Glaucoma and the Aging eye

Core Concepts • Glaucoma is the leading cause of irreversible and preventable visual disability worldwide (accounting for 12% of global blindness) • As the population ages, the coexistence of cataract and glaucoma is common • Management options of POAG in the context of coexisting cataract include cataract surgery, trabeculectomy or combined surgery • Choice of surgical algorithm is dictated by the severity of the glaucoma and pre-operative iOP control, as well as individual patient factors • For POAG patients with well controlled iOP and early to moderate disease, it may be reasonable to perform cataract surgery alone, as this may reduce iOP by 2–4 mmHg (mostly not sustainable over longer term). • In patients with uncontrolled moderate to severe glaucoma on maximal tolerable medical therapy, trabeculectomy alone may be reasonable. • In patients with uncontrolled glaucoma and visually significant cataract, combined surgery and trabeculectomy should be considered. However visual recovery and post-operative course are usually longer. • In patients with mild to moderate glaucoma and a desire to decrease medications, one of the newer techniques (trabectome, stents, eCP or canaloplasty) combined with cataract surgery may be appropriate. However, long-term outcomes data is not yet available.