This article is more than 5 years old. Information may no longer be current.
Cataract surgery does not slow visual field loss despite IOP reduction
Cataract surgery helps lower IOP in patients with glaucoma but does not slow or prevent progressive visual field loss, according to a study.
The medical records of 99 glaucoma patients (134 eyes) with a follow-up of 4 years before and 3 years after cataract surgery were retrospectively reviewed.
The mean best corrected visual acuity significantly improved after surgery, and all IOP parameters steadily decreased in the postoperative period. The number of glaucoma medications was also reduced.
However, visual field significantly deteriorated. Only in eyes with previous trabeculectomy was there no significant change in the visual field decay rates. Worse visual field at baseline and higher postoperative peak IOP were correlated with faster rates of visual field loss. In the second half of the follow-up, deterioration was faster.
“Our results indicate that cataract surgery alone does not appear to slow progression of the disease,” the authors wrote.
However, they pointed out that the study did not provide information on how visual field might have progressed if cataract surgery had not been performed. Readers should, therefore, not draw the conclusion that cataract surgery might accelerate visual field deterioration.
“It is likely that worsening of visual field rates occurred despite cataract extraction and not because of it,” they wrote.
They also hypothesized that previous trabeculectomy might decrease visual field decay rates because IOP peaks are minimized by this surgery. – by Michela Cimberle
Disclosure: Kim reported no relevant financial disclosures. Please see the published paper for the other authors’ financial disclosures.
Perspective
Back to Top
Consider this: You have a glaucoma patient with coincidental cataracts – a common occurrence. The glaucoma is progressive, yet still at a moderate stage, and the IOP is too high despite maximum topical treatment. Cataracts are similarly moderate. How about cataract surgery in lieu of filtering surgery? This has been proven to lower IOP, so you’ll improve your patient’s glaucoma treatment and spare them possible glaucoma surgical complications. You can have your glaucoma specialist use a MIGs device for good measure. Two birds with one stone!
You want to reconsider this approach.
Kim and colleagues used a novel analysis method and surprisingly found that the visual field decline rate accelerated following cataract surgery despite the expected postsurgical IOP-lowering effect. While this finding could be due to the nonlinear rate of vision loss in glaucoma, it still gives pause and is a reminder that there is much to learn. IOP control has been our sole focus in the clinical management of glaucoma, and it’s easy to forget that this is a complex, multifactorial disease. Prospective studies will better address this question, but until then understand that factors other than IOP may be influencing patient outcomes whether you know about them or not.