Being diagnosed with both cataracts and glaucoma can leave you with an important question: Can both conditions be treated at the same time?
For many patients, the answer is yes. Advances in eye surgery now make it possible for certain glaucoma treatments to be performed during cataract surgery, potentially improving vision from cataracts while also helping lower eye pressure caused by glaucoma.
At Paragon Eye Associates, we evaluate patients individually to determine whether cataract surgery alone or cataract surgery combined with a glaucoma procedure such as Minimally Invasive Glaucoma Surgery (MIGS) may be appropriate.
Understanding the Difference Between Cataracts and Glaucoma
Although cataracts and glaucoma can both affect your vision, they are very different eye conditions.
A cataract occurs when the eye’s natural lens becomes cloudy. Cataracts typically develop gradually with age and may cause blurry or hazy vision, glare, halos around lights, faded colors, or difficulty seeing at night.
Glaucoma, on the other hand, is a group of eye diseases that damage the optic nerve. Elevated pressure inside the eye is an important risk factor for many forms of glaucoma. Because glaucoma can progress without noticeable symptoms, patients may lose vision before realizing something is wrong.
There is another important difference: vision affected by a cataract can often be improved by removing the cloudy lens during cataract surgery. Vision already lost because of glaucoma generally cannot be restored. Glaucoma treatment therefore focuses on lowering eye pressure and protecting the optic nerve from additional damage.
Is It Common to Have Both Cataracts and Glaucoma?
Yes. Both conditions become more common with age, so it is not unusual for an ophthalmologist to discover that a patient has cataracts as well as glaucoma.
Having both conditions does not necessarily mean you need two completely separate surgeries. Depending on the type and severity of your glaucoma, your eye pressure, and other factors, your ophthalmologist may recommend treating glaucoma at the same time as cataract surgery.
Can Cataract Surgery and Glaucoma Surgery Be Performed Together?
For appropriate patients, cataract surgery can be combined with Minimally Invasive Glaucoma Surgery, or MIGS.
During cataract surgery, the cloudy natural lens is removed and replaced with an artificial intraocular lens (IOL). If a patient is also a candidate for MIGS, a glaucoma procedure may be performed during the same surgical session.
This approach can be particularly beneficial for certain patients with mild to moderate glaucoma who need additional help controlling their intraocular pressure.
What Is MIGS?
Minimally Invasive Glaucoma Surgery (MIGS) refers to a group of procedures designed to lower eye pressure using very small incisions and microscopic devices or instruments.
Compared with traditional glaucoma surgery, MIGS procedures are generally less invasive and are often associated with a faster recovery and a lower risk of serious complications. Some MIGS procedures can also be conveniently combined with cataract surgery.
The goal is not to cure glaucoma—there currently is no cure—but to improve the management of eye pressure and help protect the optic nerve from further damage.
How Does iStent® Work With Cataract Surgery?
One MIGS option is iStent, a tiny implant designed to improve the eye’s natural ability to drain fluid.
In certain patients with open-angle glaucoma, an iStent procedure can be performed in conjunction with cataract surgery. After the cataract is removed, the tiny implant is placed within the eye’s drainage system to create a pathway for fluid to flow more efficiently.
By improving drainage, iStent can help lower intraocular pressure and may reduce a patient’s dependence on prescription glaucoma eye drops.
Whether iStent is appropriate depends on your particular type and stage of glaucoma, current medications, eye pressure, and overall eye health.
What Are the Benefits of Combining Cataract Surgery With MIGS?
For the right patient, combining procedures may offer several advantages.
Rather than undergoing cataract surgery and then returning for a separate glaucoma operation, both conditions may be addressed during the same surgical session. MIGS may also provide additional eye-pressure control and, for some patients, reduce the number of glaucoma medications needed after surgery.
However, results vary from patient to patient. Some people will still need glaucoma medication following MIGS, and glaucoma must continue to be monitored even when eye pressure improves.
What About iDose® TR?
Not every patient with glaucoma needs surgery, and MIGS is only one of several modern treatment options.
iDose TR offers a different approach to glaucoma management. Rather than improving the eye’s drainage system like iStent, iDose TR is a small implant designed to continuously deliver glaucoma medication inside the eye for an extended period.
This can be particularly useful for eligible patients who have difficulty consistently using daily glaucoma eye drops or who would benefit from reducing their reliance on topical medication.
iDose TR and iStent work in different ways, which is why a comprehensive glaucoma evaluation is important. Your ophthalmologist can determine whether medication, iDose TR, MIGS, or another treatment strategy is most appropriate for you.
Will I Still Need Glaucoma Treatment After Cataract Surgery?
Possibly. Cataract surgery does not cure glaucoma.
Even when cataract surgery is combined with iStent or another MIGS procedure, patients still need regular glaucoma evaluations. Your ophthalmologist will continue monitoring your eye pressure, optic nerve, and vision to determine whether additional treatment is necessary.
Some patients may be able to reduce the number of glaucoma eye drops they use following treatment, while others may still require medication or additional procedures to keep their eye pressure within a safe range.
The goal is always long-term protection of your remaining vision.
Who Is a Candidate for Combined Cataract and Glaucoma Surgery?
Whether combined surgery is appropriate depends on several factors, including:
- The type and severity of your glaucoma
- Your current intraocular pressure
- The number of glaucoma medications you currently use
- The extent of optic nerve damage
- The severity of your cataracts
- Your overall eye health
- Your individual target eye pressure
Patients with more advanced glaucoma may require a different surgical approach than MIGS. That is why treatment recommendations should always be based on a comprehensive examination rather than a one-size-fits-all approach.
Cataract and Glaucoma Treatment in Arlington and Mansfield, TX
If you have both cataracts and glaucoma, you may have more treatment options than you realize.
At Paragon Eye Associates, we provide comprehensive cataract and glaucoma care for patients in Arlington, Mansfield, and surrounding North Texas communities. Our ophthalmologists can evaluate your cataracts, glaucoma, eye pressure, and overall eye health to determine whether cataract surgery alone or a combined approach with MIGS such as iStent may be appropriate.
We also offer advanced glaucoma management options, including iDose TR, to help create a treatment plan tailored to your individual needs.
If cataracts are interfering with your vision or you are concerned about managing glaucoma alongside cataract surgery, schedule an evaluation with Paragon Eye Associates to learn more about your options.
