Glaucoma management can play important role with premium IOLs

By Jeffrey Whitman, MD

Cataract surgery is a unique opportunity to treat glaucoma in patients with concomitant disease. Unfortunately, many surgeons miss the opportunity out of fear that combining a glaucoma procedure negatively will impact the refractive results, especially those patients investing in a premium intraocular lens (IOL).

However, in my experience, a well-chosen minimally invasive glaucoma surgery (MIGS) procedure will, at worst, have no effect on the refractive outcomes, and may actually improve outcomes.

When physicians are evaluating glaucoma procedures to combine with cataract surgery, they worry about any procedure impacting a patient’s refraction or astigmatism. The next concern may be how an added glaucoma procedure might burden the physician with additional post-operative care.

Surgeons often fail to consider the risks involved with leaving patients on topical glaucoma drops. Anything that interferes with or irritates the corneal epithelium, such as dryness, will affect the patient’s vision, particularly with multifocal and extended depth of focus (EDOF) IOLs.

Unfortunately, chronic use of glaucoma medications causes epithelial dryness and/or toxicity issues. While glaucoma medications help preserve vision by protecting the optic nerve, many patients experience vision compromised by irritation of the corneal epithelium. If drops can be eliminated or reduced, not only will the glaucoma be better controlled, the patient can experience better vision.

 

 

MIGS procedure

I suggest MIGS for all mild-to-moderate glaucoma patients undergoing cataract surgery, particularly premium IOL patients. Performing a MIGS procedure may be the best, and possibly only, chance to reduce medications and better protect the patient’s eyes with lower intraocular pressure (IOP).

I have the most experience with the iStent trabecular microbypass (Glaukos). The iStent bypasses the trabecular meshwork (TM) by increasing aqueous flow into Schlemm’s canal from the anterior chamber.

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