The Physiology of Cataract Formation
Numerous mechanisms are presumed causative for cataracts, including fluid and ion imbalance, oxidative damage, protein modification, and metabolic disruption. A disturbance in fluid regulation can be caused by ionic pump dysfunction and/or membrane permeability increase that allows water accumulation. If Na+/K+ ATPase pump activity decreases significantly, a rise in Na+ in the cytoplasm is accompanied by an influx of water, the lens fibers swell and tranparency diminishes. An increased level of cytoplasmic Ca++ is also associated with a loss of transparency.Water accomulation between fibers can form vacuoles causing a disruption offiber arrangement and increased light scatter. UVR snd oxidative damage as a result of free radical accumulation affects cellular function, damages lens DNA, causes protein modification, and high-molecular-weight crystallin aggregations, any of which can increase light scatter. Alpha crystallins, as molecular haperones, help to stabilize beta/gamma crystallin configuration but by age 40 have dissappeared from the lens nucleus, although the normal lens usually remains fairly transparents for year past that age. But as the concentration of alpha crystallins is reduced, aggregates accomulate and with time form light-scattering opacities.
Glutathione and ascorbate maintain reducing environment providing some protection from free radical damage and preventing protein modification. Reduced levels of glutathione allow oxidative amage o membranes and proteins. A decrease in glutathione concentration is associated with cataract development. A barrier, specterculated to develop in middle age and located at the interface of the cortex and nucleus, seems to impede the flow of small molecules from the cortex into the nuvleus and might account for the reduction in glutathione in the nucleus. A modification of the connexins in gap junctions causes a disruption in communication between fibers and might be one cause of this barrier. Changes occur in aquaporin channel proteins in the innermost nuclear regions of the lens as ealry as age 5 and by middle age (age 40 to 50), half of such channels are lost in the region of the speculated barrier . These changes can lead to the occlusion of the water channels and contribute to the barrier function
A diabetic cataract results from elevated glucose levels and can develop rapidly. With increased blood glucose, excess glucose present in the aqueous enters the lens. As this excess glucose is metabolized, sorbitol accumulates faster than it is converted to fructose. Sorbitol concentration increases within the lens fiber, because sorbitol does not readily pass through the fiber membrane, and thus water is drawn into the fiber. The fibers swell, the lens loses transparency, and the fibers may eventually rupture