Cataract Surgery When You Have Glaucoma
If you have both cataracts and glaucoma, planning cataract surgery can be a little more complex. As well as improving your vision by removing the cataract, it is important to consider your eye pressure, the severity and stability of your glaucoma, your current glaucoma treatment and whether cataract surgery should be performed alone or combined with a glaucoma procedure.
I am Ms Siene Ng, Consultant Ophthalmologist and Glaucoma Surgeon in Cardiff. I specialise in complex glaucoma and cataract surgery including the management of patients who have both cataract and glaucoma.
Can I have cataract surgery if I have glaucoma?
Yes. Cataract surgery is commonly performed in people with glaucoma and, for most patients, can be undertaken safely.
However, having glaucoma means that I may need to take some additional factors into account when planning your cataract surgery. I will consider the type and severity of your glaucoma, how well controlled your eye pressure is, whether your glaucoma is progressing, the number of glaucoma drops you use, and whether you have previously had laser treatment or glaucoma surgery.
I will also consider the health of your optic nerve and visual field when discussing the most appropriate lens implant and the likely visual outcome from surgery.
The aim is not simply to remove your cataract, but to choose an approach that gives you the best possible vision while protecting your glaucoma control in the longer term.
Can cataract surgery lower eye pressure?
Yes, cataract surgery can lower eye pressure in some people with glaucoma.
The amount of pressure reduction varies between individuals and depends partly on the type of glaucoma and the anatomy of the eye.
Cataract surgery can be particularly helpful in people with narrow drainage angles or angle-closure glaucoma. Removing the natural lens creates more space within the front of the eye, which can deepen the anterior chamber and open the drainage angle.
However, cataract surgery does not cure glaucoma. If your glaucoma requires a particularly low target eye pressure, you may still need glaucoma drops or additional treatment after cataract surgery.
Should I have glaucoma surgery at the same time as cataract surgery?
Sometimes cataract and glaucoma surgery can be performed together, but this is not necessary for everyone.
If you have a cataract causing you symptoms like misty vision or night time glare and your glaucoma is mild and well controlled, cataract surgery alone may be appropriate.
If your eye pressure is not adequately controlled, you are using several glaucoma medications, or your glaucoma is progressing, I may discuss combining cataract surgery with a pressure-lowering glaucoma procedure.
One option is minimally invasive glaucoma surgery (MIGS). Some MIGS procedures can be performed at the same time as cataract surgery and may help to lower eye pressure or reduce the number of glaucoma drops you need.
MIGS is not suitable for everyone. If you have more advanced glaucoma or need a very low target eye pressure, a different glaucoma operation may be more appropriate.
I will discuss the options with you and whether cataract surgery alone, cataract surgery combined with MIGS, or another glaucoma procedure is most appropriate for your individual eye.
Can I have cataract surgery after a trabeculectomy?
Yes. Cataract surgery can be performed after a trabeculectomy, but it requires some additional consideration.
A trabeculectomy creates a new drainage pathway for fluid from the eye, forming what is known as a bleb. If you have a functioning bleb, one of the considerations when planning cataract surgery is preserving its function.
Cataract surgery causes a degree of inflammation and healing within the eye. In some patients this can affect the trabeculectomy and lead to a rise in eye pressure several months later.
Before cataract surgery, I will assess how well your trabeculectomy is functioning and your current level of glaucoma control. I will also monitor your eye pressure and bleb carefully after surgery.
Having had a trabeculectomy does not mean that you cannot have cataract surgery. However, your previous glaucoma surgery should be taken into account when planning the operation and your postoperative care.
Which lens implant is best if I have glaucoma?
During cataract surgery, the cloudy natural lens is replaced with an artificial intraocular lens (IOL). If you have glaucoma, I will consider the type and severity of your glaucoma when discussing which lens implant is most suitable for you.
Monofocal lenses are an excellent option for many people with glaucoma. If you have significant astigmatism, a toric lens may also be considered.
Multifocal and some extended-depth-of-focus lenses require more careful consideration in glaucoma. Glaucoma can reduce contrast sensitivity, particularly when the disease is more advanced, and some premium lenses can also reduce contrast or cause visual effects such as glare and haloes.
Having glaucoma does not automatically mean that you cannot have an enhanced lens option. I will consider your optic nerve, visual field, severity and stability of your glaucoma, as well as your lifestyle and expectations, before discussing the most appropriate lens with you.
Will cataract surgery restore vision lost from glaucoma?
Unfortunately, cataract surgery cannot restore vision that has already been permanently lost because of glaucoma.
It can, however, improve the part of your vision that has been reduced by the cataract.
When cataract and glaucoma occur together, it is sometimes difficult to know how much of your visual difficulty is caused by each condition. I can use your eye examination, tests to help assess this and discuss the improvement you might realistically expect from cataract surgery.
What happens to my glaucoma drops after cataract surgery?
Unless I specifically advise you otherwise, you should continue your usual glaucoma drops.
Some patients may be able to reduce their glaucoma medication after cataract surgery, particularly if surgery has been combined with a glaucoma procedure. Others will need to continue their existing treatment.
This will depend on your eye pressure after surgery and the target pressure needed to protect your optic nerve. I will advise you if and when any changes to your glaucoma medication should be made.
What if I have narrow angles or angle-closure glaucoma?
Cataract surgery can be particularly beneficial for people with narrow drainage angles or angle-closure glaucoma.
The natural lens takes up considerably more space inside the eye than the artificial lens used during cataract surgery. Removing it can deepen the front of the eye and widen the drainage angle, which can help to lower eye pressure.
In some people with primary angle-closure disease, lens surgery can therefore form an important part of glaucoma treatment as well as improving vision from cataract.
I will consider the anatomy of your eye, your eye pressure, the presence of cataract and whether glaucoma damage has already occurred when discussing whether lens surgery is appropriate for you.
Do I need a glaucoma specialist for my cataract surgery?
Many people with mild, stable glaucoma can undergo routine cataract surgery successfully.
Specialist glaucoma input can be particularly useful if your glaucoma is moderate or advanced, progressing, difficult to control, associated with narrow angles, or if you have previously had glaucoma surgery.
It can also be helpful when deciding whether cataract surgery should be performed alone or combined with a glaucoma procedure.
Cataract and glaucoma assessment in Cardiff
XI provide private consultations for patients with cataract and glaucoma in Cardiff and South Wales, including patients seeking a second opinion where glaucoma makes cataract surgery or lens choice more complex.
During your consultation, I will assess your cataract alongside your glaucoma. Depending on your individual circumstances, this may include assessment of your eye pressure, optic nerve, visual fields and drainage angles, as well as reviewing your current glaucoma treatment, stability and any previous glaucoma surgery.
I will then discuss the options with you, which may include cataract surgery alone, cataract surgery combined with MIGS, or cataract surgery in an eye that has previously undergone glaucoma surgery.
My aim is to choose an approach that improves your vision while taking into account the long-term control of your glaucoma.
