more to the reading
In this way
in the
correction
so
this pressure.
as
to reduce excessive accommodation and relieve
Every
thoroughly refracted
case
and
of
kept
incipient
so,
123
as
cataract
should
be
the refraction may alter
J. Burdon-Cooper
rapidly
is of the
and within wide limits.
greatest importance,
as
As
prophylactic measure it
damage through want of glasses
a
is often done years before the lens shows evidence of it.
Dionin (2 to 10 per cent solution) has been used extensively
in cataract treatment, notably by Greenwood and Davis (1937),
the latter to
his
antigen treatment. He uses
2 grains three times a week during treatment and 5 grains
thereafter as drops. Dionin rapidly loses its effect, when Weeks'
solution, 3 per cent glycerin and boric acid may be used.
Smith (1924), Luther Peter and others use Cyanide of
Mercury. Smith uses a solution of 1 in 3, 5 or 6 thousand,
by
ttie
on
depending
supplement
ot
age
the
patient, giving half-a-grain of
subconjunctival injection and using cocaine
morphia
of
Iodide
potassium produces much the same effect.
locally.
Green (1919) uses 1 in 4,000 cyanide with two drops of a 2 per cent
solution of cocaine subconjunctivally, hot fomentations to control
the reaction, and a bath of 1 gr. of potassium iodide each night
with 2 gr. of dionin on alternate nights. The objection to
cyanide is the reaction, pain, oedema, soreness and possibly
before the
corneal ulceration.
drugs has been attributed to the
possibly leucocytosis (Davis).
While this may be so, what I think really happens is a reduction
of the permeability of the blood-aqueous barrier, such as takes
place with a subconjuntival injection of sodium chloride.
The effect on the lens is to remove waste products, but we
The action of all these
hyperemia they produce,
and
must remember that the process works both ways. The volume
increased, but the balance would appear to be
of toxins is
improvement, rather than the reverse. The effect
is only temporary as such treatment pays no
on the side of
at the best
attention to
cause.
Personally,
junctival^ in
equal parts.
I
prefer
sodium
2 per cent
sulphate
solution,
satisfactory cases I ever
commencing opacity, the result
One of the most
lines
was
a
to
cyaniden
subcon-
with 2 per cent of novutox,
treated
of
a
on
these
blow in
The lens showed uniform haze with
a
schoolboy's eye.
development, and vision was reduced to 6/60. I gave
three injections of a saturated solution of guyacol in normal
saline, and in four days the vision was normal and the lens
sector
124
some
Non-Surgical Treatment of Cataract
The
clear.
Had
undoubtedly
therefore
are
result with
poisonous
adopted, the case would
complete cataract. Injections
such method not been
some
have gone on to
of value, but our aim
ought
to be to
secure
the
little disturbance as possible, and with the less
drugs, and consider them as supplementary only.
as
The Vitamins.
The vitamins have taken
of cataract of
a
prominent place in the treatment
D, B2 (or G), and C.
epithelium protecting
late, especially vitamins A,
Vitamin A is the anti-infective and
vitamin, and helps also to secure orderly nutrition. Deficiency
gives rise to xerophthalmia and night blindness, and for this
reason it has been called the ophthalmic vitamin (Hess and
Kirby).
Vitamin D is the sunshine vitamin; its precursor, ergosterol,
is converted by ultraviolet light into vitamin D. It is concerned
with the
absorption
both of which
It is
are
and retention of calcium and
of great
especially high
phosphorous,
importance in cataract (Bridges, 1935).
in cod oil.
I like to combine "A" and
"
D,"
and for years have given adexolin in which they are balanced
One seems to supplement
in the same proportion as in cod oil.
the other.
"
A
"
helps
the resistance of the
capsular epithelium
the bactericidal action of the blood
and
"
D
"
(Pffannensteil, 1928)
(Walker, 1927), and secures the
maximum calcium absorption and retention. Cod oil, though
objectionable is, I have found, one of the finest remedies in the
treatment of cataract, especially if fed with calcium, preferably
I have seen incipient cataract
as chloride, acetate or kalzana.
and
capillary
serum
circulation
entirely disappear
on
cod oil and calcium alone without any
local treatment.
B2 (or G).?The
Some
observers,
effect of this vitamin
such
as
Langston
and
on
the lens is uncertain.
Day (1933), report
an
incidence of 100 per cent cataract in rats fed on diet deficient in
vitamin " B," while Bourne and Pyke (1935) found only 31 per
Ray, Gregory and Harris (1935) none whatever. Bourne
Pyke (1935) made the interesting discovery that when
cystein was added to the diets no cataract developed. Cystein,
cent and
and
it will be remembered, is a normal constituent of the lens and
as cataract forms, being absent from naphthaline
diminishes
cataract
(Tsugi, 1935).
vol. cxxx.
NO. III.
"B2"
or
"G" is of
125
outstanding
amount
H
J. Burdon-Cooper
in yeast, and I often order a teaspoonful of yeast in half-atumbler of water three times a week.
Vitamin C, Ascorbic Acid has within the last four or five
years assumed an importance in lental nutrition and cataract
It is allied to
glutathione and, like it, plays an
both in the aqueous and in
respiration,
important part
the lens; it has strongly reducing properties. In the lens it is
regarded as retarding the oxidation of its cystein (Weinstein,
1935), and probably functions as a metabolic link between its
oxidation and reduction systems, according to the following
treatment.
in tissue
formula
(Miller
Sugar.
C6H1206
and
Buschki, 1934)
Oxid. Glutathione.
C S S G
:?
Ascorbic Acid.
Red. Glutathione.
-2GSH (Fisher, 1934)
C6H806
The lens contains about 30 mgrm. per cent and the aqueous
12 per cent, blood and serum being about 1 to 2 per cent, with
an average of about 161 mgrm. per 100 cc. (Bellows, 1936).
Ascorbic acid is held
and
tenaciously by
Harris, 1935),
but it
Gregory
enormously reduced in cataract.
eye, it probably diffuses from the
is
oxidized
form,
the normal lens
less
as
blood
and it is then reduced in the
formed in the lens
itself,
it is
(Ray,
age advances, and
Regarding its origin in the
gets
thought, by
in the
reversibly
but it may be
phosphorillization of
lens,
sugar under the influence of glutathione (Miiller, 1935), and the
amount in the lens depends not only on age, but on the nutritional
state of the
patient.
The ascorbic acid of the aqueous
increases with age, and is less in the
(unlike
that of the
aphakic
lens),
than the normal
eye, a fact which is rather indicative of some balance being
maintained between the lens and the aqueous. The lens prevents
the oxidation of the ascorbic acid of the aqueous, a property
destroyed by naphthalene (Miiller, 1934). It is enormously
reduced in cataract, and in scurvy animals with no cataract, if
punctured and the aqueous withdrawn,
cataract rapidly develops (Monyukora, 1937).
the anterior chamber is
It is doubtful what effect the absence
the diet has
patients
it
than
causes no
normal
the
lens, but it is
in those without, and
on
increase in the
serum
of vitamin
"
C" in
less in the blood of cataract
unless fed in
large amounts,
content, though it does in
(Bellows, 1936), which would indicate that it
plays an important part in the nutrition of the lens. Futhermore,
cases
m
Non-Surgical Treatment of Cataract
The
it is
interesting
is far from
a low
urinary output of vitamin "C"
among the poorer classes in which cataract
(Harris and Ray, 1935). In serious chronic
to note that
uncommon
incidence is
high
infections in which cataract is associated, low serum values
are
found, though in acute cases such as appendicitis and
cholycystitis,
normal values
are
usually
obtained.
The lowered
blood content, the difficulty of increasing it, the frequency of a
general low urinary output, the lessened value in serious chronic
infections, its diminished lental content in cataract and its
probable influence in lental metabolism, all argue in favour
of feeding this vitamin in cases of incipient cataract.
I usually order one grapefruit a day or its equivalent in
synthetic vitamin, Redoxon" tablets (Hoffmann La Roche).
"
Grapefruit contains about 26 mgrm. to 100 grm. of fresh fruit.
It is contained in lemons 50, cabbage 64, and cauliflower 77.
Cataract being in the majority of cases an evidence of
chronic toxaemia, diet is a matter of the greatest
I agree with Davis when he says that the
importance.
majority of
ophthalmologists are probably as familiar with the subject as
they are with the laws of astronomy, and in general medicine
the average doctor is probably no better oft'. It is impossible
for me in a lecture such as this, to treat the subject as it
All I
deserves to be treated.
can
do is to refer to those
parts
of
it which from my experience and knowledge of the needs of the
lens, I have found to be absolutely essential if any good is to be
done to
patients;
carbohydrates.
I have spoken about
our
and first of
all,
the oxidation
I should refer to the
system
of the
lens,
how
oxygen and that the eye has not enough for the
These facts point to care being
combustion of its sugar.
it
conserves
exercised in the intake of
carbohydrate by
the cataract
patient
prevent the progress of the opacity. There is
considerable evidence extant that disturbance in carbohydrate
if he is to
metabolism
can
affect the lens.
Removal and disease of the pancreas results in
and toxic cataracts can be produced in animals
containing
lactose and
galactose,
and both
capsule.
galactose
cataract in young
127
by
diets
associated with
alteration in the blood
increased calcium in the eye, but no
Lactose probably affects the
calcium.
In
cataract,
are
permeability
of the
animals, nuclear, and
J. Burdon-Cooper
cortical cataracts
and this leads
me to
say
that for purposes of treatment I only distinguish two forms
?cortical and nuclear.
Chemically there are only two. The
occurence of opacity in various
indiscriminate
apparent
positions
in
old,
in the lens I
and do
only
are
explain by
seen,
Ostwald's
law,
that
is, they
can
where the critical concentration of the
occur
toxin is reached.
It is at that point the protein
Why the opacity should be nuclear
in the young animals in galactose cataract, and cortical in the
older animals, can be explained on much the same principle.
In the young, the effect is counterbalanced by better general
vitality and good metabolism. The toxin is relatively neutralized,
advancing
affected and
and it is
opacity
not till it comes to fibres where metabolism is slower
and resistance
effect
I
and,
the
a
less,
change.
believe,
poison
resistant.
results.
that the critical concentration is sufficient to
Nuclear varieties are less
indicate
a
less
is less intense.
Opacity
down and
severe
than
common
infection,
B.
crystalline
in,
is
is
or
cortical,
at any rate,
probably
more common
more
than in other
lens, and I believe is to be explained by the
increased temperature at that point.
If the patient is overweight, fats, sweets, cereals, and sugar
parts
of the
should be cut down
so as to conserve oxygen.
We should
in meats, 25 per cent of the substance is
delivered into the circulation as sugar.
Citronic fruits and
dairy produce are much to be preferred, and should be fed
remember that
even
together, never with meat and protein. I do not recommend
vegetables such as carrots and turnips, on account of the
enzymes they contain, and I think the vitamins of these are
better provided by synthetic vitamins, or in some other article
of diet.
I have hydrolysed the human lens during life by
with
feeding
scraped raw turnip. Greens and things that grow
in the sun, are good for cataract, with the exception of strawberries, rhubarb, tomatoes in undue amount, and early ripe fruit
such as gooseberries, as they contain oxalic acid, which
precipitates calcium. Meat, meat soups, stock, &c., are not good
for cataract patients.
Old people only need meat for their
heart muscle, and more hampers the kidney.
I prefer white
root
meats and mutton, and I do not recommend fish on account of
its high albuminoid content. The kidney is an important organ
in cataract and finds its
secretory analogue in the ciliary body
128
The
Non-Surgical
Treatment of Cataract
of the eye. The patient is best, too, on foods which result in
alkali, in order to maintain a high alkali acid balance; and
where
mixed diet is
a
balanced
provide
by
a
taken, acid
equal quantity of
an
diet list with
In
foods should be counterI usually
alkali foods.
suggestions.
important
to prevent imbibition of
treating
the
and
the
amounts
of
lens,
starch, sugar and salts
by
should be carefully scrutinized.
Many patients take too much
cataract, it is
water
salt,
and therefore drink too much.
Water is of
use
in
reducing
toxins in metabolic cases, but I think it should be limited or
controlled, and I prefer hard to soft, so as not to unduly rob the
body of its soluble mineral content. A toxic oedema of the lens
has been known to disappear by drinking water alone. The
citrates may be used to counteract acidity.
Potassium is best
as
in
and
salads
citronic
fruits, and I object to
given
greens
ad lib administration of
given, though
potassium
of
I would insist
both
Potassium should
in
good
should
potassium
to the
again
healthy
iodide for
on
reasons
the absolute
I have
necessity
and other diseased
lens.
present in every collyrium. I see no
it beyond 10 gr. to the ounce. Phosphorous
be
pushing
always be forthcoming,
and it is best
given as medicine
Wampoles phospho-lecithin;
it is quite an elegant preparation. Where cataract is complicated by general systemic disease, the treatment and diet
applicable to this should be given.
and
some
lecithin added.
I like
Conclusion.
In
conclusion,
I would like to stress
one
I think the term cataract should be determined
or
by
two
points.
the condition
of the lens rather than of the visual acuity, for in many cases
the vision may be very good while the main body of the lens
may be opaque. I think every patient should be sooner or later
informed that he has opacities in his lens, as I cannot see how
we
can
adopt
secure
intelligent co-operation
unless this is
so.
in any treatment
we
But tact is needed.
I think that at the initial consultation it is wise in order to
safeguard oneself, to inform some discreet relative. In the case
of certain types, nothing need be said to the patient until some
favourable opportunity is afforded, say, after he has got accustomed to treatment and being observed. Personally I find little
difficulty.
129
J.
Focal
after
sepsis
extremely important. Cataract often develops
septic infection or mental or bodily strain.
serious
some
Every
is
Bur don-Cooper
effort should be made to eliminate chronic
infective foci should be searched
for, especially
with the
teeth,
The
urinary
and
tonsils and sinuses.
toxaemia,
in connexion
gastro-intestinal, genito-
pelvic organs in women should be thoroughly
Crowned teeth and dead stumps should be looked
examined.
on with suspicion.
Apical abscesses are certainly worse than
pyorrhoea in causing cataract. Radiograms are advisable, but
are not infallible.
In elderly people intestinal stasis, chronic
and
colitis
are not uncommon and should receive
constipation,
The
urine
should be thoroughly examined for
attention.
proper
kidney inefficiency and bacilluria should not be overlooked.
Every endeavour should be made to improve the general health
and well-being, and to increase vitality and resistance.
As ionization with potassium constitutes an important part of
my treatment, I should like to conclude by referring to it.
Cantonnet, who published a book some years ago on ionization
in disease of the eye, summarily dismissed cataract with the
remark that cataract and vitreous opacities showed no change.
The British Journal of Ophthalmology, October, 1927, evidently
governed by this opinion, says the effect is doubtful, being
"
ineffective when
a
degree
cataract
formation
has
advanced to such
that there is actual
ment cannot
alterations.
opacity in the lens. Ionic treatthen affect them as they are definite structural
In the early stages, when bubbles are visible,
ionization may be
beneficial, but
by simpler
such
means
as
no
more
than has been secured
subconjunctival injections."
With these sentiments I do not agree. They may be true
when using iodine, but they are certainly not true when
potassium is used. I have seen opacities entirely removed,
diffuse opacities rendered less diffuse, and metabolic products
absorbed, leaving as their only evidence minute black spots like
pepper grains. Vision has been improved from blindness to
telling the time by the watch, and the intervals devoid of opacity
rendered clearer.
Furthermore,
I
am
certain it has
a
marked
influence in
modifying the chemical change that is taking place,
preventing opacity which is more important than
which in a great many cases is impossible.
it,
removing
and therefore
Potassium administered in this way has
130
a
very beneficial effect
The Non-Surgical Treatment of Cataract
both heart and nerves, and I find the well-being of my
Someone may say that very little
finds its way into the lens. I reply that it is just the very little
on
patients greatly improved.
that makes all the difference.
not its
drug,
poisoned.
You
poisonous action;
This account would not be
get
Tishner in
administration
know
is
an
now
that
adequate
This
who tried to
the
effect of the
are
some
fed,
not
reference to
first
was
produce
of naphthalene homeopathically,
Germany,
attempted
by the
cataract
but failed to do
but we
will
not
affect
the
lens
where
there
naphthalene
and
of
this
accounted
calcium,
supply
probably
JLhis seemed to
so.
specific
complete without
the homeopathic treatment of cataract.
by
the
the lens fibres
negative
homeopathic principle,
for his failure.
The remedies that have been used
but those that have
given
phosphorus, natrum
and naphthalene.
mur,
me
homeopathically
the best results
are
are
legion,
silica, calcarea,
secale, causticum, magnesia carbonate
mur is useful, and best suited to
females about the menopause, with the typical symptoms of
intense weariness and fatigue. It works well with magnesia
carbonate and secale, especially in younger women. Secale is
Natrum
to hard cataracts, and
at the menopause with uterine
peripheral opacities in women
lesions, blue rings around the
eyes, dilated pupils, asthenopia and migranous headaches;
Magnesia carbonate to asthenopic, hemorrhoidal and gastrointestinal manifestations in men?in the neuropathies, and in
adapted
with uterine
lesions; naphthalene to cataract associated
lesions, such as chorio-retinitis, myopia, retinal
exudates, albuminuria, haemorrhages, diabetes, and arthritic
women
with local
or
specific cyclitis.
Silica is indicated when
office
workers,
there
with bad
is
excessive
strain
little
as
in
exercise,
hygiene, irregular meals,
and indigestion;
phosphorus in
albuminuria, diabetes, cardiac affections, co-existing vascular
disturbances, congestions, haemorrhage, headache, and accommodative asthenopia.
Selica, phosphorous and pulsatila are useful in cataract
following serum administration and after vaccines.
One cannot refer to homeopathy without mentioning the
nosodes. Homeopaths have been using preparations of disease
overheating,
headaches
131
J. Burdon-Cooper
they call nosodes, for the past century, long
bacteriology.
Many diseases have been successfully treated in this way,
though the knowledge seems to have been little disseminated, or
merely ignored. Success on these lines led directly to vaccine
therapy. This has been extensively taken up by the profession
as a whole, though it is essentially
homeopathic in principle.
The best results are obtained nowadays with extremely small
doses, repeated infrequently, according to homeopathic principles
and experience.
On the same principle of applying specific stimuli, but with
the object of producing grosser physio-chemical effects (compared
with immunological or serological phenomena), cataractous lens
material has been used by me.
Potentization is employed,
inert
into
active
and so far the results have
material,
converting
been encouraging.
One thing I noticed with this treatment was that some did
very well both as regards the cataract and generally. In others
products,
which
before the advent of
the results did not
I think the
seem
patients
so
definite.
should be divided
according
to their blood
groups, and only material corresponding to the particular group
be given. In other words, a patient belonging to, say, Group 2
should
Group
One
only
2.
be
great thing
is the
cataractous material from
given
This is
a
matter of
tizing
a
patient
present
in
moment.
up against in the treatment of cataract
influence handed down from parent to child,
we are
hereditary
homeopathy
and I believe
by nosodes,
experiment
at the
the lines I have
on
indicated,
that is
offers the best and
possibly only means of disensibefore such opacities are normally due.
the lens
some years
I would like to refer to
an
observation (hitherto
Finally,
I
which
made
many years ago, viz., the influence
unpublished)
of iridectomy in retarding the progress of lental opacities. In
my early days I did a great many preliminary iridectomies, and
I was taught that such an operation if it did anything, rather
advanced than retarded the cataract.
that
the
exactly
great surprise,
if I had time, give you a table
by iridectomy, directly
the
I
found, however,
to my
I
could,
reverse was
of
cases
opacity
was
the
case.
treated in this way, viz.,
noticed,
but I will
only
refer to my classical case, that of a lady who consulted
twenty-seven years ago for incipient cataract.
132
me
The Non-Surgical Treatment of Cataract
I iridectomized as was my usual practice the worse eye. This
eye she sees with to-day, and the last time I refracted it she
had a visual acuity of nearly 6/9. The opacities were practically
in statu quo as at the time of her operation. The other, the
then better eye, has been blind for seventeen years, and is
beyond operation now having gone far beyond maturity. She
would never have it done, because the vision of the other was
so
good.
I
was
interested to learn from
a
distinguished colleague only
few years ago that von Graefe who originally devised the
operation, referred to its influence in improving the nutrition of
some
the
eye?I have seen it improve old corneal scars, and did an
iridectomy the other day on a surgeon, with this object in view.
I have never pressed the operation for early cataract, but where
the patient was willing I have, and would always do it, so great
is my belief in its efficacy.
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134