Publication Exclusive: Disruptive changes ahead in glaucoma space

All of us who do cataract surgery see a significant number of patients who have glaucoma as a comorbidity. At least 10% of patients who come to have cataract surgery also have a diagnosis of glaucoma or ocular hypertension, and a review of Medicare statistics suggests the number may approach 20% in the over-65-year-old population.During the first two decades of my practice, if a patient presented with combined cataract and glaucoma, I always recommended a combined phacoemulsification and trabeculectomy, because in those days I was invading prime conjunctiva by doing a conjunctival peritomy for my cataract surgery and operating superior. After switching to temporal clear corneal cataract surgery, I began to treat more of my patients presenting with combined cataract and glaucoma with phacoemulsification alone, reserving trabeculectomy for those who did not achieve good IOP control with phacoemulsification combined with argon or selective laser trabeculoplasty and/or topical drops.