Fifty percent of Americans over age 65 have some type of cataract. Cataract removal is the #1 cause for elderly surgery. Cataracts are increased with age, diabetes, high blood pressure, smoking, alcohol, sun exposure, low socio-economic status and low education.  A healthy diet appears very helpful in prevention.  I would avoid vitamin E supplements, but if you don't like spinach and broccoli, a lutein supplement helped in one study.

Dietary Factors for Cataracts: Spinach, Tomatoes, Cruciferae, Citrus, Melon, Folic Acid, Calcium, Vitamin E Good; Butter & Salt Bad: Alcohol, coffee, decaffeinated coffee, tea, and cola intakes were not associated with cataract extraction. Among food items, reduced ORs for cataract extraction (highest tertile of intake compared to the lowest), with 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), 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 butter (OR 2.8, 95% CI 1.2 to 6.4), total fat (OR 1.8, 95% CI 1.2 to 2.8), and salt (OR 2.4, 95% CI 1.4 to 4.0) compared to the lowest, and for consumption of oil other than olive oil (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). 207 cases. 600 controls. Ann Epidemiol 1996 Jan;6(1):41-6

Yogurt Safer than Milk; May be Protective: In a French study, milk ingestion was dose-related with cataract risk in lactose digesters (particularly in diabetics) but not in lactose maldigesters. Conversely, yogurt intake had a protective dose-effect on cataract formation for the whole population. Disturbed galactose metabolism in elderly and diabetic humans is associated with cataract formation. Birlouez-Aragon I, Ravelontseheno L, Villate-Cathelineau B, Cathelineau G, Abitbol G. J Nutr. 1993 Aug;123(8):1370-6

Lutein Associated with Fewer Cataracts: Modestly lower risk of cataract extraction in men with higher intakes of lutein and zeaxanthin but not of other carotenoids (alpha-carotene, beta-carotene, lycopene, and beta-cryptoxanthin) or vitamin A after other potential risk factors, including age and smoking, were controlled for. Men in the highest fifth of lutein and zeaxanthin intake had a 19% lower risk of cataract relative to men in the lowest fifth (relative risk: 0.81; P = 0.03). Among specific foods high in carotenoids, broccoli and spinach were most consistently associated with a lower risk of cataract. Harvard health professional study of 36400. Am J Clin Nutr 1999 Oct;70(4):517-24

Lutein Fewer Cataracts in Nurses: After age, smoking, and other potential cataract risk factors were controlled for, those with the highest intake of lutein and zeaxanthin had a 22% decreased risk of cataract extraction compared with those in the lowest quintile (relative risk: 0.78; 95% CI: 0.63, 0.95; P for trend = 0.04). Other carotenoids (alpha-carotene, beta-carotene, lycopene, and beta-cryptoxanthin), vitamin A, and retinol were not associated with cataract in multivariate analysis. Increasing frequency of intakes of spinach and kale, foods rich in lutein, was associated with a moderate decrease in risk of cataract. U Mass 12 year follow-up of 50,461 RNs. Am J Clin Nutr 1999 Oct;70(4):509-16

Lutein Supplement Improved Cataracts in DB: A 2 year Spanish PC DB study of patients with age-related cataracts given 15 mg lutein or 100 mg alpha-tocopherol or placebo 3 times a week found visual improvement with the lutein and cataract progression with placebo. Lutein, but not alpha-tocopherol, supplementation improves visual function in patients with age-related cataracts: a 2-year double-blind, placebo-controlled pilot study. Olmedilla B, Granado F, Blanco I, Vaquero M. Nutrition. 2003 Jan;19(1):21-

Vitamins and Minerals

Vitamin E 400 IU, Vitamin C 500mg No Benefit Cataract Prevention: 4767 pt with one opacity. AREDS study DB 6.3 yr f/u A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E and beta carotene for age-related cataract and vision loss: AREDS report no. 9. Age-Related Eye Disease Study Research Group. Arch Ophthalmol 2001 Oct;119(10):1439-52. Ed: Vitamin E supplements of over 200 IU/day may cause a slight increase in death.  It is not on my recommended list.

Vitamin E May Help: Three of six studies find plasma alpha-tocopherol inversely assoc with nuclear opacities. In Beaver Dam Eye Study of 5 year with 400 adults ages 50-86, serum alpha and gamma tocopherols RR 0.4 for highest vs. lowest tertile. Barb Lyle, Am J Clin Nutr U Wisc 69:272-7, 2/99

Vitamin E 400 IU, Vitamin C 500mg, + Zinc 80mg Helped Cataract Prevention: DB PC found only with the added zinc was prevention effective. Zinc by itself not as good as combo. RR 0.66. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Age-Related Eye Disease Study Research Group. Arch Ophthalmol 2001 Oct;119(10):1417-36

Vitamin E 650 IU, Vitamin C 750mg Slight Benefit Cataracts: REACT study 3 yr 297 pt DB found benefit in U.S. group but not in Brit group. Harvard, Ophthalmic Epidemiol 2002 Feb;9(1):49-80