Human cataract: the mechanisms responsible; light and butterfly eyes.

Age-related cataract is the leading cause of world blindness. Until recently, the biochemical mechanisms that result in human cataract formation have remained a mystery. In the case of nuclear cataract, it is becoming apparent that changes that take place within the lens at middle age may be ultimately responsible. The centre of the lens contains proteins that were synthesised prior to birth and while these crystallins are remarkably stable, it appears that an antioxidant environment may be necessary in order for them to remain soluble and for lens transparency. Once an internal barrier to the movement of small molecules, such as antioxidants, develops in the normal lens at middle age, the long-lived proteins in the lens centre become susceptible both to covalent attachment of reactive molecules, such as UV filters, and to oxidation. These processes of protein modification may, over time, lead inevitably to lens opacification and cataract.