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Cataract surgeon offers advice on glaucoma treatment options
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SAN FRANCISCO — Glaucoma treatment can be a challenge when the disease coexists with cataracts, especially for those cataract surgeons who are uncertain about what treatment options to choose, a cataract surgeon said here.
"As a simple jobbing cataract surgeon, glaucoma is a disease which presents many management challenges when cataract and glaucoma coexist," Richard B. Packard, MD, FRCS, FRCOphth, said. "Not the least being, unfortunately, how to separate fact from fiction."
At a presentation during Glaucoma Day at the American Society of Cataract and Refractive Surgery meeting, Dr. Packard said cataract surgeons have many options in treating coexisting cataract and glaucoma. Those options include phacoemulsification and IOL implantation alone, combined cataract surgery/glaucoma filtering surgery or combined cataract surgery/nonfiltering glaucoma procedure.
He said evidence from current data shows that glaucoma patients who are well-tolerated on medical therapy should have phaco alone, while those who have poor medical control or advancing visual field loss should most likely have a combined procedure.
Demographic data support Mr. Packard’s contention that the number of patients presenting for cataract surgery that have concomitant glaucoma are increasing. Data are also accruing – as recently highlighted by Richard L. Lindstrom, MD – that confirm the widely held belief that modern phacoemulsification surgery alone generally leads to a reduction in IOP, especially in eyes that have elevated pressures preoperatively. The question therefore becomes which patients deserve additional (concomitant) surgery or treatment, and if required, which modality would be best. An increasing number of glaucoma procedures are becoming available that dovetail well with concurrent phaco and IOL surgery. Further study will help to sort out which techniques will be most efficacious, and for whom we should be treating.
– Louis D. Nichamin, MD
OSN Cataract Surgery Board Member