- Cataracts (clouding of the natural lens) and glaucoma (optic nerve damage from high eye pressure) commonly occur together, especially as we age.
- Modern minimally invasive glaucoma surgery (MIGS) can be safely combined with cataract surgery, using the same tiny incision.
- MIGS procedures lower eye pressure by improving the eye’s natural fluid outflow, often reducing or eliminating the need for glaucoma eye drops.
- Options include trabecular bypass stents (iStent, Hydrus), goniotomy (Kahook Dual Blade), canaloplasty (OMNI), and laser cyclophotocoagulation.
- The combined procedure adds only a few minutes to cataract surgery and has a low risk of complications.
Did you know that it’s possible to develop glaucoma and cataracts at the same time? When that happens, and your vision is at stake, your eye doctor may recommend addressing both conditions during one procedure. Treating both conditions with one procedure can help you attain better vision and healthier eyes. Keep reading to learn more about cataracts and glaucoma and how to treat glaucoma during cataract surgery!
What are Cataracts?
A cataract is the clouding of the natural lens in the eye. It occurs when proteins in the eye clump together on the lens, making it difficult to see. The most common cause of cataracts is aging. Besides aging, you can also develop cataracts early for other reasons like the following risk factors:
- A serious eye injury
- Past eye surgery
- Smoking
- Excessive alcohol use
- A family history of cataracts
- Excessive exposure to the sun’s UV rays
- Prolonged use of corticosteroid medications
Cataracts typically develop gradually over many years, so you might not notice any symptoms during the early stages. But over time, you may experience the following symptoms:
- Blurred or clouded vision
- Halos and glare
- Sensitivity to light
- Poor night vision
- Double vision in one eye
- Colors appearing dull or faded
- Frequent prescription changes
- Need for brighter lighting for reading and other up-close activities
What is Glaucoma?
Glaucoma is a group of eye conditions that damage the optic nerve, often due to elevated intraocular pressure (IOP). The optic nerve is like a cable that connects your retina to your brain. It sends visual information from the retina to the brain, making it possible for you to see. High intraocular pressure happens when fluid in your eye, called the aqueous humor, drains slowly or if too much fluid is produced.
Glaucoma is a leading cause of blindness in the U.S. It can cause irreversible vision loss and blindness. Glaucoma is called the silent thief of sight because there are usually no symptoms early on. Most patients don’t realize they have it until irreversible vision loss has already occurred. The eye condition often sneaks up on patients, robbing them of their sight before they know it’s happening.
It’s estimated that half of the around 3 million Americans with glaucoma don’t even know they have it. Anyone can develop glaucoma. However, some people are more likely to develop the eye condition because of the following risk factors:
- Increased eye pressure
- Previous eye injury
- Being age 55 and older
- Having thinner corneas
- Family history of glaucoma
- Certain kinds of eye surgery
- Extreme nearsightedness or farsightedness
- Prolonged use of corticosteroid medications
- Being of African American, Hispanic, or Asian descent
- Certain medical conditions like diabetes, high blood pressure, migraines, sickle cell anemia, or heart disease
Unfortunately, there’s no cure for glaucoma, and any vision lost due to it is permanent and irreversible. However, you can manage the eye condition. The best way to protect your sight from glaucoma is by scheduling frequent, comprehensive eye exams. Timely detection and treatment can slow or even stop optic nerve damage and preserve your remaining vision.
Clouding of the natural lens – causes blurry vision, glare, and faded colors. Treated by replacing the lens.
Optic nerve damage from high eye pressure – causes gradual, irreversible vision loss. Managed by lowering pressure.
MIGS uses the same tiny incision as cataract surgery, adding only minutes to the procedure.
Lowers eye pressure, reduces medication burden, and may slow vision loss progression.
Can You Combine Glaucoma and Cataract Surgery?
Left untreated, both cataracts and glaucoma can cause vision loss. You can regain vision loss due to cataracts by having cataract surgery. However, vision loss due to glaucoma is irreversible. When cataracts start to impact your eyesight, making it challenging to complete your routine and everyday activities like driving, reading, and cooking, your ophthalmologist will recommend cataract surgery. Cataract surgery is the only way to treat cataracts and have them removed.
Your ophthalmologist may recommend undergoing a procedure to treat cataracts and glaucoma simultaneously. However, this will depend on how advanced your cataract is and the severity and type of glaucoma you have, among other factors. Newer treatment options are available for patients who undergo a procedure that combines these. These treatment options are called MIGS or minimally invasive glaucoma surgeries. MIGS can be successfully performed in conjunction with cataract surgery.
Combining cataract surgery with MIGS offers a powerful “two-in-one” solution: restore clear vision by removing the cataract while simultaneously lowering eye pressure to protect the optic nerve. For eligible patients with mild to moderate open‑angle glaucoma, this approach can reduce medication dependence and simplify long‑term management.
What is MIGS?
MIGS are a range of procedures that use tiny incisions and microscopic-sized instruments. They are designed to lower intraocular pressure by improving fluid outflow from the eye with minimal disruption to surrounding structures like the sclera or the conjunctiva.
As a result, MIGS procedures significantly reduce the risk of complications compared to traditional glaucoma procedures. MIGS works by improving the eye’s natural drainage system – most procedures target the trabecular meshwork and Schlemm’s canal, which are the eye’s primary outflow pathways. By removing blockages or implanting tiny stents, MIGS helps fluid drain more efficiently, lowering eye pressure without the need for a large incision or external filtering bleb.
Cataract Surgery and MIGS
During the procedure, Dr. Tokuhara will remove your natural lens and break up the cataract formed on it. Then, he will replace your natural lens with an artificial lens called an intraocular lens (IOL). The IOL will ensure you can see clearly. Cataracts cannot form on the intraocular lens.
After Dr. Tokuhara implants your IOL, he will begin the MIGS part of the procedure. Performing MIGS only adds a few minutes to the procedure and won’t considerably increase the risk of cataract surgery.
If you have mild to moderate glaucoma, you may be a good candidate for MIGS. Several types of MIGS can be performed at the time of cataract surgery at Desert Vision Center by Dr. Tokuhara. They include:
iStent Inject
The iStent Inject is no larger than a grain of rice. It comprises two small titanium stents that create two permanent bypasses between your natural drainage pathway and the front part of your eye. These stents continuously increase fluid flow out of your eye, safely decreasing eye pressure. Studies have shown that iStent combined with cataract surgery provides a significant reduction in medication use and can slow the progression of visual field defects compared to cataract surgery alone.
Hydrus Microstent
The Hydrus Microstent is a flexible stent approximately the size of an eyelash. Once implanted in the Schlemm’s canal (the main drainage channel), it acts as a scaffold to keep the canal open and widen your eyes’ pathway. Consequently, fluid can exit easily from your eye, reducing intraocular pressure. Like the iStent, the Hydrus has been shown to provide additional pressure lowering beyond cataract surgery alone, with an average additional reduction of 1.8 mmHg.
Kahook Dual Blade
The Kahook Dual Blade is a single-use blade used to lower intraocular pressure. It enables Dr. Tokuhara to create tiny, precise incisions in the trabecular meshwork and the wall of Schlemm’s canal. These incisions encourage more fluid to exit your eye, lowering intraocular pressure.
OMNI Canaloplasty
The OMNI canaloplasty alleviates high intraocular pressure by eliminating unnecessary blockages. It does this by unblocking three vital pressure points in the outflow pathway, which helps restore your eye’s natural drainage system. No device is implanted during the OMNI canaloplasty procedure. The OMNI canaloplasty system allows Dr. Tokuhara to access Schlemm’s canal with a microcatheter. It’s designed with an internal reservoir that delivers a controlled amount of viscoelastic jelly into the canal. The jelly widens Schlemm’s canal, and the small collector channels are found downstream in the drainage pathway. This minimizes the resistance to fluid outflow in these areas of the drainage pathway. Dr. Tokuhara will also insert the microcatheter into Schlemm’s canal and pull it through the roof of the trabecular meshwork to break it open and remove this area of resistance.
Laser Cyclophotocoagulation
A micropulse laser is used during cyclophotocoagulation to treat glaucoma by targeting the anatomy of the eye where eye pressure is created in the ciliary body. By treating the ciliary body with on-and-off cycles of short laser bursts, glaucoma pressure is reduced inside the eye.
Achieve Clear Vision with Cataract Surgery and MIGS
If you have cataracts and glaucoma, undergoing cataract surgery and MIGS helps ensure Dr. Tokuhara addresses all your vision problems simultaneously, leaving your eyesight as clear and healthy as possible.
Do you want to learn more about treating cataracts and glaucoma together? Request your appointment at Desert Vision Center in Rancho Mirage, CA, today!
Two conditions, one solution
If you have both cataracts and glaucoma, you don’t need two separate surgeries. Schedule a consultation with Dr. Tokuhara to learn how combined cataract and MIGS surgery can restore your vision and protect your optic nerve.