Our Summary

This research paper discusses the challenge of managing a patient with both cataract and glaucoma, two eye conditions that can lead to vision loss. The strategies to treat these conditions are still being debated. Currently, the surgical choices include: removing the cataract only, performing glaucoma surgery then cataract removal, or combining both surgeries.

When glaucoma can be managed with medication and the vision loss is moderate and not getting worse, the researchers suggest just removing the cataract. However, if the glaucoma is severe (requiring three or more medications) and there is an early-stage cataract, it might be best to delay cataract surgery until after the glaucoma has been treated. This is because the process of removing the cataract could potentially make the glaucoma worse. Additionally, removing a cataract after a glaucoma surgery could reduce the effectiveness of the glaucoma treatment.

If both glaucoma and cataract are significantly affecting vision, a combined surgery might be the best approach as it could potentially lower the pressure in the eye more than just removing the cataract.

FAQs

  1. What are the surgical options available for treating coexisting cataract and glaucoma?
  2. When is it suggested to opt for phacoemulsification alone in the treatment of cataract and glaucoma?
  3. What factors should be considered when deciding the order of cataract and glaucoma surgeries?

Doctor’s Tip

A doctor might advise a patient undergoing glaucoma surgery to follow post-operative care instructions carefully, including using prescribed eye drops as directed, avoiding strenuous activities that could increase eye pressure, and attending follow-up appointments to monitor progress and make any necessary adjustments to treatment. It is also important for patients to communicate any changes in vision or symptoms to their doctor promptly.

Suitable For

Patients who are typically recommended glaucoma surgery are those with refractory glaucoma (requiring 3 or more types of medication), those with early-stage cataract and moderate nonprogressive visual field defects, and those with both glaucoma and cataract that are sight impairing. Combined surgery may be indicated in cases where both conditions are present to achieve a greater decrease in intraocular pressure. Patients with a coexistence of cataract and glaucoma should be evaluated on a case-by-case basis to determine the most appropriate surgical management option.

Timeline

Before glaucoma surgery:

  • Patient may experience symptoms such as blurry vision, eye pain, headaches, and halos around lights
  • Patient undergoes a comprehensive eye exam, including measuring intraocular pressure, visual field testing, and evaluating the optic nerve
  • Ophthalmologist discusses treatment options, including medication, laser therapy, and surgery
  • Patient may need to discontinue certain medications or follow a specific pre-operative regimen

After glaucoma surgery:

  • Patient may experience mild discomfort, redness, and blurred vision immediately following surgery
  • Patient is prescribed eye drops to prevent infection and reduce inflammation
  • Follow-up appointments are scheduled to monitor intraocular pressure and healing
  • Visual acuity and visual field may improve over time as the eye heals
  • Patient may need to continue using eye drops or other medications to control glaucoma and prevent complications

Overall, the goal of glaucoma surgery is to reduce intraocular pressure, preserve vision, and improve quality of life for the patient. Regular follow-up care and adherence to post-operative instructions are important for successful outcomes.

What to Ask Your Doctor

  1. What are the different surgical options available for treating glaucoma and cataracts?

  2. What are the potential risks and complications associated with glaucoma surgery?

  3. How long is the recovery time for glaucoma surgery and what can I expect during the recovery process?

  4. Will I still need to use glaucoma medication after the surgery?

  5. How successful is glaucoma surgery in improving my vision and managing my glaucoma?

  6. Are there any alternative treatments or procedures that I should consider before opting for surgery?

  7. How will the surgery affect my cataracts and will I need additional treatment for them in the future?

  8. How often will I need follow-up appointments after the surgery and what will be involved in these appointments?

  9. Will the surgery be covered by my insurance and what are the potential costs associated with the procedure?

  10. Are there any lifestyle changes or precautions I should take after the surgery to ensure the best possible outcome?

Reference

Authors: Marchini G, Ceruti P, Vizzari G, Berzaghi D, Zampieri A. Journal: Dev Ophthalmol. 2017;59:155-164. doi: 10.1159/000458494. Epub 2017 Apr 25. PMID: 28442695