Combining procedures may reduce vision loss in some cases

NEW YORK — Because elderly cataract patients often are at greater risk of vision loss from glaucoma, ophthalmologists must decide whether a combined procedure is warranted for the individual patient, according to a surgeon speaking here.

Cataract surgery performed alone has many advantages, including lowering IOP, Bradford J. Shingleton, MD, said at the OSN New York meeting.

"Clearly we get the fastest rehabilitation [from phaco]. A single procedure is easiest and shorter, and there will be less [incision-related] complications," Dr. Shingleton said, noting that glaucoma surgery can still be performed at a later time.

Phacoemulsification has some drawbacks, though. It can result in early postop IOP increases and provide less IOP control compared with glaucoma surgery. It may also affect future glaucoma procedures, he said.

However, some glaucoma patients who are at a greater risk of vision loss can benefit from combined procedures. Such patients include those who are younger, those who are using more than three glaucoma medications, those with allergy or tolerance issues, those with significant cupping and visual field loss, and those who cannot tolerate two separate procedures.

"All these things have to come into consideration when we operate on our patients," Dr. Shingleton said.