NAC Eye Drops:
An Important New Discovery in the Treatment and Prevention of Cataracts

Individuals with cataracts often end up having surgery. But just as any surgery is not without risk, about 2% of the 1.35 million (or approximately 27,000 individuals), just in the US each year, develop serious complications, including retinal detachments, corneal edema, and the need for a cornea transplant. Fear and discomfort, not to mention future potential problems from an artificial lens, contribute to the overall unpleasantness that accompanies this surgery.

An alternative to surgery

A new form of carnosine—n-acetylcarnosine, abbreviated as NAC—is now available in the form of eye drops, and has been shown to slowly reverse existing cataracts and prevent new ones from forming. NAC was developed because it is much more stable and effective than regular carnosine when used as eye drops. (Note: This is not the same thing as n-acetylcysteine, which is also sometimes abbreviated to NAC.)

NAC has shown a significant clinical success rate for patients within 3-12 months of treatment. The eye-drops are also being used to help treat glaucoma, but the research for that disease is not published yet.

Human trials

A long-term study observed the changes in lens clarity over a 6 to 24 month period for 49 volunteers. The average age of the participants was 65 and all suffered from senile cataract ranging from minimal to advanced opacification (clouding of the lens).

The patients received either a 1% solution of NAC eye-drops or a placebo, as 2-drops twice a day in each eye. The patients were then evaluated at 2- and 6-month periods. The tests consisted of ophthalmoscopy (glare test), stereo-cinematagraphic (slit-image) and retro-illumination (photography). A computerized digital analysis then displayed the light scattering and absorbing effects of the centers of each lens. Here is the outcome after 6 months:

88.9% of the patients who were treated with NAC had an improvement of glare sensitivity (lowest individual score was a 27% improvement, all the way up to a 100% improvement)
41.5% had a significant improvement in the light transmission of the lens
most importantly; 90% showed an improvement in visual acuity
The patients in the placebo group exhibited little change in eye quality at 6-months and a gradual, significant deterioration at 12 to 24 months.

Continued improvement

This study also showed that at 24-months the NAC treated group, (who already had significant improvement to the quality of their eyesight), sustained these results with continued use of the NAC eye-drops. There were no significant side effects noted in any cases throughout the 2-year period.1

Another study evaluated two groups of 49 patients (with the average age being 65), who had advanced symptoms of cataract. After a 24-month course of treatment, the group that was treated with the eye drops had a cumulative positive change when compared with the group that did not receive the eye-drops.2

How does NAC work?

The body is made up largely of proteins. As we age, proteins tend to undergo destructive changes due largely to oxidation and interactions with sugars and aldehydes. These interrelated protein modifications include oxidation, carbonylation, cross-linking, glycation and advanced glycation end product (AGE) formation. These processes contribute to the aging process.

More specifically, cataracts are formed by the glycation of proteins. Glycation occurs when proteins react with sugars and form advanced glycation end products (AGEs). AGEs physically alter proteins, DNA and lipids, changing their chemical properties. The result of this reaction leads to the discoloration of the eye lens to yellow and brown, which consequently results in the impairment of vision.

Studies show that carnosine is effective against all these forms of protein modification.

When the NAC eye drops are administered, carnosine competes for the glycating agent on the molecule, and protects cellular structures against aldehydes. Therefore, it is believed that carnosine can slow and help to prevent proteins from cross-linking and becoming a cataract, and break existing cross-links, too.

NAC acts as an antioxidant

Once in the eye, NAC was shown to act as an antioxidant and enter the lens tissue, and to be particularly effective against potent free radicals, especially the superoxide and the hydroxyl. It is therefore presumed that the antioxidant role of L-carnosine (within the aqueous humor) is a major factor in slowing and preventing the appearance of cataract. It is also believed that NAC may help in the treatment of eye disorders other than cataracts, that are the result of oxidative stress, including: glaucoma, retinal degeneration, corneal disorders, ocular inflammation, complications of diabetes mellitus, and systemic diseases.3

NAC appears to act as a universal antioxidant, both in the lipid phase of the cellular lens membranes, and in the aqueous environment. It also protects the crystalline lens from oxidative stress-induced, cross-linking damage.

How much should you use?

NAC eye-drops appear to be a unique and safe treatment for cataracts, and offer an exciting new solution to the way that cataracts are controlled. The studies used two drops in each eye twice daily continuously for a 24-month period.

But since there is no data on a "preventative" dosage there's no way of knowing if 1 drop twice daily works as well as 2 drops twice daily. What we do know is that the maximal effect of improvement of visual acuity is obtained within the first 3-5 months of treatment. Then the goal is to maintain that outcome.

NAC as a preventative against cataracts

Please keep in mind that NAC is no miracle. Yet, approximately half the people studied showed dramatic improvements … and almost all of them experienced an improvement in their vision, and a stabilization of their cataracts. It's quite possible that using NAC eye drops more often than twice a day is more effective, but no studies have been done to indicate that.

Studies done to date have only examined the effects of NAC in patients who have existing cataracts, with impressive results. However, NAC's unique protective mechanism most likely means that using NAC before the development of eye problems, as a preventative, will provide useful protection from age-related eye disorders.

As a preventative: Use 1 drop of NAC eye drops once daily
For existing cataracts: Use 2 drops twice daily.
Then, after cataracts have been reduced to an acceptable level, use a maintenance dose of one drop twice daily.

Conclusion

Cataracts are a widespread age-related affliction. In the US alone, Medicare estimates the annual cost at $3.5 billion for the 1.35 million cataract operations performed annually. Considering the high cost of undergoing cataract surgery, and the low cost and low risk of using NAC eye drops, it makes sense to give this a try before doing something as dramatic and invasive as surgery.

References:

Babizhayev MA, Deyev AI, Yermakova VN, Semiletov YA, Davydova NG, Doroshenko VS, Zhukotskii AV, Goldman IM. Efficacy of N-acetylcarnosine in the treatment of cataracts. Drugs R D 2002;3(2):87-103
Abstract
Babizhayev MA, Deyev AI, Yermakova VN, Semiletov YA, Davydova NG, Kurysheva NI, Zhukotskii AV, Goldman IM. N-Acetylcarnosine, a natural histidine-containing dipeptide, as a potent ophthalmic drug in treatment of human cataracts. Peptides 2001 Jun;22(6):979-94
Abstract
Babizhayev MA, Yermakova VN, Semiletov YA, Deyev AI. The natural histidine-containing dipeptide N-alpha-acetylcarnosine as an antioxidant for ophthalmic use. Biochemistry (Mosc) 2000 May;65(5):588-98
Abstract

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NAC Eye Drops:An Important New Discovery in the Treatment and Prevention of Cataracts