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Cataract Eye Surgery with Glaucoma: Is It Safe?

If you or a loved one has both cataracts and glaucoma, you might be wondering if cataract surgery is safe. The simple answer is yes! Cataract surgery is a commonly performed procedure that can be safely done for patients with glaucoma.

However, there are certain factors to consider, such as the severity of your glaucoma, the type of glaucoma you have, and whether a combined surgery might be more beneficial for you.

Rest assured, when planned carefully, cataract surgery can significantly improve your vision and may even help reduce eye pressure.

But that’s just the beginning of this story. I’m here to walk you through everything you need to know about undergoing cataract surgery when you have glaucoma.

From understanding these two eye conditions to pre and post-surgery care, this comprehensive guide will answer every question you have along the way.

AUTHOR

Ophthalmologist/ Eye Surgeon 13+ Years Exp

MBBS, MS – Ophthalmology

TSMC- TSMC/FMR/05251 (2018)

CONDITION

Cataract

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What Are Cataracts and Glaucoma?

Before we talk about surgery, it’s essential to understand what cataracts and glaucoma are, as these conditions affect the eyes in different ways.

Cataracts: A cataract is when the natural lens of your eye becomes cloudy. It’s a normal part of aging for many people and can cause blurry vision, difficulty seeing at night, and increased sensitivity to light. Cataract surgery is the only way to remove cataracts, where the cloudy lens is replaced with a clear artificial lens.

Glaucoma: Glaucoma isn’t just one condition, but a group of eye diseases that damage the optic nerve, often caused by high pressure within the eye. If untreated, glaucoma can lead to permanent vision loss. Unlike cataracts, the damage from glaucoma is irreversible, but early intervention and treatments can slow or stop its progression.

The Challenge of Having Both Cataracts and Glaucoma

Having cataracts and glaucoma together can complicate things. Cataracts primarily affect the clarity of your vision, while glaucoma poses a risk to your overall field of vision. If both conditions are advanced, your day-to-day activities, such as reading or driving, might become increasingly difficult.

One of my patients, Mr. Kumar, 72, came to me with both conditions. He had been diagnosed with glaucoma years earlier and was managing it with medications. However, increasing cloudiness in his vision from cataracts began to interfere with his ability to watch cricket on TV, something he truly loved.

“Doctor, I’m worried—I don’t want my glaucoma to worsen if I get surgery for cataracts,” he said during our consultation. The good news? With the right planning, we managed both conditions successfully.

How Cataract Surgery Helps Glaucoma Patients?

Cataract surgery for glaucoma patients works the same way it does for those without glaucoma. The cloudy lens is removed, and a clear artificial lens, called an intraocular lens (IOL), is implanted.

Here’s the interesting part about cataract surgery in glaucoma patients: Research shows that removing the cataract alone can lower intraocular pressure (IOP) in some cases. For those with early or moderate glaucoma, this can be a sizeable benefit as reducing IOP is a critical part of managing the disease.

For more advanced glaucoma or patients requiring additional pressure reduction, combined cataract and glaucoma surgery might be an option. Keep reading as we’ll discuss this soon.

Benefits and Risks of Cataract Surgery for Glaucoma Patients

⇒Benefits

Improved Vision: Cataract surgery removes the cloudy lens, leading to clearer, sharper vision.
Possible Reduction in Eye Pressure: Some glaucoma patients experience a drop in eye pressure post-surgery, particularly those with open-angle glaucoma.
Reduction in Glaucoma Medications: For some patients, fewer drops or medications might be needed after surgery.
Customised Lenses: Modern IOLs, such as multifocal lenses, can improve vision quality for activities like reading or driving.

⇒Risks

Pressure Spikes: Some patients might temporarily experience a spike in eye pressure after surgery. This is usually managed with medications.
Further Damage to the Optic Nerve: Precaution is critical for patients with advanced glaucoma to prevent worsening optic nerve damage.
Glaucoma Progression: While cataract surgery can help manage IOP, it is not a cure for glaucoma.

If you’re worried about these risks, rest assured doctors like me take plenty of steps to monitor and reduce complications.

Types of Surgery Available

There are different surgical approaches for patients with both cataracts and glaucoma. The choice depends on your specific condition and needs.

1. Cataract Surgery Alone

This is the most common approach for patients with stable or mild glaucoma. The cataract is removed, and the resulting reduction in IOP can often be enough to manage early-stage glaucoma.

2. Combined Cataract and Glaucoma Surgery

For patients with moderate to severe glaucoma or those struggling to control their IOP with medications, combining cataract surgery with a glaucoma procedure (such as trabeculectomy or a MIGS device) might be recommended. This approach tackles both issues simultaneously, potentially eliminating the need for future interventions.

3. Minimally Invasive Glaucoma Surgery (MIGS)

If you have mild glaucoma, your doctor might suggest pairing your cataract surgery with a MIGS procedure like the implantation of an iStent or Hydrus Microstent. These small devices work to improve fluid drainage and lower pressure.

Pre-Surgery Preparation

If you’re preparing for cataract surgery and have glaucoma, your doctor will take steps to ensure everything goes smoothly. Here’s what you can expect:

Thorough Assessment of Both Conditions: Detailed tests, including measuring your IOP, visual field testing, and evaluating the health of your optic nerve, are performed.
Medication Plan: Your glaucoma medications might be adjusted before surgery to optimise IOP levels and reduce the risk of pressure spikes.
Discussion About IOL Choices: Depending on your vision goals and eye health, different types of lenses might be recommended.
Managing Anxiety: Many of my patients feel nervous before surgery, especially if they’ve had glaucoma for years. It’s perfectly normal, and I always encourage open conversations so concerns can be addressed.

Post-Surgery Care and Recovery

Like any cataract surgery, recovery is typically smooth, though there are specific steps to follow as a glaucoma patient.

Follow Medication Instructions: You may need to continue using your glaucoma medications and prescribed post-surgery drops to manage inflammation and prevent infection.
Monitor Eye Pressure Closely: Regular post-op check-ups will include monitoring your IOP to detect and address any changes promptly.
Avoid Straining Activities: Protect your eyes by avoiding heavy lifting, bending, or rubbing your eyes for a couple of weeks. Remember, healing can differ for glaucoma patients, so don’t rush the recovery process.

*“For my glaucoma patients, I always stress that patience is key after surgery,” I told Mr. Kumar. By diligently following these steps, his vision became clearer within a few weeks, with no complications from his glaucoma.”

Alternatives and Additional Treatments

Cataract surgery may not always be the immediate solution for everyone. Here’s a look at other options available:

Managing Cataracts Conservatively: If your cataracts aren’t yet affecting your daily life, it might be safe to wait and focus on optimising glaucoma treatments.
Eye Drops and Medications: These can help control your glaucoma, allowing more time before cataract surgery becomes necessary.
Laser Surgeries: Non-invasive options like SLT (Selective Laser Trabeculoplasty) can be considered to manage eye pressure pre- or post-cataract surgery.
Regular Monitoring: For glaucoma patients, routine eye exams are crucial to track any changes and decide the best course of action.

Addressing Common Concerns

Patients often ask me the following questions before scheduling their surgery:

Will my glaucoma worsen after cataract surgery?
With appropriate planning, complications are rare. For many, the condition stays stable or benefits from the procedure.
Will cataracts come back?
No, cataracts don’t “grow back.” However, sometimes a thin layer of natural lens capsule remaining in the eye can become cloudy over time. This is easily treated with a quick and simple laser procedure.
Which surgeon should I choose?
Always choose a trusted and experienced ophthalmologist who understands how to balance the complexities of cataract and glaucoma co-management.

Final Thoughts

Cataract surgery for patients with glaucoma isn’t just safe; it often provides life-changing benefits. Whether you’re concerned about vision clarity, eye pressure, or recovery time, the key takeaway is that the procedure is tailored to you.

With a skilled surgeon by your side and advancements like MIGS and combined procedures, there are plenty of safe and effective ways to manage both conditions.

Remember, your vision is unique. Talk to your doctor about your concerns and goals, and choose the treatment plan that suits your needs best. Clearer, healthier vision could be just around the corner!

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