2011-06-29

lifestyle choices for blindness prevention

The Cataract Cure: The Russian eye-drop breakthrough: The story of N-acetylcarnosineintro

6.21: intro:
. 48% of world blindness is attributed to
Age-related cataract;
. the term "(aging) actually refers to
an increasing amount of metabolic disorder
including diabetes, hypertension, and hypothyroidism .
extent of cataract formation by age range:
42% affected by ages of 52 to 64,
60% affected by ages 65 and 74,
91% affected by ages 75 and 85 .

[. macular degeneration is the leading cause of
age-related blindness .
. there are some dietary factors that may prevent this;
but the most important contributary causes
are the same as for cataracts:
one's lifestyle or medication choices
can affect the rate of aging .
. for example,
at the same time there were cataracts [6.29:
within my circle of friends ]
there was also use of Dalmane,
a benzodiazepine sleeping medication
that is known to increase the likelihood of cataract .
. children and other behaviors are increasingly being
medicated with tranquilizers and other psychotropics
that contribute to the big 3 metabolic disorders:
diabetes, hypertension, and hypothyroidism .

. risk factors are [6.29:
proportional to one's lifetime dose,
and dose variations for ]
sunlight, smoking, alcohol, other medications .
. dietary protective factors
include:

# high-fiber vs high-carb':

[6.29: ie, high-carb diets are good only when
much of the carb is fiber,
and none of it has a high glycemic index .]

# good fat vs bad fat:

 [6.29:  mono'fats are good fats for energy;
other fats are essential for body maintenance;
use only low doses of fish-related poly'fats,
and even lower doses of non-fish poly'fats;
sat'fats cause carb'intolerance,
so they don't mix with a glycemic diet .]

# moderate fat vs high or low fat:

[6.29: mono'fats (olive oil, almonds, hazels)
are a safe source of energy;
but fats are a special source of
carcinogenic pollutants and mold toxins;
moreover,
low calorie is safer than high calorie .]

# peak resistance training

[6.29: short bursts of moving heavy things
can increase insulin sensitivity,
and reduce carb'intolerance .]

Ann Epidemiol. 1996 Jan; 6(1):41-6.
. this study indicates that diet
plays a considerable role in
the risk of [needing and being eligible for]
cataract extraction
in at least a certain Italian population,
with a protective action played by
some vegetables, fruit, calcium, folic acid,and vitamin E,
and an increased risk
associated with elevated salt and fat intake [6.29:
-- this could have been a measure of
where these Italians were getting their
extra doses of salt and fat:
the usual culprit is luncheon meat
-- known to promote diabetes by
mixing sugar with the meat .]
. a significant inverse trend in risk,
were found for intake of
meat (OR 0.6, 95% CI 0.4 to 0.9),
cheese (OR 0.7, 95% CI 0.5 to 1.0),
[implied a more low-carb' diet?
the atkins effect .
6.19: ie,
not necessarily an endorsement
of cheese ! ]
cruciferae (OR 0.5, 95% CI 0.3 to 0.8),
spinach (OR 0.6, 95% CI 0.4 to 0.9),
tomatoes (OR 0.5, 95% CI 0.4 to 0.8),
peppers (OR 0.7, 95% CI 0.4 to 1.1),
citrus fruit (OR 0.5, 95% CI 0.2 to 1.3),
and melon (OR 0.5, 95% CI 0.4 to 0.8).

. a significant increase in risk
was found for
the highest intake of
(compared to the lowest intake)
butter (OR 2.8, 95% CI 1.2 to 6.4),
[6.29: apparently Italian cheese is
not a significant source of butter ? ]
total fat(OR 1.8, 95% CI 1.2 to 2.8),
[ie, sat'fats vs oils]
salt (OR 2.4, 95% CI 1.4 to 4.0)
[luncheon meats vs fresh meats]

. a significant increase in risk
was found for consumption of
oil other than olive oil
[mono'fats vs poly'fats]
(OR 1.6, 95% CI 1.1 to 2.2).

Among micronutrients,
lower ORs for cataract extraction
(highest quintile of intake compared to the lowest)
were found for intake of
calcium (OR 0.5, 95% CI 0.3 to 0.8),
folic acid (OR 0.4, 95% CI 0.2 to 0.7),
and vitamin E (OR 0.5, 95% CI 0.3 to 1.0),
[this may have more to do with
the foods that provided these micronutrients]

. intakes of
methionine, retinol, beta-carotene,
and vitamins A, C, and D
were not associated with cataract risk .

foods that prevent macular degeneration:

6.20:
. being low on zeaxanthin or lutein
is associated with risk of amd
(age-related macular degeneration);
it's easy to get lutein
-- dark green leafy vegetables --
but zeaxanthin is a bit less common;
so this section has a list of
zeaxanthin-specific foods
sorted by density .
. some other carotenoids were included
for their anti-cancer importance .

. this research confirms previous reports
that the primary eyecare superfoods
are egg yolks for zeaxanthin
and dark green leafies for lutein .

. corn and sweet citrus are high in zeaxanthin
but not so relative to either
corn's glycemic and inflammation indices,
or citrus's fructose levels
(a source of liver-produced triglycerides).
--
. I noticed huge variations among 2 databases:
eg, the lab that gave percentages of zeaxanthins
differed wildly from percentages implied by
usda's nutrient density data;
so, consider this to be a very rough estimate
for where your eyecare diet should be .

sources of zeaxanthin:

. many texts give levels of carotenoids in foods;
here is a source that tells
what percentage of the carotenoids there are
for these famous varieties:
{zeaxanthins, lutein, lycopenes, beta-carotenes}
(as a percentage when counting by molecules,
not a percentage by weight):

Fruits and vegetables that are sources for lutein and zeaxanthin:
the macular pigment in human eyes
O. Sommerburg, J. Keunen, A. Bird, and F. J G M van Kuijk
Br J Ophthalmol. 1998 August; 82(8): 907–910.
todo:
see the articles that cited that one:
# elders respond postively to egg consumption
# controversial role of lutein and zeaxanthin
in protecting against age-related macular degeneration:
. most of the dark green leafy vegetables,
have 15-47% of their carotenoids as lutein,
but very little zeaxanthin (0-3%)
[6.20:
... not many were tested, however ...

. the reason dark green leafies may still
help to avoid macular degeneration
despite being short zeaxanthin,
is that this disease depends a lot on
metabolic disorder and clogged arteries
whereas dark green foods have a lot of
the magnesium from chlorophyll
that can support the insulin sensitivity
that prevents metabolic disorder;
and, they are also high in the
vitamin K that can hold calcium in bones
to prevent calcium-clogged arteries
(a major cause of irreversable circulation loss).

. this list is sorted by a food's
zeaxanthin density, which is a product of
both the ratio of zeaxanthin to other carotenoids,
and the total carotenoid density .
. even though corn appears to have
great values for zeaxanthins,
high-glycemic foods like corn
can bring down HDL; and ]
while most of the absorbed carotenoid
is carried in LDL,
53% of the (lutein, zeaxanthins) group
is carried by HDL .
[6.21:
. another source that conflicted with my first was:

Lutein and Zeaxanthin Scientific Review:

for instance, they claimed cooked spinach had
0.2 mg Zeaxanthin rather than 0.0000 .
. they gave a list of zeaxanthins per 100g servings,
which I have appearing like this:
[corn 0.5mg Z per 100g] -- with a Z added;
if the Z is not there, then it refers to
combined {zeaxanthins, lutein} amounts .]

== high-density zeaxanthin sources ==

ratio's of
zeaxanthins,
lutein,
beta-carotene,
and lycopenes(omitted if zero):
[plus amounts of (zeaxanthins, lutein) per serving]

35,54,0 Egg yolk [0.5 mg per 2 eggs (100g)][6.29:
^-- that number(35) mean 35% of the 0.5mg
is the rare zeaxanthins form ]
-- selenium 17.2 mcg (varies widely)

[Persimmons, Japanese, raw 0.49 Z per 100g]
[Spinach, raw 0.33 Z per 100g]
37,8,21 orange pepper [1.6mg Z per 100g]
2,27,11 brussel sprouts, [2.389mg per 155g]
3,36,12 green pepper [0.586 mg per 136 g]
5,47,5 zucchini squash [1.15mg per 100g of
... Squash, summer, zucchini, includes skin, boiled,]
3,27,0 scallions, [1.137mg per 100g of
. . . Onions, spring or scallions (tops and bulb).]
3,22,5 green beans, [0.64mg per 100g of
. . Beans, snap, green, raw, 0.44mg canned]
2,32,0,1 celery [0.494 mg per 150 g]
[Turnip greens, cooked 0.27 Z per 100g]
[Collard greens, cooked 0.27 Z per 100g]
[Lettuce. cos or romaine, raw 0.19 Z per 100g]
[Spinach, cooked 0.18 Z per 100g]
[Kale, cooked 0.17 Z per 100g]

== moderate-density zeaxanthin sources ==

ratio's of zeaxanthins, lutein, beta-carotene,
and lycopenes(omitted if zero):
[plus amounts of (zeaxanthins, lutein) per serving]

25,60,0 corn [0.19 mg per 28g --
. . a safe 100-colorie dose for this inflammatory grain]
http://nutritiondata.self.com/facts/cereal-grains-and-pasta/5687/2
[Tangerine, mandarin 0.14 Z per 100g]
20,15,8 orange juice [0.10mg per orange(86g)]
. 15,7,11,11 orange [0.17mg per peeled(131 g)]
. 6,6,48 nectarine [0.185mg per peeled(142g)]
18,17,48 honeydew melon [0.027 mg per 100g]
16,2,20,6 mango [0.023 mg per 100g]
10,43,16,5 red seedless grapes [0.072 mg per 100g of
. . . red or green seedless has ]
. 7,25,7 green grapes
. 4,33,6 red grapes [0.064mg per 100g of
. . Grapes, muscadine(has seeds).]
8,5,50 peach [0.089 mg per 98g]
4,38,4 cucumber [0.07mg per veg(301g)]

2,11,16,57 tomato juice (needs heat & oil)
0,6,12,82 tomato whole [0.08mg per 100g
. . but the lycopene is 9.66mg ]
1,19,17,13 apple(red delicious) [0.029mg per 100g of
. . . Apples, raw, with skin ]

== low-zeaxanthins relative to lutein ==

ratio's of lutein, beta-carotene,
and lycopenes(omitted if zero):
-- these are among the many examples of
high-lutein foods that have no zeaxanthins .
49,21 pumpkin
47,16,4 spinach
44,9 yellow squash
41,5 pea
37,0 butternut squash
22,27 brocolli
16,0 lettuce
12,0 yellow pepper
7,3 red pepper [0.05 mg per 100g]
2,55 carrots
1,87,3 cantaloupe

### top lutein+zeaxanthin foods at usda database: ###

. nutrients per food .
. foods rich in a given nutrient .
### Lutein + zeaxanthin ###
[. this data(pdf) was merged with the
zeaxanthin table (above) ]

### Lutein content of best sources ##

(extracted from a pdf)
Spinach, frozen, boiled, 130g 25.606 mg
Spinach, canned, 214 g 22.631 mg
-- Magnesium 87 mg per mg
-- Vitamin K (phylloquinone) mcg 493 per 100g
Kale, frozen, boiled, 130g 25.606 mg
Kale, boiled, 130 g 23.720 mg
-- Vitamin K (phylloquinone)      mcg 817 per 100g
-- Magnesium 18 mg per mg
Turnip greens, frozen, boiled, 164 g 19.541 mg
Collards, frozen, boiled, 170 g 18.527 mg
Collards, boiled, 190 g 14.619 mg
-- Vitamin K (phylloquinone)      mcg 440 per 100g
-- Magnesium 20 mg per mg
Turnip greens, boiled, 144 g 12.154 mg
Dandelion greens, boiled, 105g 9.616 mg
Mustard greens, boiled, 140g 8.347 mg
Squash, summer, boiled, 180 g 4.048mg
Peas, green, frozen, boiled, 360 g 3.840 mg
Peas, edible-podded, frozen, boiled, 160g 1.429 mg
Peas, edible-podded, boiled, 160 g 1.123 mg
Squash, winter, baked, 205g 2.901 mg
Beet greens, boiled, 144g 2.619mg
Pumpkin, boiled, 245 g 2.484 mg
Squash, summer, raw 113g 2.401 mg
Broccoli, frozen, boiled, 184g 2.015 mg
Broccoli, boiled, 156 g 1.685 mg
Broccoli, raw 88 g 1.235 mg
Lettuce, raw 1 head 163 g 1.993 mg
-- butterhead (includes boston and bibb types),
Lettuce, raw 1 head 539 g 1.493 mg
Lettuce, cos or romaine, 56 g 1.295 mg
-- iceberg (includes crisphead types),
Lettuce, green leaf, raw 56 g 0.969 mg
Asparagus, frozen, boiled, 180 g 1.112 mg
Carrots, boiled, 156 g 1.072 mg
Leeks, (bulb and lower leaf-portion), boiled,  104 g 0.962 mg
Asparagus, boiled, 60 g 0.463 mg
Asparagus, canned, 72 g 0.454 mg
Pepper, sweet, red, raw 119 g 0.061 mg

#### lycopene content of best sources ####

Watermelon, raw 6.889 mg per 152 g
Tomatoes, red, ripe, canned, 6.641 mg per 240 g
Tomatoes, red, ripe, raw, 4.631 mg per 180 g
Papayas, raw 2.559 mg per 140 g
grapefruit 1.745 mg per 123 g

supp's that may reduce blindness risk

(from macular degeneration and cataracts)

5 mg zeaxanthin,
10 mg lutein:
800 mg magnesium,
400 mg potassium
Lutein and zeaxanthin offer protect from both
age-related macular degeneration and cataracts .
. Carotenoids are fat-soluble,
and are therefore absorbed with oil;
eg, after steam-sterilizing the greens,
puree them with olive oil .
. leafy greens are a good source of
lutein, magnesium, and potassium;
esp'ly spinach . green = magnesium .
. supp's are economical .

0.5 ... 3.0 mg Melatonin at bedtime
400 mcg selenium
600 mg N-Acetyl-Cysteine or eggs
210 .. 420 mg R-ala (alpha lipoic acid)
. melatonin stimulates glutathione production;
it is a potent inhibitor of cataracts;
proven in animal models .
Melatonin production slows after age 40,
but by age 60 virtually no melatonin is produced
at a time when most cataracts develop.
. 3 mg of mel at bedtime in elders with AMD
prevented further vision loss (Yi 2005).
[6.21:
. melatonin needs selenium and cysteine to work;
egg yolk has 250mg of cysteine;
but it's not as stable as N-acetyl-cysteine;
so, it's recommended it be taken with vit'C,
and other anti-oxidants found in a normal diet,
along with the r-ala .]
. ala prevents cataract by
protecting glutathione synthesis.
. in animal models it reduced cataract by 40%
and protected the lens from losing
vitamins C, E, and glutathione.
. vitamin C is a first-line neutralizer of radical;
it is then recycled by glutathione .

. Selenium works with alpha-lipoic acid
to increase cellular concentrations of glutathione,
. Low plasma levels of vitamin E
increase the risk of lens opacities.
[. the Vitamin Book said vit'E's job was

facilitating the transport of selenium;
there have been contradictory results from
trying to megadose vit'E as an anti-oxidant .]
. cysteine is a component of glutathione;
A combination of diallyl disulfide
(a major organosulfide in garlic oil)
and N-acetyl-cysteine (NAC)
completely prevented cataract development in animals.
50 .. 150 mg riboflavin:
Riboflavin reduces oxidized glutathione;
it is a precursor FADH
(reduced flavin adenine dinucleotide)
which is used by glutathione reductase,
to reduce and activate glutathione;
it makes glutathione available for the enzyme
glutathione-selenium peroxidase,
which neutralizes peroxide free radicals .
250 mg Inositol nicotinate:
. occurs in high concentrations in the lens.
Inositol quenches reactive oxygen .
2.5 mg folic acid
50 mg B6 [6.29: that's a high dose; addicting?]
1 mg B12
. B-6 prevents free-radicals by
properly metabolizing homocysteine
and is required for absorption of vitamin B12,
and proper synthesis of nucleic acids.
. . low levels of the B vitamins that are
critical to the metabolism of homocysteine),
will result in elevated levels of homocysteine,
which is a risk factor for both AMD and
other cardiovascular diseases .
. supplementing with folic acid, B6, and B12
can significantly reduce the risk of AMD
in adults with high homocysteine (Christen 2009).
100-200 mg CoQ10;
500mg acetyl-L-carnitine
+ 500mg arginine base
[= acetyl-L-carnitine arginate? 6.29:
-- perhaps a patents issue]:
. Mitochondrial dysfunction can result in
reactive oxygen species
linked to both cataracts
and macular degeneration;
a combination of CoQ10, acetyl-L-carnitine,
and proper diet,
improved mitochondrial function .
Acetyl-L-carnitine can reduce cataract risk
by acetylating potential glycation sites
that would otherwise cloud lens crystallins .
DHEA
. abnormally low in patients with AMD (Bucolo 2005).
DHEA also has been shown to protect the eyes against
oxidative damage (Tamer 2007).
[6.21:
. do not take this hormone orally;
it can be very effective nasally
in micronized form 5..10mg;
or blenderize dhea into a progesterone cream .
. exercise can raise dhea,
as can lowering cortisol .

[6.29: my cortisol-lowering diet module is this:]
a low carb diet; and,
arginine+lysine several times:
1 tsp 3 times per day;
and 6tsp at night .]

120 mg Gingko biloba
100 mg bilberry
Gingko biloba has anti-cataract potential;
Bilberry, a proanthocyanidin,
Gingko biloba and bilberry may restore
microcapillary circulation.
. bilberry contains Anthocyanidins
and Cyanidin-3-Glucoside (C3G);
. anthocyanidins may prevent leakage from capillaries,
prevalent in neovascular AMD.
Studies also show that bilberry increases
oxidative stress defense mechanisms in the eyes (Milbury 2007).
C3G fights inflammation by
inhibiting inducible nitric oxide synthase (iNOS),
C3G increases cytokine adiponectin
[. helps burn energy instead of letting it
raise sugar levels and increase fat .]
C3G may be protect against Alzheimer’s
[. that wouldn't be surprising,
if it does reduce sugar spiking .]
C3G helps to induce apoptosis
in a number of human cancer lines .
Bioflavonoids are powerful inhibitors of
the enzyme aldose reductase.
If aldose reductase activity falls,
sorbitol is not synthesized.
This reduces the accumulation of
water in the lens.
The bioflavonoids quercetin, myrcetin,
and kaempferol (from limes)
specifically inhibit diabetic cataracts.
Gingko is a widely used flavonoid that
maintains microcirculation to the eye
and inhibits free radicals.
500-1000 mg carnosine
inhibits formation of AGEs
(advanced glycation end products)
Eye drops containing N-acetyl-L-carnosine
can delay vision senescence in humans:
effective in 100% of primary senile cataract cases
and 80% of mature senile cataract cases.
N-acetyl-L-carnosine eye drops are approved for
human use in Russia for the treatment of many eye diseases.
Brite Eyes II contains
1% N-acetyl-L-carnosine
L-Carnosine is an anti-glycation agent;
Topically applied N-acetyl-carnosine
prevented light-induced DNA strand breaks
and repaired damaged DNA strands (Specht 2000),
and has improved visual acuity,
glare and lens opacification
in animals and humans with advanced cataracts
(Williams 2006, Babizhayez 2009).
Phil Micans PharmB, Vice President, IAS Group:
Dr. Mark Babizhayev:
. the application of L-carnosine for the treatment of
human cataracts is misleading.
This is because L-carnosine readily becomes a substrate for
the activity of natural peptidases (i.e. carnosinase)
in the aqueous humor.
So much so, that there is
no sign of L-carnosine in the aqueous humor
within 15 minutes after instillation.
Furthermore,
I consider that L-carnosine eye-drops
may even be harmful for eyes because
it gradually releases histamine,
which, located as it would be
in the presence of the eye-lens
is a very toxic agent.
However, NAC eye-drops are resistant to
hydrolysis with natural carnosinase.
Therefore, NAC is the only currently known agent
which reverses and prevents human cataracts.
update understanding of cataract:
NewsRx.com 01-29-10/Study data from M.A. Babizhayev and colleagues
"The antioxidant activity of L-carnosine (beta-alanyl-L-histidine,
bioactivated in ocular tissues)
versus N-acetylcarnosine (N-acetyl-beta-alanyl-L-histidine,
ocular-targeted small dipeptide molecules)
was studied in aqueous solution
and in a lipid environment,
employing liposomes as a model of lipid membranes.
Reactive oxygen species (ROS) were generated by an
iron/ascorbate promoter system for induction of lipid peroxidation (LPO),"
investigators in Russia report .

"L-carnosine, which is stabilized from enzymatic hydrolysis,
operates as a universal aldehyde and ROS scavenger
in both aqueous and lipid environments
and is effective at preventing ROS-induced damage
to biomolecules.
Second-generation carnosine analogs bearing the
histidyl-hydrazide moiety
were synthesized and tested versus L-camosine
for their ability to reverse the glycation process,
also known as the Maillard reaction,
and reverse the stable intermolecular cross-links,
monitored in the glucose-ethylamine Schiff base model,
ultimately resulting in the formation of
the advanced glycation end products (AGES)
from nonenzymatic glycation,
accumulating in numerous body tissues and fluids.
The obtained data demonstrate the transglycation properties
of the ophthalmically stabilized L-camosine
and L-carnosine histidyl-hydrazide derivatives tested
and can be used to decrease or predict the occurrence of
long-term complications of AGE formation
and improve therapeutically the quality of vision
and length of life for diabetes mellitus patients
and survivors with early aging.
Scientists at Innovative Vision Products, Inc. (IVP),
developed lubricant eyedrops designed as a
sustained-release 1% N-acetylcarnosine prodrug of L-camosine.
The eyedrops contain a mucoadhesive cellulose-based compound
combined with corneal absorption promoters
and glycerine in a drug-delivery system.
Anti-aging therapeutics with the
eyedrop formula including N-acetylcarnosine
showed efficacy in the nonsurgical treatment of
age-related cataracts for enrolled participants
in the prospective, randomized, double-masked,
placebo-controlled crossover clinical trial
after controlling for age, gender, and daily activities.
In a cohort in excess of 50,500 various patients
seeking cutting-edge medical care,
the N-acetylcamosine topical eyedrops target therapy
was demonstrated to have significant efficacy, safety,
and good tolerability for the prevention and treatment of
visual impairment in this older population
with relatively stable patterns of causes
for blindness and visual impairment.
Overall, accumulated study data demonstrate that
the IVP-designed new vision-saving drugs,
including N-acetylcarnosine eyedrops,
promote health vision and prevent vision disability from
senile cataracts, primary open-angle glaucoma,
age-related macular degeneration, diabetic retinopathy,
and aging.
N-acetylcarnosine eyedrop therapy is the crown jewel of the
anti-aging medical movement
and revolutionizes early detection, treatment,
and rejuvenation of aging-related eye-disabling disorders,"
wrote M.A. Babizhayev and colleagues.

Babizhayev and colleagues published their study in
American Journal of Therapeutics
(
N-Acetylcarnosine Lubricant Eyedrops
Possess All-In-One Universal Antioxidant Protective Effects
of L-Carnosine in Aqueous and Lipid Membrane Environments,
Aldehyde Scavenging, and Transglycation Activities
Inherent to Cataracts:
A Clinical Study of. American Journal of Therapeutics,
UNKNOWN DATE;16(6):517-533
).
For additional information, contact
M.A. Babizhayev, Innovat Vis Prod Inc.,
Moscow Division, Ivanovskaya 20, Suite 74, Moscow 127434, Russia.
The publisher of the American Journal of Therapeutics
can be contacted at: Lippincott Williams & Wilkins,
530 Walnut St., Philadelphia, PA 19106-3621, USA.

medications that increase blindness risk

6.22:

pills vs eyes 2008:

Open-angle glaucoma
((a bunch of corticosteroids))
Angle-closure glaucoma:
--[ what do these drugs have in common with eph? ]
[any anticholinergic may precipitate narrow-angle glaucoma]
cimetidine     TAGAMET
ephedrine   PRIMATENE, eph
epinephrine     ADRENALINE, PRIMATENE MIST
fluoxetine     PROZAC, SERAFEM
fluvoxamine     LUVOX
ipratropium     ATROVENT
paroxetine     PAXIL, PEXEVA
ranitidine     ZANTAC
sulfamethoxazole (with trimethoprim)     BACTRIM, COTRIM, SEPTRA
sulfisoxazole     GANTRISIN
topiramate     TOPAMAX
venlafaxine     EFFEXOR, EFFEXOR XR
Cataracts
betamethasone     ALPHATREX, DIPROLENE, DIPROSONE
busulfan     BUSULFEX, MYLERAN
chlorpromazine     THORAZINE
desoximetasone     TOPICORT
dexamethasone     DECADRON, HEXADROL, MYMETHASONE
fluocinolone     SYNALAR
fluocinonide     LIDEX-E, LIDEX
hydrocortisone (oral)     CORTEF, HYDROCORTONE
hydrocortisone (topical)     ALA-CORT, HI-COR, HYTONE, NEACLEAR LIQUID OXYGEN SCAR, PENECORT, SYNACORT
methylprednisolone     MEDROL
prednisolone     PRELONE
prednisone     DELTASONE
thioridazine     MELLARIL
triamcinolone (injectable)    
triamcinolone (topical)     ARISTOCORT, KENALOG, TRIACET, TRIDERM
Retinal Abnormalities
acitretin     SORITANE
chloroquine     ARALEN
chlorpromazine     THORAZINE
etretinate     TEGISON
hydroxychloroquine     PLAQUENIL
isotretinoin     ACCUTANE
tamoxifen     NOLVADEX
thioridazine     MELLARIL
tretinoin     RENOVA, RETIN-A
vitamin A (retinol)     AQUASOL A
Optic Nerve Diseases
amiodarone     CORDARONE, PACERONE
ethambutol    
linezolid     ZYVOX
sildenafil     VIAGRA
tadalafil     CIALIS
vardenafil     LEVITRA

sleeping aids

dalmane is a benzodiazepine

dalmane cataracts heavily affect females:
. of the few people developing Cataracts while on Dalmane
most were women, and 21% were
age 20..30 -- very early for cataracts .
[6.29:
. keep in mind that nothing here is proven;
because, it's epidemiology,
not data from randomized studies .
-- this reminds that the pharm'industry
was once notorious for allowing women to be users,
but not including women in their pre-market trials;
dalmane could be one of these?
had they taken women's chemistry into account,
there may have been a different presentation of it ? ]

anti-aggressives

benzodiazepines are related to anti-aggressives:
Epidemiological reviews have suggested
a possible link between cataract occurrence
and other psychotropic medications,
including benzodiazepines .
. long-term use of corticosteroids, phenothiazines,
certain other antipsychotic drugs,
some antineoplastic agents, and amiodarone
may increase cataract incidence.

. in the mid-1960s,
a decade after the marketing of phenothiazines,
drug-related ocular changes were reported in
patients who had been receiving years of
high-dose antipsychotic medication;
chlorpromazine was the primary offender.

Research also associated cataract occurrence with
other phenothiazines;
thioridazine, thiothixene,
trifluoperazine, levomepromazine,
and perphenazine are frequently cited examples.

A 1999 study of cataract occurrence
compared schizophrenic patients (26%)
with the general population (<1%).
. in addition to pharmaceutical exposures
schiz'ics often have additional risk factors:
smoking and poor dietary habits,
along with emotion-based metabolic disorders
(high cortisol, high insulin,
and blood sugar instabilities) .
[6.21:
. some of the new atypicals are clearly
increasing carb' intolerance,
and thus any cataracts blamed on sugar instabilities
must again point the blame at these meds .]

Epidemiological reviews have suggested
a possible link between cataract occurrence
and other psychotropic medications,
including benzodiazepines
and certain antidepressants
of the tricyclic and mao inhibitor classes .
ref# Exposure to phenothiazine drugs and risk of cataract.
Arch Ophthalmol. 1991;109(2):256-260.
Clinical reports have indicated an increased risk of
ocular opacities in users of phenothiazine drugs,
and some recent epidemiologic studies have found
an association between cataract and a
history of tranquilizer use.
To examine the effects of major tranquilizers
(phenothiazines and haloperidol)
on the risk of cataract extraction,
while controlling for suspected risk factors
such as diabetes and steroid use,
a matched cohort study was performed .
The use of either antipsychotic
or other phenothiazine drugs
increased the risk of cataract extraction
by roughly 3.5 times
in those who were both current users
and were exposed some time in the
2 to 5 years prior to their extraction.
Risk was also increased in individuals with
prior use of
antidiabetic agents,
systemic steroids,
and benzodiazepines.
ref# Sunlight and other risk factors for cataracts:
an epidemiologic study.
American Journal of Public Health, Vol. 78, Issue 11 1459-1462
. relation between individual exposure to sunlight
and the risk of cataracts.
Sunlight exposure was very slightly related to
all types of opacities combined.
Although the numbers of cases with
each type of opacity was small,
the risk of cataracts was slightly increased
in medium and high exposure categories
for persons having cortical or
posterior subcapsular opacities only,
but not nuclear sclerotic changes.
Persons with dark brown or hazel eyes
are at increased risk.
An unexpected finding was that
persons who reported using tranquilizers
for six months were at increased risk.
renewed interest in issue with anti-aggressives
. recent questions about quetiapine (seroquel)
as a possible cataract inducer
have increased the current interest in this issue
across the antipsychotic pharmacotherapy spectrum.

. photosensitizing agents
like chlorpromazine and its metabolites
denature proteins,
which become opacified when exposed to sunlight
and are deposited in the lens, cornea, and skin.
Melanin is also considered a probable cause
of lens discoloration
because it traps free radicals produced by
chlorpromazine.
Melanin and chlorpromazine
have a strong bonding affinity.
When chlorpromazine interacts with
ultraviolet-B light,
it produces purple or bluish colored
free-radical metabolites.
This phototoxic reaction creates the
cataract cellular changes.
-- agingeye.net's summary:
Thorazine has been shown to be associated with
pigmented corneal deposits
and anterior capsular cataracts.
Pigmentary retinopathy is usually associated with
a much higher dose (>2400 mg/d).
Pigment deposition on the cornea and lens
appears to be dose related and is usually irreversible.
Chlorpromazine-induced anterior cataracts
do not normally extend to the rest of the lens
even when patients continue taking chlorpromazine.
They usually enjoy good vision for a long period
despite a dense cataract at the pupillary region.
Thioridazine (Mellaril)
has also been reported to induce
lenticular changes unrelated to pigmentary retinopathy.
[Siddall J:
Ocular complications related to phenothiazines.
Dis Nerv Syst 1968; 29:10-13]
However, contrary reports have indicated
no evidence of lens opacity
in patients taking this drug.
[Barnes G, Cameron M:
Skin and eye changes with chlorpromazine therapy.
Med J Aust 1966; 1:478-481]
the risk of cataract occurrence remains unclear.
[6.29:
it's mainly known for retinopathy:
(Thioridazine can remain bound to melanin
in the retinal pigment epithelial cells
for many years with progressive visual loss
despite discontinuation of their use.)]
Ziprasidone (Geodon)
Cataract occurrence was observed as an infrequent finding
during screening for adverse events
before ziprasidone was approved for clinical use.
[Geodon, in Physicians' Desk Reference, 56th ed.
Montvale, NJ, Medical Economics Co, 2002, pp 2688-2692]
However, there is no known causal connection
between this drug and lenticular opacities.
6.22:
Claudio Cepeda`Psychotic symptoms in children and adolescents
. cataracts from chlorpromazine, thioridazine, and perphenazine
seem to be more frequent in young schiz'ic's
with rates in 22 ... 26%;
the young schiz'ics have an 82%
overall ocular pathology rate .
. these numbers seemed consistent with
smoking and diabetic effects
and there are multiple sources of diabetes
in most schiz'ics:
chronic stress, poor sleep, and bad diet .
. thioridazine > 800 mg results in
irreversible retinal pigmentation
which can result in blindness .
Handbook of Psychiatric Drug Therapy
 By Lawrence A. Labbate,

[. among the antipersonell drugs
-- anti-psychotics, anti-aggressives --
all the highly sedating ones
{ thioridazine
, chlorpromazine
, quetiapine
} are suspected of causing cataracts;
is this true also for any of the
moderately sedating: ?
{ fluphenazine
, trifluoperazine
, loxapine
, molindone
} ]
. any anticholinergic may precipitate
narrow-angle glaucoma;
this happens less with the higher-potency 1st gen's,
and by avoiding co.use of antiparkinson drugs,
most of which are anticholinergics
(another class of antiparkinson drugs
is the dopamine releaser, eg: amantadine).
. thioridazine has potent anticholinergic effects .

. the antipsychotics best known for
not causing weight gain (abilify, geodon)
also may cause insomnia that leads to
co.use of benzodiazepines or trazodone;
benzodiazepines are anticholinergic .
[trazodone is weakly anticholinergic
but used cautiously on elders who have
glaucoma, especially angle-closure .]
. non-sedating antipsychotics are also
the most likely among
later generation antipsychotics to cause
akathisia (6.29:
that is the feeling of
getting sick from having to sit still;
but moving around doesn't really help
because the lack of stimulation
has to do with the way certain meds
can affect your neuro-hormones .
people with natural akathisia
are said to have attention deficit disorder,
and the cure is amphetamines;
generally the opposite of anti-dopaminergics)
. akathisia is more likely in
the higher-powered 1st-gen's
(they have less anticholinergic properties);
so they may be co.used with
sedatives:
# beta-adrenergic blockers
(propranolol or nadolol);
# or rarely a benzodiazepine or clonidine .

. quetiapine induces cataracts in animals
so the product label susggests slit-lamp exam's;
ophthalmologic studies find no evidence
supporting regular eye exam's;
however, since schiz'ics have
other risk factors for cataracts,
a referral to an ophthalmologist
for an eye exam
can be part of routine medical care
[6.29:
. but that shouldn't be expected;
not in tightly managed hmo's, right? ]

[. in the section on endocrine side effects
there's no mention of effects on thyroid;
of course,
there's no mention of insulin either,
but there's a whole section reserved for
"(weight gain),
and that's all with a chapter titled:
"(metabolic monitoring for 2nd-gen antipsychotics) !
...
. plus, what do you say about something like dhea,
after your profession has publically said
dhea seems to have no function ? ]
. diabetic ketoacidosis remains a rare possiblity
for all these antipsychotics .

. among the new anti-aggressives,
ziprasidone and aripiprazole cause
the least weight gain,
[ziprasidone is not a sedative;
if you're used to sedatives,
it can cause eno' anxiety to inhibit appetite .]
. all schiz'ics on 2nd-generation antipsychotics
should be monitored at least twice yearly
for glucose abnormalities
and lipid profile .
[is ziprasidone 2nd generation?
it specifically prefaced the call for
diabetes monitoring
with the assertion that ziprasidone
was causing no glucose abnormalities .
6.29:
. yea, but geodon's anx might increase
carb intolerance?
or they could be saying that
one may as well operate as if
geodon is not being used,
because they don't think highly of it
(they mention the profession was finding out
the dose needed to suppress aggression
is considerably higher than documented
and the new dose and rate of attack
could precipitate a cardiac event .]