Why early cataract surgery may help glaucoma later


Cataract surgery not only can result in a reduction of IOP, it also provides benefits for future management of glaucoma, according to this article.

The treatment is generally safe, cost-effective, may improve vision in more than 90% of patients and may improve the margin of safety for future glaucoma surgery.

If such a therapeutic profile could be achieved with an eye drop, it would be a blockbuster, said Dr Kuldev Singh, MPH, professor of ophthalmology and director, Glaucoma Service, Stanford University School of Medicine, Stanford, California, USA.

Treatment background

Cataract surgery is already the most commonly performed IOP-lowering procedure.

While there are fewer than 100 000 glaucoma surgeries in the US annually, Dr Singh explained, an estimated 15% of the 3.5 million patients who undergo cataract surgery also have primary open-angle glaucoma or ocular hypertension.

That is about 500 000 patients who typically benefit from lower IOP following phacoemulsification.

Multiple studies and meta-analyses have shown similar IOP-lowering effects from cataract surgery, Dr Singh noted.

Some ophthalmologists may not recognize this benefit and hold off on cataract surgery until vision loss is more severe, he said.

While there must be vision loss impacting some activities of daily living to consider cataract surgery, the visual threshold for surgery should be different in patients with coexistent glaucoma who will likely derive added benefit from lower postoperative IOP.

The positive impact on IOP has not yet been fully integrated in surgical decision-making.

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