Intraocular lens choices for patients with glaucoma

To discuss the unique functional and structural changes in glaucoma and the impact on intraocular lens (IOL) selection.

Glaucoma is a common ocular disease. Functional and structural changes associated with glaucoma require special consideration in the patient who is undergoing cataract/IOL surgery. Decreased contrast sensitivity found in glaucoma may be enhanced by the use of aspheric IOLs. Small pupils and weakened zonules necessitate meticulous surgical technique and increase the risk of IOL dislocation, as does anterior capsular contraction. Posterior capsular opacification is a common postoperative complication and may be related to IOL material and design. Both anterior chamber depth and axial length may change in patients who have had trabeculectomy and should be considered in the preoperative plan. Multifocal IOLs may afford spectacle independence for patients; however, there is a paucity of data for their use in concurrent ocular disease.

Although there are challenges in performing cataract surgery in patients with glaucoma, excellent outcomes may be obtained with proper preoperative planning, meticulous intraoperative technique, and appropriate selection of IOL design.