A 56-Year-Old Man Comes to the Physician Because of Progressive

A 56-year-old man comes to the physician because of progressive worsening of vision in both eyes over the past 6 months. The patient reports that during this period he has had blurry vision and a glare in the evenings. He works as a tower crane operator and spends most of his day outdoors. Ophthalmologic examination shows visual acuity of 20/100 in both eyes. Which of the following is the most likely etiologic factor for this patient's eye condition?

A) Accumulation of sorbitol in the lens
B) Age-related oxidative injury
C) Decreased collagen fibril production
D) Ischemia and neovascularization
E) Loss of lens distensibility