Advances in Cataract Surgery for Patients with Glaucoma

MIGS: A Gentler Approach to Glaucoma
One of the most significant developments in recent years is Minimally Invasive Glaucoma Surgery (MIGS). These procedures can be performed at the same time as cataract surgery, helping to lower eye pressure with minimal additional risk or recovery time.

Two Notable MIGS Devices
iStent: This tiny titanium device—one of the smallest medical implants used in the human body—creates a permanent opening in the eye’s natural drainage system. Think of it as installing a tiny bypass to help fluid flow more freely out of the eye, reducing pressure. It’s inserted through the same small incision used for cataract surgery.

Hydrus Microstent: Slightly larger than the iStent, this flexible scaffold supports a larger section of the eye’s drainage canal, keeping it open to improve fluid outflow. Studies suggest it may provide pressure reduction across a wider area of the drainage system.
Both devices work by targeting the eye’s natural drainage pathway, which often becomes less efficient in glaucoma. The appeal of MIGS is clear: they’re less invasive than traditional glaucoma surgery, have faster recovery times, and can help reduce the need for glaucoma eye drops. These procedures work best for patients with mild to moderate glaucoma, and whilst the pressure reduction is typically modest compared to traditional glaucoma surgery, many patients benefit from reduced medication burden.

Premium Intraocular Lenses: Seeing Clearly at Multiple Distances
When your natural lens is removed during cataract surgery, it must be replaced with an artificial lens called an intraocular lens (IOL). Whilst standard monofocal lenses provide excellent vision at one distance (typically far), premium lenses offer additional benefits.

Extended Depth of Focus (EDOF) Lenses
These innovative lenses are designed to provide a continuous range of clear vision from far to intermediate distances. Unlike multifocal designs, EDOF lenses create a single elongated focal point, which many patients find provides more natural vision with fewer visual disturbances like halos around lights. Whilst reading small print may still require glasses, EDOF lenses offer excellent functional vision for many daily activities.

Trifocal Lenses
Trifocal lenses offer distinct focal points for near, intermediate, and far vision. These lenses can be particularly beneficial for patients who want to minimise their reliance on reading glasses. The trade-off is that some patients may experience slightly more visual phenomena such as halos around lights at night.

An important consideration with trifocal lenses is that they can reduce contrast sensitivity compared to monofocal or EDOF lenses. For patients with moderate or advanced glaucoma, this reduction in contrast sensitivity may be noticeable and could affect visual quality. However, trifocal lenses may still be suitable for patients with mild glaucoma or ocular hypertension.

Toric Lenses for Astigmatism
Many patients have astigmatism—an irregular curvature of the cornea that causes blurred or distorted vision at all distances. Toric intraocular lenses are specifically designed to correct astigmatism during cataract surgery. These lenses are available in both monofocal and premium (EDOF or multifocal) versions.

Combining MIGS with Premium IOLs
For suitable patients, combining MIGS with premium IOL implantation during cataract surgery offers a comprehensive approach to managing both conditions simultaneously. This combined procedure can address cataracts, reduce eye pressure, and optimise vision quality in a single operation with one recovery period.

A Personalised Approach
The decision to combine MIGS with cataract surgery, or to choose a premium IOL, should be made collaboratively with your ophthalmologist. Several factors influence these choices:
– The severity and type of your glaucoma
– Your current eye pressure and medication regimen
– The health of other structures in your eye
– Your visual goals and lifestyle needs
– Your realistic expectations about outcomes.

Next Steps
If you’re considering cataract surgery and have glaucoma, schedule a thorough consultation with your glaucoma surgeon to discuss whether these advanced options are suitable for your individual situation.

*This article is for informational purposes only and does not constitute medical advice. Individual treatment recommendations should be made following comprehensive clinical evaluation.*