Patients with glaucoma who need cataract surgery are no different than similar patients without glaucoma: Both groups expect a full range of vision after cataract surgery; neither group wants to be dependent on glasses, and both groups should be offered the most appropriate range of premium IOLs to meet those expectations.
“From the patient’s perspective, it’s all about the outcome,” said Richard A. Lewis, MD, co-founder of Sacramento Eye Consultants, Sacramento, CA.
“For the surgeon, managing all aspects of their refractive needs should be the obvious course,” Dr. Lewis said. “The premium lens—the right premium lens—has tremendous value in glaucoma.”
Premium IOLs in glaucoma
Cataract surgery is the most common surgical procedure used in patients with glaucoma, as well as the safest and most effective procedure for restoring vision, Dr. Lewis noted.
The surprise, he said, is just how few glaucoma specialists complete cataract surgery by implanting a premium IOL.
When it comes to recommending an IOL, the status of the patient’s glaucoma is only one factor to consider. Just like any other patient planning cataract surgery, visual needs and preferences for or against glasses are the most important factors.
Ask the right questions
All of the usual questions about work and lifestyle apply regardless of the presence or absence of glaucoma. Always ask patients what they do for a living and what they do for fun, Dr. Lewis advised.
Also, ask if they do close-up detail work, such as needlework.
It is just as important to explore their attitudes and preferences for glasses. Do they mind wearing glasses? Do they hate taking glasses on and off? The answers help shape IOL recommendations.
Traditional spherical IOLs offer monofocal vision. While traditional IOLs are less expensive than premium lenses, traditional lenses also provider less satisfactory visual outcomes compared with premium choices.
Too many glaucoma specialists forget that the premium IOL category includes several types of lenses. Each type of IOL offers a different combination of advantages and disadvantages that can make it more—or less—suitable for specific patients.