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How can emerging developments in IOL materials, designs and optics optimize treatment options available to patients with glaucoma and cataracts?
Accommodating IOLs best suited for glaucomatous eyes
 Mark Packer |
The two primary trends in IOL design and optics — greater spectacle independence and enhanced quality of vision — converge in the development of accommodating lens designs that incorporate correction of ocular aberrations. In the glaucomatous eye, even the mild compromise of contrast sensitivity inherent in aspheric multifocal IOLs may lead to earlier decline of functional vision. For this reason, refractive options for patients with glaucoma remain limited to correction of astigmatism (toric IOLs or LRIs) and today’s repertoire of accommodating lens technology.
However, devices that harness the action of the ciliary muscle and capsular bag to significantly increase optical power through axial movement or through changes in surface curvature, while at the same time producing a high-quality, high-contrast image on the retina by reducing total ocular aberrations, will allow patients with glaucoma to benefit from greater spectacle independence. The entry of these additional patients as candidates will expand the market for presbyopia correction.
At the same time, the development of ab interno intraocular stents, such as the micro trabecular bypass and the anterior chamber/suprachoroidal space shunt, promise a relatively gentle method of lowering IOP at the time of cataract extraction. As an adjunctive procedure, these devices would complement refractive lens exchange in the population with glaucomatous field loss or high risk of future loss.
Mark Packer, MD, is a surgical partner at Drs. Fine, Hoffman, Packer, LLC, Eugene, Ore.
Monofocal lenses most appropriate for glaucoma patients
 Douglas J. Rhee |
Optimizing the visual functioning of any patient is the ideal goal. Glaucoma patients present a challenge in this current era of presbyopia-correcting IOL implants. Contrast sensitivity is critical to the real-world functioning of any person. Aging itself and glaucoma degrade contrast sensitivity. Multifocal IOLs decrease contrast sensitivity as one of the trade-offs for enhanced accommodative function. The degradation of contrast sensitivity occurs even with mild glaucoma. Our inability to accurately predict which glaucoma patient will have progressive disease makes me very concerned about using these lenses in patients with early-stage disease. Furthermore, if the pseudophakic patient with a multifocal lens needs to undergo filtration surgery, it is possible that the eye will become more hyperopic due to a slight change in axial length induced by the change in IOP. Because of these issues, I still advocate the use of monofocal lenses.
Douglas J. Rhee, MD, is an OSN Glaucoma Board Member.