As both glaucoma and cataract primarily affect the older people, it is often common to see patients who have both diseases coexisting. Also, as we age, all of us will need cataract surgery, and this includes glaucoma patients as well. Glaucoma however, disease complicates matters a little, and these patients need extra care both before, during and after surgery.
These are the special considerations for deciding about cataract surgery in eyes with glaucoma:
1. When cataract is not affecting vision:
Not all cataracts require treatment: If the cataract doesn’t interfere with the glaucoma patient’s activities, and the vision loss is not significant, then there is no immediate need for cataract surgery in the eye. The glaucoma can be treated first with laser surgery or medication as decided by the eye doctor, or even by surgery if required.
2. When glaucoma is not threatening vision:
That is, in patients with mild glaucoma, and visually significant cataract,the doctor can decide to remove the cataract first, and then decide on glaucoma therapy.
This is especially important because cataract surgery can lower eye pressures in most patients, which can help in better management of their glaucoma as well.
3. When both cataract and glaucoma are severe–
In this subgroup of patients where both cataract and glaucoma require definitive and immediate action, a combined surgery may be performed. This can be cataract removal with IOL implantation, along with glaucoma surgery like trabeculectomy, or Ahmad Glaucoma Valve implantation. This is called a triple procedure.
The decision regarding which of these steps must be taken by an experienced glaucoma surgeon, who will perform a comprehensive evaluation of the glaucoma, in consultation with a cataract surgeon, to ensure the best clinical outcome in this situation.
These are the special precautions during cataract surgery in glaucoma patients:
The special precautions which must be taken before, during and after cataract surgery in glaucoma patients include:
1. Your doctor may stop certain drugs before cataract surgery to improve outcomes. These include pilocarpine and drugs from the prostaglandin group. This may be done for up to a week before surgery, and be continued for four to six weeks in the post-operative period. You may be prescribed an alternate eye drop or an oral medicine during this period.
2. In case of advanced glaucoma, with severe field loss, your doctor will discuss the visual prognosis with you. If you have had prior glaucoma surgery, the doctor will discuss the risks of failure of that surgery with you in addition to the visual prognosis.
3. Your doctor will also want to set a new baseline for visual fields, eye pressures and RNFL thickness since your cataract can also make them seem a lot worse than they actually are.
The good news is that there usually is a drop in eye pressure after cataract surgery, so your doctor may want to reduce the number of medications needed by glaucoma patients after the healing is complete following surgery. Despite this, you may need extra glaucoma medications during the immediate post-operative period because you will be given steroid eye drops which can increase eye pressures, as can the surgical trauma:
4. The main thing to remember is that cataract surgery in a glaucoma patient cannot be treated like a simple cataract surgery, and requires special expertise. That said, current technology for cataract surgery is extremely safe and effective in restoring vision, provided the proper precautions are taken, and the surgeon is experienced.
Your treating ophthalmologist will tailor the specific treatment plan for your eyes if you have both cataract and glaucoma and need surgery. This will ensure that the cataract surgery in an eye with glaucoma derives maximum benefits and minimizes the risk to the eye.