Glaucoma and Cataracts

Glaucoma and cataracts are medical conditions that cause vision loss which both can be treated by our glaucoma eye doctors at Glaucoma Associates of Texas. When glaucoma and cataracts occur simultaneously, they can present a unique set of problems for the patient that requires a doctor experienced at treating both disorders. Cataracts typically come on gradually, causing a change in the eye’s lens over time, resulting in cloudiness which reduces vision. Glaucoma encompasses a group of eye diseases characterized by a buildup of intraocular pressure (IOP) that causes damage to the optic nerve and subsequent loss of vision. While vision loss from cataracts can be reversed with surgical intervention, sight lost due to glaucoma cannot be regained.

Glaucoma and Cataracts May Occur Simultaneously

Glaucoma and cataracts are not typically related, however, because both eye conditions often develop or worsen with age, there is a significant chance that a glaucoma patient may be affected by cataracts at some time, especially over the age of 50 when cataracts commonly form.

Treating Cataracts in Glaucoma Patients

While cataract treatment is usually considered to be a fairly simple procedure with little risk, for glaucoma patients, the ophthalmologist must consider many factors when deciding on how best and when to perform cataract surgery to ensure that eye pressure is not affected. Increases in intraocular pressure after cataract surgery on glaucoma patients are not unusual and can often be managed with medication.

Since cataract surgery can result in changes in eye pressure (sometimes short-term and sometimes permanent), each patient with glaucoma and cataracts should be assessed on an individual basis to determine which cataract treatment option will be safest and most effective. Glaucoma Associates of Texas provides comprehensive care with the most advanced glaucoma diagnosis and testing technology available.

Some cataract treatment options for glaucoma patients include:

Cataract monitoring: If cataracts are not significantly interfering with a patient’s daily activities, the ophthalmologist may recommend a wait-and-see approach concerning the cataract while treating the glaucoma with laser treatment for glaucoma patients or glaucoma medications.
Cataract surgery: In milder cases of glaucoma that are considered stable, cataract removal can be performed while glaucoma treatment is ongoing.
Combined glaucoma surgery and cataract removal: For patients with more serious cases of glaucoma, cataracts may be removed in combination with a glaucoma surgery. Recent advances in glaucoma surgeries have increased the number of options glaucoma surgeons have to treat high intraocular pressure at the same time as cataract surgery. These newer techniques are often safer and may be used in mild, moderate, or severe glaucoma to achieve different goals (e.g. pressure lowering or decreased medications use).

When both cataract surgery and glaucoma surgery are needed, controlling the patient’s glaucoma is always the ophthalmologist’s priority. Due to the possible complexity involved with treating both conditions simultaneously, the ophthalmologists at Glaucoma Associates of Texas recommend using a glaucoma specialist with extensive training and experience in the comprehensive management of glaucoma.

Medicine to treat Glaucoma and Cataracts

Certain glaucoma eye drops (such as Propine and epinephrine) can dilate the pupils which subsequently allows more light exposure on the cataract. When the pupil is enlarged, glaucoma patients with a cataract may begin to experience an increase in glare.

Vision can also be affected by miotic eye drops (used for controlling IOP) when a cataract is present. These medications often shrink the pupil, lowering light entrance into the eyes, which can worsen vision already clouded by cataracts.

Compliance with glaucoma treatment and medication schedule is imperative for glaucoma patients before and after cataract surgery to control eye pressure. Your ophthalmologist will also want to closely monitor your IOP during this time to ensure successful cataract treatment and glaucoma management.

Can Glaucoma Cause Cataracts?

Glaucoma does not cause cataracts; however, some types of glaucoma surgery or treatment may accelerate cataract formation. Research suggests that tube shunt surgery or a trabeculectomy, as well as certain glaucoma medications, can exacerbate the progression of cataracts. The importance of glaucoma treatment, however, outweighs any risk of cataract development.

Less commonly, a cataract can be a contributing factor to optic nerve damage or elevated eye pressure. Cataracts can also play a role in primary-angle closure glaucoma due to additional narrowing of the drainage angle as the lens thickens from the cataract.

Benefits of Cataract Surgery for Glaucoma Patients

While extra care is required for glaucoma patients before, during, and after cataract surgery in glaucoma patients, the outcome can be an extremely positive one when performed by an experienced eye surgeon. In addition to improving vision, removal of cataracts may also result in a beneficial lowering of eye pressure. Studies suggest that patients with a higher IOP prior to cataract surgery experience the most significant drop in pressure afterward.

Some glaucoma patients are also able to lessen the amounts of glaucoma medication taken after they undergo cataract surgery, especially when combined with glaucoma surgery. The surgeons at Glaucoma Associates of Texas are at the forefront of combined cataract-glaucoma surgical technique and can discuss your options with you.

Glaucoma and Cataracts – Possible Complications with Cataract Surgery

Some glaucoma patients have smaller pupils (which are more difficult to dilate) due to certain glaucoma treatments, and this can result in more complexity involved in the cataract surgery. In cases where glaucoma is caused by flaky deposits that clog the eye and damage the optic nerve (pseudoexfoliation syndrome), the lens can become unstable, making cataract surgery more difficult.

Other possible complications with cataract surgery in glaucoma patients include:

Medication problems: Use of some glaucoma medicines, such as pilocarpine, Xalaton, and Propine, can cause difficulties after cataract surgery.

Knowing and understanding the individual’s ocular situation is vital to successful cataract surgery in glaucoma patients and will minimize the risk of complications. The surgeons at Glaucoma Associates of Texas are highly experienced (over 60 years combined) in performing both glaucoma and cataract surgeries and understand the risks and benefits involved in performing both procedures.

Every surgeon at GAT is fellowship trained in glaucoma and cataract surgery, to provide patients the highest level of care available!

At Glaucoma Associates of Texas (GAT), we are dedicated to providing the most advanced and balanced care to preserve the sight of our glaucoma patients. If you have glaucoma and cataracts or are experiencing signs of cataract formation, please contact us by completing an appointment request form or call us at for an evaluation at: