Hello, and welcome to today's BrightFocus
Glaucoma Chat. My name is Kaci Baez, Vice President of Integrated Marketing and Communications
at BrightFocus, and I'm so happy you're here today to chat with us about Cataracts and
Glaucoma: What You Should Know in 2024. Our Glaucoma Chats are a monthly program, in partnership
with the American Glaucoma Society, designed to provide people with glaucoma and the family
and friends who support them with information straight from experts. BrightFocus is com
mitted
to investing in bold research worldwide that generates novel approaches, diagnostic tools,
and life-enhancing treatments that serve all populations in the fight against age-related
brain and vision diseases. Today, we're excited to introduce guest expert, Dr. Aakriti Shukla.
Dr. Shukla is the Leonard A. Lauder Assistant Professor of Ophthalmology at Columbia University
Medical Center. Dr. Shukla has published over 70 peer-reviewed articles and book chapters
and has been invited to speak n
ationally and internationally on patient care and research.
She serves on many advisory boards, and her research interests include structure function
relationships in glaucoma, optimization of surgical outcomes, and sustainability in ophthalmology.
She is passionate about trainee education in the clinic and operating room and is committed
to excellent clinical care. Welcome, Dr. Shukla. Thank you so much for having me.
Thanks for joining us on this Valentine's Day as we show our eyes some love.
So, today
we ll just dive right in and talk about glaucoma and cataracts, and just starting off with
a foundation of: What is a cataract? Great question. What is a cataract? A cataract
is clouding of the natural lens of the eye. This lens lies between the iris, right behind
the pupil the very center of the eye. The lens adjusts its shape and thickness to focus
the light rays that enter through the cornea and through the pupil onto the retina. And
the clouding of the lens can lead to vision probl
ems by preventing light from passing
clearly through the lens, causing blurred or distorted vision. A cataract is a common
condition that's associated with aging, but can also occur due to other reasons, like
injury, the use of certain medications, or certain medical conditions. I guess we should
also talk about what glaucoma is see if we can quickly define that, too. Glaucoma is
a number of different eye diseases that are characterized by specific patterns of optic
nerve damage that's visible w
hen one views the optic nerve just by looking at the optic
nerve and also, when one tests the function of the optic nerve so, visual fields are another
way to kind of test for glaucoma. In glaucoma, lowering the eye pressure usually slows the
progression of disease, so it prevents someone from getting worse glaucoma. And although
the lowering of the eye pressure is important in preventing the worsening of glaucoma, the
eye pressure can really be high or normal or even low, and one can still have
glaucoma.
Thanks for explaining what glaucoma is. It's important to understand that it's not just
one disease, but a series of diseases. And cataracts versus glaucoma I think there's
differences in being able to reverse glaucoma versus cataracts. So, do cataracts cause glaucoma?
And what are the symptoms of cataracts in comparison to glaucoma?
Good question. Cataracts themselves usually do not cause glaucoma. However, both conditions
can coexist in the same individual. Sometimes, people with ve
ry advanced cataracts have an
increased risk of having elevated eye pressure, and this can lead to the increasing risk of
developing glaucoma. A large lens or a more spherically shaped lens can sometimes also
cloud the anterior chamber angle, which is where the natural drain of the eye is located,
and removing the lens in these cases can help lessen the risk for particular types of glaucoma
in which the angle of the eye becomes very narrow or closed. They are, however, distinct
conditions. Catar
acts I like to say that, if we all live long enough, then we ll all
get cataracts. Glaucoma, however, does not affect the entire population in the way that
the cataracts do with time. The symptoms of cataracts versus the symptoms
of glaucoma: There is some overlap in symptoms, but they re fairly different. Symptoms of
cataracts include blurry or cloudy vision, difficulty seeing at nighttime, a fading of
colors people tell me they can no longer match socks as well or the movies just don't seem
as
bright to them. People also complain of glare; sensitivity to light; seeing halos
around lights, especially when driving or looking at streetlights. Glaucoma, on the
other hand, often early on, has no symptoms. People do over time describe experiencing
some glare. They can also see that maybe they have some peripheral or maybe even central
vision loss or areas of blurring, areas where the images don't seem as crisp. In the later
stages of glaucoma, and I guess the final stages of glaucoma, the
eye can completely
lose vision. And what s very important that distinguishes
the two conditions also is that glaucoma leads to irreversible vision loss, so anything one
loses from the glaucoma, we cannot bring that back. It's all about preventing the vision
loss due to optic nerve damage in glaucoma. Cataracts, however, are completely reversible,
so when one decides to get cataract surgery, any vision that's lost from the cataract really
should come back after that surgery. So in general, when p
atients have cataracts, for
the most part, I leave it up to them when they want to get the cataract surgery. However,
with glaucoma, sometimes it really requires educating the patient and talking to them
about the condition and really explaining that we're trying to prevent vision loss in
this case and kind of creating that sort of understanding with the patient. And sometimes
having them undergo surgery even when they don t necessarily have symptoms, just to try
to prevent those symptoms from d
eveloping over time if we think that glaucoma will progress
without that sort of treatment. Does glaucoma actually cause cataracts?
That's a good question. Glaucoma does not directly cause cataracts. They are separate
eye conditions, but a person can have glaucoma and cataracts simultaneously. They have some
of the same risk factors the main one being age. And another example is if one has a history
of eye trauma or if one chronically uses steroid medications, both of these situations can
increa
se the risk of cataract development earlier in life and can also increase the
risk of glaucoma. That's so fascinating. And can a person be
more at risk for glaucoma versus their risk for cataracts? Understanding that they are
different diseases, and age is a factor for both, but can a person just naturally be more
at risk for one versus the other? That's a good question. I guess maybe first
I'll speak about cataracts. Like we were saying, everyone, if we are lucky to live long enough,
we're all
going to develop cataracts over time. There are some families in which cataracts
show up earlier; sometimes babies are born with cataracts, and they need cataract surgery
very early on in their life to allow them to develop vision in their eyes. And then,
there are some people who get cataracts in their 30s and 40s, requiring cataract surgery.
But I would say the majority of people who are getting cataract surgery are at least
in their late 50s and beyond. So, aging is really the primary risk fa
ctor for cataracts.
Other risk factors also include diabetes, smoking, prolonged exposure to sunlight, and
certain medications. Glaucoma, however, affects anywhere from 2 to 6 percent of the population,
a much lower percentage than cataract. And the risk factors for glaucoma include age,
especially those over the age of 50; a family history of glaucoma if one has a first-degree
relative with glaucoma, they have a nine times greater risk of the disease, and most people
are unaware they have this
greater risk with that family history; certain types of ancestries
so, African American ancestry or Asian ancestry can often predispose one to glaucoma. That's
just a more common condition in those groups. Those of Hispanic ethnicity are also at higher
risk of developing glaucoma. And people who have diabetes are at higher risk of developing
glaucoma. In general, we recommend that everyone 40 years or older should have a comprehensive
eye exam performed every 1 to 2 years to pick up these condit
ions because, especially as
we were talking about glaucoma, it's totally asymptomatic in the beginning, so it really
requires the physician picking this up on eye exam. Patients really can't tell in the
beginning that this is something that's affecting their eyes.
Okay. Thank you. And I think many people don't realize that cataracts and glaucoma can both
occur even as early as birth, so understanding your history and your risk is so important,
as you mentioned. You touched on the eye exam, so wh
at exactly happens during an eye exam
for cataracts, and how is this different from an eye exam for glaucoma?
Sure. Good question. A complete eye exam is required for both cataract and glaucoma diagnoses.
And it s important to rule out other conditions that can lead to vision loss. This generally
involves going in person to see the doctor. They ll check your visual acuity so, that
means reading off the eye chart that we're all pretty familiar with. They'll check your
intraocular pressure so, tha
t's the pressure inside your eye, which is different from blood
pressure. They'll check your visual fields and assess the reactivity of your pupil to
see how well the eye reacts and the iris constricts to light. A microscope called a slit lamp
will be used to assess the front of the eye, which includes the cornea, the iris, the lens,
or the cataract, as well as the back of the eye, which includes the retina and optic nerve.
And especially when we re assessing glaucoma, but really for everyone ev
eryone deserves
one gonioscopy exam. In this exam, a special mirror is used to assess the angle of the
eye that's where the natural drain of the eye is located. And if the angle of the eye
is deemed to be open, your ophthalmologist will likely dilate the eye to better assess
the cataract and evaluate the posterior segment that's where the retina and the optic nerve
are. And if there's any suspicion of glaucoma or retinal disease, your doctor will perform
a special scan of your optic nerve and re
tina, called optical coherence tomography. This
test takes a picture of your optic nerve and retina and really uses light waves to visualize
microscopic abnormalities that may be present. This test can help us determine if the earliest
signs of glaucoma are present. You will also have the thickness of your cornea measured,
because this can be a risk factor for glaucoma, as well. If there is a suspicion of glaucoma,
they will also check your peripheral or side vision, as this is most commonly aff
ected
first. Of course, some patients can have central loss prior to their peripheral visual field
involvement, but all of this really needs to be tested using automated perimetry, which
is kind of a standardized way of checking one's visual field.
If your doctor is planning on doing cataract surgery or if they see a visually significant
cataract, and they are discussing it with you, they will obtain a biometry test that
helps measure the front and back of the eye, and it also takes some measure
ments of the
lens itself. They may also obtain a map of the cornea to see how the cornea is shaped.
They will measure your refraction or what type of glasses you're currently using. They
will also, importantly, have a conversation with you about your preferences about what
sort of activities you like to do, and are you someone who wishes to see at distance
without glasses and wear reading glasses for up close, or are you someone who prefers to
be able to read without glasses, and you really don
t mind glasses for driving? Once your
doctor has all of this information, they will help you choose an intraocular lens or an
artificial lens that best fits your eye's anatomy and your own preferences, and then
that will be the lens that they ll put in during the cataract surgery.
Okay. So, you mentioned cataract surgery. What are all of the treatment options for
cataracts, and can cataracts and glaucoma be treated at the same time?
Great question. The early symptoms of cataracts, like a little
bit of blur or changing refraction,
can be helped with just getting a new pair of glasses. But eventually, one reaches the
point where glasses are not really helping, and the glare and the dimness and maybe the
lack of color contrast is something that's bothersome enough, and then you go down the
surgery route. The only real way to fix cataracts is performing cataract surgery. That's the
only way to treat the cataract. And the surgery involves removing the cloudy lens and replacing
it with a cle
ar intraocular lens, which is an artificial lens. Let's talk a little bit
briefly about the surgery. This is the same-day outpatient surgery. You get there about an
hour before surgery; surgery itself can take anywhere from 10 to 50 minutes based on the
complexity of your cataract it may take even longer if other procedures are required and
then the patient goes home typically about an hour after surgery. Several decades ago,
patients used to stay in the hospital for cataract surgery for several
days, but this
is definitely not the case anymore. Let's talk a little bit about the surgical
day. You arrive at the surgical facility about an hour or two before surgery. When you get
there, they will have you change into a gown, you will get an IV put in your arm, you will
review some paperwork, and then they will dilate your eye, and you will go into the
operating room. During the surgery, you will receive twilight anesthesia. It's a similar
type of anesthesia as one would get for a colonosc
opy, so you can hear some sounds,
see some lights, but you really shouldn't feel any pain, and you shouldn't feel anxious
about the situation. During the surgery, as I mentioned, we remove the lens, the cataract,
and put in a new, clear intraocular lens. And then once the surgery is all wrapped up,
then you go into the postoperative recovery area, where you wake up from anesthesia pretty
much instantly and then are on your way home about 30 minutes or so later.
You asked whether we can treat cat
aract and glaucoma at the same time. This is becoming
increasingly more common. There are different types of surgeries for glaucoma. There s a
whole category of surgery called minimally invasive glaucoma surgery. These have become
more popular in the last 10 to 12 years or so, and these typically involve either the
placement of a tiny stent in the eye, and that stent goes into the natural drain of
the eye, or it involves a procedure called goniotomy, in which we create an opening in
the natural
drain of the eye, and that opening helps us bypass resistance in the natural
drain of the eye that we think is present in people with glaucoma. There are a number
of other minimally invasive glaucoma surgeries in the pipeline. I would say those are probably
the two most common ones. There are also bigger surgeries for glaucoma,
including trabeculectomy and a tube shunt. And both of these surgeries actually involve
creating a brand-new drain for the eye. In trabeculectomy, we create a drain using
your
eye's natural tissues, and in the tube shunt, we actually place an implant onto the eye
that acts like the new drain for the eye. And these surgeries can be done at the same
time as cataract surgery. One of the advantages of doing that is that it's really one surgical
procedure for the patient, so it's one instance of anesthesia and tends to be more convenient
in that way. It's also just one recovery process, so it's all done at the same time. Your doctor
will be the best person to assess,
first of all, whether you need cataract surgery, then
if you do have glaucoma, whether you need minimally invasive glaucoma surgery along
with the cataract surgery, or one of the conventional surgeries, including trabeculectomy and tube
shunt. But there are plenty of options, and it's a nice opportunity to try to limit some
of the eye drops that you may be on. I would say that sometimes the recovery takes a little
bit longer if one is to get a glaucoma procedure along with cataract surgery, so
that's something
we can talk about a little bit more, but that is just one small consideration. But many
times, it really is worth it to do these additional procedures to get the glaucoma under control
at the same time as doing the cataract surgery. So, how safe would cataract surgery be for
glaucoma patients? Are there risks or adverse effects on patients with glaucoma when it
comes to cataract surgery? Great question. Cataract surgery is generally
safe for all glaucoma patients. The main risk
of cataract surgery includes infection inside
the eye, bleeding inside the eye, changes to the eye pressure, needing to go back to
the operating room to do a second procedure, or needing to go back if the entire lens was
not able to be removed from the eye. The risk of all of these outcomes happening is really
very, very low it's less than 1 percent. If your eye has a particular type of anatomy,
let's say you are someone who's extremely nearsighted and there is some risk of retinal
detachment in
everyone who's getting cataract surgery, but if your anatomy is very different
from average such as if you're very nearsighted then your risk of retinal detachment may be
a little bit higher. Everyone's individual risk is different, but the overall risk is
extremely low, and the risk for glaucoma patients doesn't really differ from the risk of the
cataract surgery for the average person in a big way.
You ll want to be sure that your surgeon knows how to manage glaucoma during the postoperative
period, because there can be some temporary increases in pressure associated with some
of the postoperative eye drops or even some of the solutions that we use during the surgery.
For these reasons, your doctor may need to watch you more closely than other patients
who undergo cataract surgery and do not have glaucoma. As mentioned, your recovery, if
you have glaucoma, and especially if you undergo glaucoma procedure along with cataract surgery,
may take longer than if you're getting cataract su
rgery alone. But then, of course, you're
getting the benefits of the glaucoma procedure, as well, and your sight will be maintained,
perhaps in a superior way than if you were to just get cataract surgery alone.
Okay, thank you. Will cataract surgery lower eye pressure, and should one have cataract
surgery instead of glaucoma surgery? That's a good question. Cataract surgery has
been demonstrated to have a modest effect on eye pressure. And in many cases, it has
been shown to lower eye pressure
anywhere from 2 millimeters of mercury to 10 millimeters
of mercury, and some people having less or more of an effect there. This is especially
the case in eyes with angle closure glaucoma. In these eyes, the front of the eye is smaller
and kind of more crowded than the average eye, so removing the cataract, which tends
to be pretty bulky, and putting in an intraocular lens the artificial lens, which actually is
very thin can open up a lot of space in the anterior chamber, and then that can help
lower
the pressure. So, in some folks who have angle closure glaucoma, doing the cataract surgery,
even doing it alone as a first step, maybe what your physician chooses to do instead
of doing cataract surgery plus glaucoma surgery as a first step. It's really so individual
for every patient, but I would say if you're going to do cataract surgery instead of glaucoma
surgery, and for angle closure eyes, that's something I would certainly consider. But
if somebody has very advanced glaucoma and h
as high pressures, and clearly showing signs
of damage and maybe even progression, then probably you need more than just cataract
surgery alone. You probably need a combined cataract and glaucoma procedure.
Thank you. Always important to get a personalized plan and guidance with your doctor, but it's
so great to have so many options. When it comes to implants, what are the different
types of lens implants, and which lens should someone with glaucoma get?
Great question. So, there are a variety o
f different types of intraocular lenses, including
monofocal lenses, multifocal lenses, and toric lenses, and they are each designed to address
specific visual needs. In general, we do not recommend multifocal lenses for patients with
glaucoma because the advantage of multifocal lenses is that they can theoretically help
you see at distance and up close without the use of glasses. So, it's kind of like the
vision that we all have when we're young, where we're not reaching for reading glasses
or
anything like that and we have good vision at a distance and up close. However, these
lenses can lower your overall contrast sensitivity, making your overall vision more dim, and in
patients with glaucoma and other eye conditions that are already reducing their vision, multifocal
lenses are not recommended in that case. Toric lenses are an option for certain people who
have certain types of astigmatism that affect the cornea, that change the curvature of the
cornea, and these are assigned option
s. So, if there's a patient with glaucoma who has
significant corneal astigmatism and it's deemed to be regular corneal astigmatism and I can
t find other corneal problems, toric lenses are a fine option for folks with glaucoma
and astigmatism who do not need conventional glaucoma surgery at the same time as cataract
surgery or anytime in the near future. And the reason is that conventional glaucoma surgery
can actually change the corneal curvature and would change the type of toric lens someone
would need, so we don't recommend the toric lens procedure if other surgeries are planned.
And then monofocal lenses are the most common type of lenses that are put in the eye, and
they are a safe choice for everyone. Okay, great. And so the lenses, are they different
for closed angle versus open angle glaucoma? Great question. Lens choices shouldn t differ
too much for people with closed angle or open angle glaucoma. Your surgeon may identify
other risks, such as not having support in the caps
ular bag, which is where the artificial
lens will fit after cataract surgery. So, they may end up choosing a particular type
of lens, such as a three-piece lens, to have the lens in the eye in these cases. And if
they don't find enough support in the capsular bag, they may avoid something like a toric
lens, which can rotate and move, and if that happens, you end up needing an even bigger
glasses prescription than you may have had before. So, in general, there really shouldn't
be any difference i
n lens choices between closed angle versus open angle glaucoma. But
there are so many other considerations about the eye's anatomy the surgeon takes into account
when choosing the type of lens. Okay. Thank you. That's so helpful. And our
listeners do have a lot of questions around this topic, and one of the questions we received
is: Should people with glaucoma receive steroids during cataract surgery or use steroids after
the surgery? And how often are glaucoma patients steroid responders versus
people without glaucoma?
This is a great question. After cataract surgery, the eye generally responds very favorably
to cataract surgery. The average person does very well, but everybody needs some sort of
anti-inflammatory eye drop after cataract surgery. And I would say, for most surgeons,
the drops of choice are a steroid eye drop, so almost everyone is going to be on some
sort of steroid after cataract surgery. Generally, we start with something like prednisolone
four times a day. Some peop
le might need it more frequently, and then we taper it off
after cataract surgery over the course of about a month or so. Over time, now, these
kind of depo steroids have become more common, and the advantage of these depo steroids is
that patients don't have to use drops as often after surgery or may not have to use drops
at all. These are fine options, but in the setting of glaucoma, I would hesitate to use
these on my patients because of this risk of steroid response. The nice thing about
dro
ps is if I start to see that, Okay, I m having my patients using the steroid drops.
The pressure is starting to go up, then I know that I can always decrease the frequency
of the steroid drop and manage their pressure that way. A steroid depo is something that's
going to be sitting in the eye, that's going to be acting, and I have no way to titrate
the effect of the steroid after surgery. So, personally, I would recommend definitely using
steroid drops and probably avoiding the steroid depo.
So,
how do the steroids work? The steroids can alter the microstructure of the trabecular
mesh work, which is the natural drain of the eye. It can influence the turnover of the
substances that live there, which can increase the resistance to outflow and can increase
the eye pressure. What percentage of the population has steroid response? It s hard to know exactly
how many, but it's been estimated that about 30 percent of people show a moderate increase
in pressure after using these steroid eye dro
ps, and about 5 percent of people are highly
responsive to these steroid eye drops in which they have high IOP elevation like, more than
10 millimeters of mercury once they start using steroid eye drops. So, there is a proportion
of the population that's going to be very sensitive. I watch my patients very carefully
when I start them on these types of medications, just knowing that it s possible, and it is
more common amongst people who have glaucoma to have this response to the steroids compare
d
to people who don't have glaucoma. So, I'm certainly more aware in my patient population,
and I look out for this, and that's really the reason why I would avoid the longer-acting
depo steroid. Okay. Thank you. That is so helpful. We have
an additional listener question, and it s: Can cataracts cause a blind spot area to be
reported on visual field test? Good question. Cataracts can definitely affect
one's vision, and that's why we choose to do cataract surgery, to improve people's vision
and
quality of life. They can also show up in the visual field in certain ways. Generally,
in glaucoma, we're looking for focal defects in the visual field. Cataracts can lead to
an overall more generalized depression of the visual field. So, it is interesting, of
course, get baseline visual fields on everyone, but sometimes it is fun to kind of check the
visual field a month or two after the person's had cataract surgery. And many times, there's
some improvement in the visual field after the catara
ct surgery, because that kind of
generalized depression has lifted once the cataract has been removed. So, there can be
some areas that are kind of faded or have more of a defect because of cataracts in the
visual field. Okay, great. Thank you. And just thinking
about the cataract surgery again, you mentioned taking drops for a certain number of weeks,
but how long does it take generally to recover from cataract surgery, particularly if you
have glaucoma? I usually tell people that it will take
about
a month to be fully recovered. And for a certain proportion of people, it's going to take longer
than a month. And I would say probably in the majority of people, it takes less than
a month, but I ask people to expect at least a month for recovery. Generally, I tell people
the day after surgery, You may feel that the vision is a lot better, you may feel that
it's worse, you may feel it is the same. It's hard to predict that, but a week out after
surgery, you'll probably feel that the visio
n has improved, and then a month out you will
feel a pretty significant improvement. But like I said, there is a proportion of people
who will take even longer to improve and to stabilize.
And do you have any tips on how to have a successful recovery from cataract surgery
if you have glaucoma? Good question. Number one, of course, following
your doctor s guidance and instructions to the T would be helpful. There are going to
be a lot of things that change, so if you're someone who has cataracts
and glaucoma, you're
most likely going to be on some sort of eye drop for glaucoma before surgery. It's very
important to know after the surgery exactly how the drops are changing because, more than
likely, your surgeon's going to start you on a steroid drop, and then an antibiotic
drop, and then you need to ask them, Well, what should I do now with my glaucoma drops?
Should I continue them? Should I take them off? And a lot of that's going to be dependent
on whether you have just a cataract sur
gery alone or whether you had cataract plus a glaucoma
surgery. Your surgeon will be able to tell you that. Generally, you'll be asked to use
a clear plastic shield to cover the eye when you're sleeping, and that's really to prevent
the eye from hitting your pillow or from accidentally rubbing the. Usually, for about a week or
so, you're told to restrict your activities, not lift anything heavier than 10 pounds,
not bend over or doing activities that would really strain your body. I tell people
it's
absolutely fine to use your eyes for anything you'd like you can read, watch TV, etc. And
those are kind of my standard instructions. I also tell people no eye makeup, don t get
soap in your eyes for a few days. I also tell people, importantly, everyday
things should be the same, or they should get a little bit better. If anything is getting
worse, that's really not normal, and our office needs to be alerted right away. The risk of
infection after cataract surgery is rare, but if it happens
; it's very serious and needs
to be treated right away. So, really, following your doctor's instructions, I think, is the
best way to go about doing things. Something additional that you could consider is using
some more artificial tear drops to lubricate the eye to kind of optimize the ocular surface
to help speed up recovery. If you are using artificial tear drops, I'd recommend waiting
about 30 minutes between the medicated drops and artificial tear drops because you don
t want the artificial
tear drops to dilute the medicated drops.
Great. Thank you. That's really helpful. And, our listeners have another question, and it
s: What pressure range indicates that MIG surgery should accompany cataract removal?
Interesting question. It's really so different for everyone, and the answer to this question
depends on, number one, how much glaucoma damage the person has. So, if you have very
advanced glaucoma and your pressures are 20, that really might be too high, given you have
advanced gla
ucoma, and so then you probably do need combined glaucoma and cataract surgery.
If you have no evidence of glaucoma at all, and you just have pressures that are above
whatever target pressure that your doctor has set for you, it's possible that the MIGS
option is kind of an optional thing. But a lot of it depends on your level of glaucoma
damage how many eye drops you're using, how well you're able to tolerate those eye drops,
what your rate of progression is, and not only how much damage do you
have, but how
quickly is it getting worse? A number of different considerations, so there's really no cutoff
in the range of pressures that tells me this person definitely needs MIGS or not. But for
most people who are on a drug, they are looking for opportunities to get off that drug. And
the MIGS procedure or other glaucoma procedures do give you those opportunities. So, I usually
offer it to most patients, if possible, if they're already on a glaucoma eye drop or
if they have significant fin
dings of glaucoma when I examine their optic nerve or have them
do a visual field. Okay, great. Thank you. And our last question
from our listeners: If you have retinal vein occlusion, can you still have surgery for
glaucoma and cataracts? Good question. Retinal vein occlusion and
glaucoma have been found to be somewhat comorbid in that they are kind of associated to occur
together. They don t always occur together, of course, but there is some association between
those two conditions. And certa
inly, if you have a history of retinal vein occlusion and
you have uncontrolled eye pressures, then certainly you can have glaucoma surgery. And
cataract surgery, like we talked about, everyone in their lifetime, if they live long enough,
will need cataract surgery, so that's fine to do in the setting of retinal vein occlusion,
as well. Whenever I do these surgeries in the setting of any retinal disease and specifically,
retinal vein occlusion I work very closely with a retina specialist because
it's possible
that you may need an injection in your eye of anti-VEGF, which is the vascular endothelial
growth factor medicine that can help reduce swelling before the surgery or help prevent
swelling from developing in the eye after the surgery. So generally, if you have a history
of retinal vein occlusion, I would make sure that your retina specialist knows that I'm
planning on doing cataract surgery, and your retina specialist may choose to do one of
these injections or pretreat you with a
certain kind of nonsteroidal anti-inflammatory eye
drop prior to the cataract surgery to prevent the chance of swelling or other problems related
to the retinal vein occlusion occurring after cataract surgery.
Thank you, Dr. Shukla. That's so valuable for our listeners to know. These topics are
so complex, and surgery can generate a lot of complex feelings and questions. It's always
helpful to be prepared with expert information. Is there anything yo' d like to share with
our listeners regarding
glaucoma and cataracts? Any parting tips on the subject that maybe
we haven't touched on? I think your questions have really been excellent
and comprehensive. The biggest thing I would say is I think it's important for the listeners
to know that they really should form a connection with their glaucoma specialist. This is someone
that they're going to know for a very long time, as glaucoma is a chronic disease and
it's sort of a silent disease that the glaucoma specialist has to help translate f
or the patients
by evaluating all the scans and testing that we do. It's important for the glaucoma specialist
to really help the patient understand what all of these things mean and what the significance
of the condition is. So, make sure that you take time to really get to know your glaucoma
specialist and that you feel comfortable with the person that you're seeing because that
person is going to be an important person who helps navigate the field of ophthalmology
and helps navigate a conditi
on that can be pretty anxiety provoking otherwise. So, that
would be my main advice to the listeners out there. Make sure you find the glaucoma specialist
you love. Excellent. Thank you so much, Dr. Shukla,
for all the important information that you shared with us today. That wraps up our questions
and thank you to our listeners so much for joining us today for our Glaucoma Chat. We
sincerely hope that you found it valuable. Next month on Wednesday, March 13, we will
dive into Building Connectio
n and Community: Take Charge of Your Glaucoma Diagnosis, and
we hope that you can join us then. And, until then, thank you again for joining us, and
that concludes today's BrightFocus Glaucoma Chat.
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