Glaucoma and the Ageing Eye
• Glaucoma is the leading cause of irreversible and preventable visual disability worldwide (accounting for 12% of global blindness)
• The surgical management of the patient with cataract and glaucoma is dictated by the severity of the glaucoma, pre-operative intraocular pressure (IOP) control, and individual patient factors
• In patients with well-controlled IOP and early to moderate disease, cataract surgery alone could be considered, as this may reduce IOP by 2-4 mmHg (mostly not sustainable over longer term).
• In patients with uncontrolled moderate to severe glaucoma on maximal tolerable medical therapy, staged surgery where trabeculectomy is completed first may be reasonable, or combined cataract and trabeculectomy could be considered. However, visual recovery and post-operative course are usually longer.
• In patients with mild to moderate glaucoma and a desire to decrease medications or improve IOP control, a combined MIGS and cataract surgery may be appropriate. However, long-term outcomes data is not yet available.
• Multifocal lenses should be not be placed in patients with glaucoma and used with caution in glaucoma suspects.
• Femtosecond laser-assisted cataract surgery may be safe to use in glaucoma but should not be used in patients with a filtering bleb.
• Intra-vitreal injection of antivascular endothelial growth factors can cause sustained IOP rises and patients should be monitored closely and treated accordingly.