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Glaucoma linked to lower visual acuity, more complications after cataract surgery
Eyes with glaucoma had a higher risk of complications and less visual improvement after cataract surgery than eyes without glaucoma, according to a large study. However, glaucoma patients still had a significant improvement in visual outcomes.
Data were culled from the Veterans Affairs Ophthalmic Surgery Outcomes Database Pilot Program, which was designed to assess and improve cataract surgery in the VA system. The study included 4,914 eyes that underwent cataract surgery: 608 eyes with glaucoma and a control group comprising 4,306 non-glaucomatous eyes.
Investigators analyzed case records of patients who underwent cataract surgery. Preoperative and postoperative scores on the National Eye Institute-Visual Function Questionnaire (NEI-VFQ) were also analyzed.
Adjusted data showed that eyes with glaucoma were significantly more likely to have posterior capsular tears with vitrectomy (P = .03) and sulcus IOL placement during cataract surgery (P = .03) than eyes without glaucoma.
Eyes with glaucoma were more likely to have postoperative inflammation (P < .0001), prolonged IOP elevation (P = .0003) and additional surgery within 30 days (P = .03).
Mean best corrected visual acuity and NEI-VFQ scores improved significantly in both groups (P < .0001). However, BCVA and NEI-VFQ scores improved significantly more in the non-glaucoma group than in the glaucoma group (P = .01 and P < .0001, respectively).
Postoperative BCVA was 20/40 or better in 94.1% of non-glaucoma cases and 89.6% of glaucoma cases; the between-group difference was significant (P = .0003). – by Matt Hasson
Disclosure: Turalba reports no relevant financial disclosures. See the full study for a list of all authors’ relevant financial disclosures.
Perspective
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Treating glaucoma with topical medications can be a complex undertaking. For patients with advanced glaucoma, the decision to treat with multiple medications is easy to justify.
However, in mild glaucoma the potential long-term medication side effects become a more significant consideration. Cost, adherence, ocular surface disease and propensity for cataract development are primary concerns.
Although inconclusive in the association, this study demonstrates that glaucoma patients are more susceptible to complications following cataract surgery than those without glaucoma.
In thinking about our prescribing patterns, one can see the pitfalls in over-treating patients with glaucoma drops, whereby more treatments may result in a greater propensity for cataract. This could potentially hasten the need for cataract surgery, which this study suggests will have a higher complication rate.
Their findings reaffirm the importance of judiciously prescribing glaucoma drops, recognizing that their side effects are not inconsequential and that we should treat with the minimum amount necessary to stabilize the disease course.
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Turalba A, et al. Am J Ophthalmol. 2015;doi:10.1016/j.ajo.2015.07.020.