Cataracts and Glaucoma

Cataract and glaucoma are “sister diseases”, and the incidence of both diseases increases after the sixties. The rate of cataracts in glaucoma patients is higher than in normal individuals. In some types of glaucoma (e.g., exfoliative glaucoma, myopia, narrow-angle glaucoma), cataract formation is more frequent, and cataract development may accelerate after glaucoma surgeries.

Cataract development can impair glaucoma control and make its follow-up difficult

In glaucoma treatment, the goal is to lower and control intraocular pressure to levels that will not pose a danger to the optic nerve (target intraocular pressure). However, considering that glaucoma continues for a lifetime and becomes more difficult to control with advancing age, it may be necessary to take additional precautions such as medication, laser, or operation over time.

During glaucoma follow-up, in addition to measuring intraocular pressure, it is also necessary to monitor the changes occurring in the optic nerve with computerized visual field tests or special diagnostic methods that analyze the optic nerve head. In the presence of a cataract, performing these tests accurately and following up on the disease may also become difficult.

Also, a maturing cataract can narrow the channel system where the fluid inside the eye leaves the eye, making it difficult for this fluid to drain and impairing the control of intraocular pressure.

One should not wait too long for cataract surgery in patients with glaucoma

Performing cataract surgery at an earlier stage in patients with glaucoma provides some benefits. First of all, in all types of glaucoma, there are certain decreases in intraocular pressure values after cataract surgery. Accordingly, glaucoma medications can be reduced after surgery, or if a single medication is used, it can be discontinued completely.

If the glaucoma type is “narrow-angle” or “closed-angle glaucoma,” the decrease in intraocular pressure is greater compared to “open-angle glaucoma” types. Therefore, cataract surgery to be performed in cases of “narrow or closed-angle glaucoma” can be recommended in the early period since it positively affects glaucoma treatment as well as visual improvement.

Cataract surgery can be more difficult in eyes with glaucoma

Today, the current method applied for cataract surgeries is “phacoemulsification,” and the lens material is aspirated using “ultrasonic” energy through an incision of approximately 2 mm, and an artificial intraocular lens is folded and placed into the cleaned bag.

Since the pupil dilates more difficultly in glaucoma patients, it may be necessary to use special auxiliary instruments and techniques during cataract surgery. In addition, the ligaments holding the eye lens in place may be weak in exfoliative glaucoma. This can cause the artificial intraocular lens placed in the eye to dislocate or shift. In this case, special precautions must be taken.

When should we perform glaucoma, when cataract, and when combined surgery?

If the cataract is at an advanced level, whereas the glaucoma is under control with a small number of medications, only cataract surgery can be performed, and glaucoma medications can be continued after the surgery.

If glaucoma cannot be controlled with medications, if there is advanced glaucomatous damage, and if the cataract is not very dense, glaucoma surgery should be performed first.

If the cataract is dense and, at the same time, glaucoma cannot be controlled with medications, cataract and glaucoma surgery can be performed in the same session.

This preference is determined by the physician, illuminating information is given to the patient, and the surgery is performed after obtaining the patient’s consent.