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Offering hope to thousands of elderly people who could lose their sight to cataracts, a Yale University professor believes aspirin can retard the advance of the disease in its early stages. Dr. Edward Cotlier, a professor of ophthalmology at Yale’s School of Medicine, said his study showed that simple aspirin – the type sold over-the- counter – can slow the development of the blinding disease for as long as a decade.

If additional research supports his initial findings, Cotlier said it would offer an alternative treatment to the estimated five million Americans suffering from cataracts, which gradually cloud the transparent lens that allows light into the eye.

The only treatment for cataracts is surgical removal of the diseased lens – a procedure that 400,000 Americans underwent last year.

Cotlier said if aspirin proves effective in retarding the advance of the disease, it could reduce the number of cataract operations by 45 percent or more.

The research still is in the preliminary stages and conclusive results won’t be available until after completion of several extensive studies; however, Cotlier said he is confident enough to recommend that ophthalmologists prescribe aspirin therapy for patients in the early stages of the disease.

“What we think is those patients beginning to develop cataracts could slow down their formation by taking aspirin,” Cotlier said in an interview. “From the data we have at the present time, we consider it positive enough to recommend aspirin therapy, on an elective basis, for those patients who are beginning to develop cataracts.”

Unfortunately, Cotlier noted, aspirin won’t help people already sufferingfrom the advanced stages of the disease or those suffering from congenital cataracts. For them, the only answer is surgery.

Cotlier explained that once the transparent lens is made opaque by the advancing disease, “it is not possible to reverse that particular opacity. If you take an egg, once you fry it and once you get the white formed, you’re not going to be able to get it clear again.

“To some extent, the lens is very much like a transparent egg in that you have a structure that is crystal clear and allows light to go through. Once it becomes opaque, you cannot reverse it to the way it was before. So basically, aspirin will not have any effect on reversing opacity.”

But, Cotlier said, research does indicate that “those taking aspirin for many years seem to have retardation of cataracts compared to those who have not taken aspirin.”

The results of Cotlier’s research initially were published in the Canadian Journal of Ophthalmology. He plans to present another paper on the subject during an Aspirin Foundation of American symposium in New Orleans in April.

During his research, Cotlier studied more than 300 patients at Yale-New Haven Hospital and the University of Illinois Eye and Ear Infirmary in Chicago.

While looking into the incidence of cataracts in people suffering rheumatoid arthritis, Cotlier said he discovered that patients who had taken large daily doses of aspirin daily for an average of 10 years to relieve pain and inflammation showed marked delays in developing the disease.

Cotlier divided his test pool of patients with rheumatoid arthritis into four groups – diabetics receiving aspirin or not receiving aspirin and nondiabetics receiving aspirin or not receiving aspirin. Diabetes, a high level of blood sugar, is a known to hasten the development of cataracts.

“We were able to determine that the aspirin takers had a much lower incidence of cataracts,” Cotlier said. “And the figures were very significant.”

According to the research, the prevalence of cataracts in nondiabetic patients taking large doses of aspirin over an average period of 10 years was 14 percent while those taking no large doses of the patent drug was 43 percent. Among diabetics taking aspirin, the incidence of cataracts was 20 percent compared with a 78 percent rate among those not taking aspirin.

Cotlier said when a person takes aspirin, the active ingredient, salicylate, apparently penetrates into the eye and the cataract and stays in the lens for a period of up to 48 hours. “This is a tremendous retention of the drug by the tissue, indicating one massive dose per day would be enough for therapeutic purposes,” the doctor said. “And perhaps after we learn more, perhaps once every two days.”

The average aspirin intake of the group Cotlier studied was between 2.3 grams and 2.7 grams daily. Every patient was taking seven or eight 325- milligram tablets daily.

Although it’s still not clear why aspirin works to block the advance of cataracts, Cotlier said indications are it’s related to the salicylate interacting and coating blood plasma proteins and blocking a cross-link of proteins with the cataract. The location of the salicylate within the eye shows doctors where on the eye lens a cataract is causing its initial damage.

“Our initial rationale was patients with cataracts have elevated levels of tryptophan and amino acids and by lowering the tryptophan levels you can retard cataract formation,” he said. “And aspirin is the only drug that lowers the tryptophan levels in the blood plasma by about 50 percent.

“But the story is not complete by any stretch of the imagination. We are continuing to work to see if aspirin will block formation of those products (that form cataracts*,” he said.

Cotlier said that while patients in the initial stages of cataract development could benefit from his research, it may take some time to find conclusive results because of the small number of doctors and scientists involved in cataract study.

“It’s a major problem when you think there are only 20 researchers in this area and only a minimum amount of research is getting done. Patients beginning to develop cataracts could benefit from this, but it all depends upon the emphasis physicians and doctors place on following up on the therapy.

“It will be necessary for ophthalmologists to follow up on patients over three- to six-month intervals to make sure the cataracts are not advancing or what the progression is and to make sure there are no side effects from the aspirin,” Cotlier said.

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