GLAUCOMA EWAP JUNE 2023 41 Patients with glaucoma who need cataract surgery have many lens options available, and it’s important for physicians to present the potential benefits and risks so patients can make the best decision. Steven R. Sarkisian Jr., MD, and Deborah Ristvedt, DO, discussed different lens options for glaucoma patients and important factors to consider. “The ‘combined procedure’ looks nothing like it did when I started my training,” Dr. Sarkisian said. “Back then, the major controversy was ‘one site’ vs. ‘two site’ phaco/ trabeculectomy.” The combined procedure, phacoemulsification combined with MIGS, is now Dr. Sarkisian’s primary source of referrals. “IOL technology has evolved, along with MIGS. It was once considered inappropriate to combine a multifocal IOL of any kind with glaucoma surgery, which is understandable when you consider what glaucoma surgery used to be,” he said. He added that the release of the iStent (Glaukos) in 2012 changed this. Dr. Ristvedt agreed that the IOL technology has come a long way, allowing for physicians and patients to explore premium IOL options even in the context of glaucoma. “It’s important to look at each individual case and by Ellen Stodola EyeWorld (US) Editorial Co-Director Contact information Ristvedt: deborah.ristvedt@vancethompsonvision. com Sarkisian: admin@okeyesurgeons.com choose an IOL that you would use if that patient were your own family member,” she said. With all multifocal lenses, there is some loss of contrast sensitivity, but it is less than it was in the past, Dr. Sarkisian said. “For my glaucoma patients with visual field loss, I prefer an EDOF lens such as the Vivity IOL [Alcon] because these do not typically reduce contrast sensitivity, and they do not split the light going to the retina,” he said. “My typical glaucoma patient receiving the PanOptix IOL [Alcon] has essentially full visual fields.” He added that with highly motivated and carefully selected patients, he will offer the PanOptix IOL in those with well-controlled moderate to severe glaucoma, as long as they have good central vision and they understand the potential risks. With glaucoma surgery performed in conjunction with cataract surgery, Dr. Ristvedt still uses technology for more precision in outcomes. Source: Deborah Ristvedt, DO Lens options in glaucoma patients This article originally appeared in the April 2023 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.
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