While “Cataract surgery does not cure most kinds of glaucoma,” says glaucoma specialist Dr. Sarah Maki, there are certain benefits to undergoing the procedure. In an interview with fellow ophthalmologist Dr. Michele Lee, Maki explains why some types of glaucoma surgery are often performed at the same time as cataract surgery, and why others are done separately.*

How Cataract Surgery Can Help With Glaucoma

Glaucoma is often the result of pressure buildup inside the eye when fluid called aqueous humor is unable to drain properly. This drainage issue is usually caused by some sort of blockage, similar to leaves preventing rainwater from draining down through a sewer grate.

Sometimes, the eye’s drainage system is made smaller because a cataract, which is largely made of protein deposits, is pressing against it, blocking the flow. In this scenario, Maki says, “Removing the cataract and replacing it with a thin implant can open the drainage space and resolve the issue.”

Cataract and Glaucoma Surgery

Minimally-Invasive Glaucoma Surgery

Very often, Maki explains, while they are already working inside your eye, the surgeon who is removing your cataract can also operate on your natural drainage system, to help it work better and slow the glaucoma progression. They do this using minimally-invasive glaucoma surgery, also known as MIGS.

MIGS generally involve either stents or what Maki refers to as “Roto Rooter”-type techniques. Some common MIGS she uses involve:

• iStent Inject W,
• iStent,
• XEN Gel Stent, and
• Hydrus Microstent.

When asked if she has a favorite MIGS, Maki replied that a lot of her patients are proactive in their research and come to her already asking about a specific type. Even then, there’s no single option that’s best for everyone. “There are a log of new devices and techniques coming out every day,” she says, “but it really just depends on the patient.”

Both laser therapy and surgery work to correct the eye’s natural drainage system or build it a new one.

“There are many tools in our toolbox to help their glaucoma,” says Maki.” We just try to pick the one that’s right for them depending on their intolerance of the medication [eye drops] and the stability of their disease.”

Traditional Glaucoma Surgery

Whereas MIGS came onto the scene just in the last 10 years or so, traditional glaucoma surgeries have been around for decades. The two most frequently used are:

• Tube shunt procedures, in which a device is implanted in one of many possible places around the eye, usually below the upper eyelid. The device acts “like a hose,” allowing previously trapped fluid to “drain behind the eye and back into the body.”
• Trabeculectomy, in which the surgeon uses the patient’s “own natural tissues” to create a new drainage pathway.

Traditional glaucoma surgeries carry more risk, Maki says, though with glaucoma, “the bigger the risk, the bigger the reward.”

In addition to a higher risk of infection and bleeding, more invasive surgeries involve the possibility of your eye pressure getting too low, and pressure that is “too low is just as bad as too high.”

For these and similar reasons, Maki says, attempting both the glaucoma and cataract surgeries together isn’t always recommended.

“If you’re doing cataract surgery, killing two birds with one stone always makes sense to me,” she says. With more involved surgeries, however, research suggests that doing the procedures separately “allows for greater success.”

Either way, Maki says, surgeons “have to ‘Goldilocks’ and try to make it ‘just right’ for the patient.”

*Lee, M. (2022, July 16). Can Cataract Surgery Cure GL? | Traditional Versus Minimally Invasive Glaucoma Surgery [Video file]. https://www.youtube.com/watch?v=Mx9kwfm8x_E 

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