Smarter cataract surgery in glaucoma: When MIGS, refractive goals and multispecialty care align
Cataract and glaucoma frequently coexist, presenting complex diagnostic and surgical challenges. While cataract extraction can improve intraocular pressure control in some patients, inappropriate case selection or surgical planning may accelerate glaucoma progression, destabilise disease control, or lead to suboptimal refractive and functional outcomes.
This session will provide a pragmatic, case-based approach to managing cataract surgery in patients with glaucoma, aimed at both ophthalmologists and optometrists involved in peri-operative care. The talk will explore pre-operative assessment strategies including risk stratification, visual function considerations, role of premium lens, and the impact of cataract surgery on glaucoma monitoring.
A major focus will be on the evolving role of minimally invasive glaucoma surgery (MIGS). Through real-world clinical cases and evidence-based discussion, the talk will clarify:
When MIGS provides meaningful benefit
When traditional glaucoma surgery should still be prioritised
The session will also explore emerging approaches that push conventional boundaries of MIGS utilisation. This includes combining MIGS with vitreoretinal procedures in carefully selected patients, as well as considerations of using premium or monofocal-plus intraocular lenses. Practical discussion will focus on balancing refractive ambition with glaucoma stability, managing patient expectations, and maintaining long-term disease control.
Learning outcomes
- Recognise key factors influencing cataract surgery planning in patients with glaucoma, including disease severity and visual function.
- Identify common pitfalls and complications associated with cataract surgery in glaucoma patients and apply strategies to minimise surgical and postoperative risk.
- Evaluate which patients are suitable candidates for minimally invasive glaucoma surgery (MIGS) when combined with cataract surgery.
- Differentiate clinical scenarios where MIGS may be less effective or inappropriate, and recognise when alternative glaucoma interventions should be considered.
- Discuss emerging approaches to integrating MIGS with complex surgical scenarios
- Assess the considerations and limitations of premium and monofocal-plus intraocular lenses in glaucoma patients, balancing refractive outcomes with disease stability.
- Understand the role of multidisciplinary collaboration in peri-operative glaucoma and cataract care.
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