A number of factors affect the decision of whether to surgically remove cataracts in the patient with glaucoma. A cataract is a natural clouding of the lens in the eye. Since the lens is responsible for focusing objects clearly, if the lens is cloudy seeing clearly becomes difficult. Usually the cataract does not interfere with vision initially, and cataracts are not considered an urgent problem. Your ophthalmologist will probably detect a cataract long before you notice it. Remember cataracts are a natural process and an unavoidable part of aging. Because age is a risk factor for glaucoma as well, many patients with glaucoma also have cataracts. Although all of us will eventually develop cataracts, the good news is that the treatment for cataracts is very successful with the latest surgical techniques. When treatment for a cataract is warranted, it is surgically removed and an artificial lens is put in its place. Glaucoma, however, damages the optic nerve, the critical structure that transmits the visual signal from the eye to the brain. Unfortunately, in contrast to cataracts, we are not yet able to repair or replace the optic nerve. This important difference affects the management of these two diseases when they co-exist in the same eye.
For patients with mild glaucoma that is stable we might consider surgically removing the cataract and treating the glaucoma with pressure-lowering medications or laser treatments. Cataract surgery alone on an eye with glaucoma will sometimes lower the pressure in the eye. For patients with more serious glaucoma and the need for cataract surgery, a combination cataract removal and glaucoma filtering procedure can be considered. For patients using multiple anti-glaucoma medications, a combination procedure such as this would be appropriate. Combination procedures, however, are not for everyone. The decision to perform a combination procedure depends on the number of anti-glaucoma medications used, how mature the cataract is, and the state of the glaucoma.