Making Cataract Treatment Decisions When You Also Have Glaucoma

Cataract and Glaucoma Treatment at a Glance

The short answer

Your doctor will examine the whole eye and talk with you about the choices. These may include surgery for the cataract, surgery for glaucoma, or one operation for both. ¹

During cataract surgery, the doctor removes the cloudy lens and puts in a new lens. ² Glaucoma care cannot bring back sight that is lost. It can help keep the damage from getting worse. ³

Why two people may receive different recommendations

People who have cataract and glaucoma need a complete eye examination to determine how much each disease contributes to vision loss before choosing cataract surgery, glaucoma surgery, or a combined operation. ¹

Your decision should have two named goals. Ask, “What are we trying to improve about my vision?” and “What are we trying to accomplish for my glaucoma?” If the answers stay vague, ask the surgeon to explain each goal separately.

What to bring to the decision visit

• A complete list of eye drops and other medicines, including doses and missed doses.
• Examples of tasks the cataract now limits, such as night driving, reading, work, or recognizing faces.
• Your priorities for glasses, night vision, near work, and recovery time.
• Questions about the expected pressure plan after surgery and who will monitor it.

What Each Condition Contributes to Your Vision

What the cataract changes

A cataract is clouding of the eye’s natural lens. Surgery is generally considered when cataract-related vision loss interferes with activities such as reading, driving, or watching television, although the timing can usually be planned rather than rushed. ²

Tell the surgeon which tasks have become difficult and whether glare, dim-light vision, blur, or another problem is driving your interest in treatment.

What glaucoma changes

Glaucoma is a group of diseases that damage the optic nerve. Open-angle glaucoma often has no early symptoms, while treatment may involve medicines, laser, or surgery to protect remaining vision. ⁴

Cataract surgery replaces the cloudy lens. ² Glaucoma damages the optic nerve and can cause vision loss. ⁴ Ask which parts of your current difficulty are likely due to cataract, which are likely due to glaucoma, and where the answer is uncertain.

What cataract surgery may do to eye pressure

A 2024 systematic review included 41 study groups covering 2,302 eyes. Its meta-analysis found statistically significant pressure reductions at 6, 12, and 24 months in open-angle and angle-closure glaucoma, although results varied. ⁵

Pressure reduction can be a benefit of cataract surgery, but the average study result is not a personal guarantee. ⁵ Ask your clinician what pressure change is realistic for your glaucoma type and whether you should expect to continue drops, laser treatment, or another procedure.

Comparing the Main Treatment Paths

A side-by-side decision table

One path is continued cataract monitoring because cataract surgery usually does not need to be rushed; it is generally suggested when cataract-related vision loss interferes with daily activities. ² Cataract surgery removes the cloudy lens and replaces it with an artificial lens. ² It can also lower eye pressure on average, although the size of the change varies. ⁵ For the Hydrus microstent or iStent, adding the device to cataract surgery may improve the chance of controlling glaucoma without medication. ⁶ Glaucoma surgery alone or combined cataract and glaucoma surgery may be considered after a complete eye evaluation. A combined operation may be discussed when glaucoma is advanced or only borderline controlled despite the maximum medication regimen, when pressure remains uncontrolled on that regimen, or when medicines cause significant side effects. ¹ The choice depends on what the examination shows and on the goal for each condition.

People with both cataract and glaucoma should have a complete eye examination to determine how much each disease contributes to vision problems. After that evaluation and discussion, the choice may be cataract surgery alone, glaucoma surgery alone, or combined cataract and glaucoma surgery. ¹

How strong is the evidence for adding MIGS?

An overview of six Cochrane reviews found that adding certain trabecular bypass devices to cataract surgery improved the chance of glaucoma control without medication, but the average effects were modest, certainty differed by device, and evidence was insufficient for several MIGS techniques. ⁶

MIGS is a family of procedures with different evidence and effects, not one interchangeable treatment. ⁶ Ask for the exact procedure name, the outcome the surgeon expects for your eye, how often additional treatment is needed, and what the alternative would be if the target pressure is not reached.

When cataract surgery alone may be discussed

Cataract surgery alone can lower eye pressure on average, but the amount is variable and may be smaller in open-angle glaucoma than in angle-closure disease. ⁵

A discussion of cataract surgery alone is more informative when it includes your current pressure, target pressure, rate of glaucoma change, medication burden, and what will trigger an additional glaucoma treatment later.

When a combined or staged plan may be discussed

Combined surgery may be considered when pressure is controlled but medicines cause significant side effects; when pressure is controlled on the maximum medication regimen but glaucoma damage is advanced; when pressure is only borderline controlled on the maximum medication regimen; or when glaucoma remains uncontrolled on that regimen, vision must be restored urgently, and two operations are not feasible or in the patient’s best interest. ¹

Ask the surgeon to compare the likely pressure range, drop burden, recovery demands, follow-up schedule, and backup plan for each realistic option. A recommendation should connect to your eye’s findings and your goals rather than to the fact that two conditions happen to be present.

Tests and Questions That Shape the Plan

Separate cataract blur from glaucoma damage

Glaucoma should be identified and assessed before cataract surgery because an eye condition that already limits vision can change the expected visual result and the risk discussion. ⁷

Ask the clinician to show you the cataract, optic-nerve images, and visual-field results. Useful questions include: “Which finding explains my current difficulty?” “Is my glaucoma stable?” and “What improvement would be realistic if surgery goes as planned?”

Clarify the pressure target and medication goal

A lower pressure number is not the only possible goal. You may also care about fewer drops, fewer side effects, easier adherence, preserving future surgical choices, or avoiding multiple recovery periods. Ask which goal is primary and which outcomes are uncertain.

Bring your bottles or a current medication list. Ask for written, individualized instructions about which drops to use before and after surgery. A general article or another patient’s experience cannot determine your medication plan.

Plan who will provide follow-up

Evidence-based cataract guidance recommends tailoring postoperative follow-up when an ocular condition such as glaucoma is present. ⁷

Before scheduling, know who will check the eye soon after surgery, who will reassess the pressure goal, and who will manage glaucoma over time. If a cataract surgeon and glaucoma clinician are both involved, ask how they will share results and who you should call after hours.

Lens Choice, Risks, and Realistic Outcomes

Choose the artificial lens around the whole eye

A systematic review found that premium intraocular-lens selection in glaucoma should be individualized by the desired refractive result, visual expectations, glaucoma subtype, the type and severity of visual-field loss, ocular-surface disease, and the planned glaucoma surgery. ⁸

Compared with traditional monofocal lenses, premium lenses can offer greater freedom from glasses, while multifocal lenses have a higher risk of glare, halos, and lower contrast sensitivity. ⁸ Ask the surgeon to explain the tradeoff for your actual field loss and night-vision needs.

Be cautious about promises from a premium lens

The 2023 systematic review included 12 studies. It noted that few studies had examined premium lenses in glaucoma and that some included only a small number of glaucomatous eyes. The authors stated that evidence may be insufficient to support premium-lens safety in advanced glaucoma. ⁸ The review also reported that multifocal lenses may affect the sensitivity of visual-field testing and optic-nerve imaging used to monitor glaucoma progression. ⁸

The review recommends choosing an intraocular lens individually according to the person’s visual goals and glaucoma findings. ⁸ Ask what is known for people with your glaucoma severity and what visual quality matters most in your daily life.

Set expectations for recovery and continued care

Cataract surgery can cause swelling, infection, retinal detachment, or unusual eye-pressure changes, and recovery includes scheduled checks. ² Postoperative follow-up should be tailored when an ocular condition such as glaucoma is present. ⁷

Ask how the proposed glaucoma procedure changes the usual cataract recovery, activity restrictions, drop schedule, and visit frequency. Keep the plan in writing, especially if different clinicians are responsible for cataract and glaucoma care.

When to Call Your Eye Doctor

Before surgery, report meaningful changes

Contact the eye clinic if your vision or eye comfort changes while you are waiting, or if you cannot follow the current drop plan. Ask whether the surgical plan should be reviewed.

A sudden burst of new floaters or flashes, especially with a curtain or cloud in your vision, needs an immediate eye examination. ⁹

After surgery, call right away for warning signs

New flashes, many new floaters, or a curtain or cloud in your vision after surgery needs an immediate eye examination. ⁹

These symptoms can occur with posterior vitreous detachment and are associated with retinal tears, so they require an immediate eye examination. ⁹ Use the surgeon’s urgent contact instructions.

Keep routine glaucoma monitoring even if vision is clearer

Many people with open-angle glaucoma have no symptoms until vision loss begins, and they may not notice that loss right away. ⁴

Regular glaucoma testing remains important because most types have no early symptoms. ⁴ Ask when the care team will judge whether the procedure met its pressure and medication goals.

Common Questions About Cataract Surgery With Glaucoma

More Questions to Settle Before Surgery

Is a multifocal lens safe if I have glaucoma?

There is no single answer. The review found that few studies had examined premium lenses in glaucoma and that some included only a small number of glaucomatous eyes. Its authors stated that evidence may be insufficient to support premium-lens safety in advanced glaucoma. ⁸ They recommend individualizing lens choice according to the person’s visual goals, glaucoma subtype, visual-field loss, ocular-surface disease, and planned glaucoma surgery. ⁸ Ask what benefit the lens is expected to add and which visual tradeoffs matter for you.

Should cataract surgery and glaucoma surgery happen together?

After a complete eye evaluation and discussion, the choice may be cataract surgery alone, glaucoma surgery alone, or combined cataract and glaucoma surgery. ¹ Ask the surgeon to compare the realistic paths for your eye.

What if the cataract is mild but glaucoma is changing?

Ask whether treatment should focus on glaucoma first and whether cataract removal would add enough benefit now. The answer should include what will be monitored, who owns the next step, and what change in daily vision or examination findings would make cataract surgery worthwhile later.

Questions to Ask Your Doctor

• How much of my current vision problem comes from cataract, and how much from glaucoma?
• What is the target pressure for this eye, and is my glaucoma stable?
• Why do you recommend cataract surgery alone, combined surgery, or staged treatment?
• Which exact glaucoma procedure are you considering, and what outcome is realistic?
• How does my glaucoma affect the artificial-lens choice?
• Which drops should I use before and after surgery?
• Who will monitor my pressure after surgery, and whom should I call urgently?