Narrative review of age-related crystalline lens decline (DLS)
This narrative review describes dysfunctional lens syndrome as a progressive age-related decline in the crystalline lens that begins before clinically significant cataract, and proposes an integrated perspective for managing its stages. [1]
Automatic summary · not editorially reviewed
The key findings
The review describes dysfunctional lens syndrome as a progressive age-related decline in the optical and functional performance of the crystalline lens, with cataract as the most clinically recognizable endpoint of lens aging. [1]
According to the abstract, visual changes such as presbyopia, higher-order aberrations, intraocular scatter and reduced contrast sensitivity often occur much earlier than cataract. [1]
The authors describe a narrative review based on a PubMed search and reference lists of reviews, clinical studies and book chapters from the last 25 years. [1]
The source at a glance
- Study type / format
- Narrative review (abstract only)
- Population / context
- People with age-related changes of the crystalline lens, including those with preserved visual acuity but impaired quality of vision
- Summary based on
- Study abstract
- Original publication
- October 17, 2026
Lens aging before visible cataract
The review defines dysfunctional lens syndrome as a progressive age-related decline in the optical and functional performance of the crystalline lens. Cataract is described as the most clinically recognizable endpoint of lens aging, but visual changes often occur much earlier: presbyopia, increased higher-order aberrations, intraocular scatter, reduced contrast sensitivity and poorer retinal image quality. These are attributed to molecular, biomechanical and optical alterations across different stages.
Supporting source [1]
Search basis of the narrative review
The authors describe a narrative review based on a PubMed literature search plus reference lists of relevant review articles, clinical studies and book chapters from the last 25 years. Search terms concerned dysfunctional lens syndrome, the crystalline lens, lens aging, lens biomechanics, presbyopia, higher-order aberrations, the dysfunctional lens index and refractive lens exchange. Articles were chosen for relevance to molecular, biomechanical, optical, clinical and therapeutic aspects of lens aging.
Supporting source [1]
Proposed integrated management perspective
According to the abstract, the evidence indicates that lens aging begins before clinically significant cataract becomes evident. Molecular changes in long-lived crystallins, impaired redox homeostasis, altered ion-water balance and membrane remodeling are said to contribute to increased lens density, reduced transparency and protein aggregation, accompanied by lens growth, nuclear stiffening, loss of accommodation, altered gradient refractive index, higher-order aberrations, intraocular scatter and reduced contrast sensitivity. The authors suggest that recognizing dysfunctional lens syndrome may improve assessment of patients with preserved visual acuity but impaired quality of vision, and propose an integrated perspective as guidance for the practical ophthalmologist.
Supporting source [1]
How to interpret this
This is an abstract only; the full text was not reviewed. The source is a narrative review, not a new study, and its search and selection are described only briefly. The abstract reports no sample sizes, effect estimates or formal certainty assessment. The integrated management perspective is proposed, not validated.
Based on the study abstract; the full paper, tables and supplementary data were not reviewed.
Source & supporting passages
Janicijevic I, Teren D, Alió JL. · europepmc.org · October 17, 2026