Killing Two Blurs With One Stone
Is combined cataract-glaucoma surgery worth considering?
David Bernard, Senior Associate Editor
For patients suffering from cataracts and glaucoma, treating both conditions in a single surgery can deliver clinical advantages. But does it make business sense for your surgical facility to offer phaco and pressure relief as companion procedures? Read on to consider what's at stake.
In chronic, open-angle glaucoma, the most commonly diagnosed form, intraocular pressure climbs gradually over time. In acute, angle-closure glaucoma, the blockage and pressure are sudden. Either way, the solution is restoring the flow and reducing IOP. Eye surgeons have a range of conventional and micro-incisional methods at their disposal for accomplishing these goals.
Cataract surgery itself provides some relief in mild to moderate open-angle cases. "When you take out the cataract, you get some glaucoma control. It lowers IOP in and of itself," says Steven Dewey, MD, an ophthalmologist with Colorado Springs (Colo.) Health Partners. "But it doesn't always give as much pressure reduction as you need. Cataract surgery alone works for a limited time. Glaucoma is progressive. You want your results to work for a long time."
Partnering cataract and glaucoma treatments, however, delivers multiple benefits to the patient. "You get better IOP lowering, first of all," says Steve Vold, MD, founder of Vold Vision in Fayetteville, Ark. "You also get better vision. You remove the cloudy cataract, replace it with a clear lens, correct the refractive error. This can be a pretty big deal for a glaucoma patient," whose options may have been previously limited to IOP-lowering medicated eye drops and declining vision.
One company's mini-stent has only been indicated for use in patients who are also undergoing cataract surgery. "Pivotal trials showed that cataract surgery alone did a pretty good job at reducing IOP," says Dr. Vold, "and that adding the inserts meant even more reduction."
Safely and efficiently performed by practiced hands, the micro-incisional technology and techniques of some glaucoma treatments are ideal additions to cataract cases, says Dr. Dewey. "We're going to be in the eye anyway, why revisit the risk of infection with a second procedure?" he asks.