Cataract surgery and co-existing glaucoma: Expert insight on phaco-plus procedures

In this informative article, we hear expert insight from revered consultant ophthalmic surgeon Mr Chrysostomos Dimitriou on simultaneous cataract and glaucoma micro-incisional and minimally invasive surgery for patients suffering from both eye conditions concurrently. Mr Dimitriou, a highly respected specialist in cataract surgery and glaucoma management also details the most common causes of blindness in over fifties worldwide and explains how innovation in the field is improving outcomes for patients.

How do glaucoma and cataract affect our vision?

Glaucoma, also known as the “silent thief of vision” is a progressive damage to the optic nerve, the cable that connects the back of the eye to the brain. It usually affects peripheral visual function, so-called “tunnel vision”, thus for example “stealing” patients’ driving eligibility and subsequent licence at advanced disease stages. It may also lead to serious partial or total loss of central vision, which is irreversible, if left untreated for too long. Lowering the pressure inside the eye, a major risk factor for glaucoma progression, is the main target of all currently available anti-glaucoma treatment modalities.

Cataract is the clouding of the normally clear natural lens of the eye, simulating vision while looking through a frosty or fogged-up window. When our vision is clouded by cataracts, it is more difficult to read, drive a car (particularly at night) or distinguish expressions on people's faces. Cataract surgery, the most common operation performed worldwide amongst all medical specialties, has been successfully addressing this problem with very high safety profile and patient satisfaction for decades.

Nowadays, the growing and ageing of populations have led to increasing numbers of individuals with moderate to severe vision impairment globally. These trends triggered World Health Organisation and the International Agency for the Prevention of Blindness to establish an initiative in 1999 named 'Vision 2020: The Right to Sight'. In 2020, the leading global causes of blindness in those aged 50 or over were identified as:

• Cataract: 15.2 million cases
• Glaucoma: 3.6 million cases
• Under-corrected refractive error: 2.3 million cases
• Age-related macular degeneration: 1.8 million cases
• Diabetic retinopathy: 0.86 million cases

​Of those cases, glaucoma is the primary cause of irreversible visual loss worldwide.

What are the latest treatment modalities?

As modern, micro-incisional, ultrasonic (phacoemulsification) and laser-assisted cataract surgery has evolved over the recent years, a new era of minimally invasive glaucoma (MiGS) procedures (micro-pulse lasers, micro-stents, micro-tubes and micro-shunts) has arisen. The eruption of those MiGS technologies has evidently increased the treatment options and therapeutic approaches to tackling intraocular pressure control (IOP) at the time of cataract surgery, in one combined operation.

At The Oaks Private Hospital, as well as The Colchester Eye Centre of Excellence, a significant proportion of the globally available MiGS have become routine practice of phaco-plus procedures, meaning cataract surgery combined with a glaucoma operation in less than half an hour on the operating table, under local or topical anaesthesia, significantly reducing IOP, as well as the burden of topically applied anti-glaucoma eye-drops on a daily basis.




Mr Dimitriou is a senior full-time consultant ophthalmologist and the lead clinician for glaucoma at his NHS base and has performed in excess of 2000 MiGs procedures. He is currently recognised as the eye surgeon with the highest number of successful MiGS procedures in the whole of East Anglia to include SLT Laser, Micro-Pulse Laser, XEN45, iStent G2W, KDB, PRESERFLO, HYDRUS, OMNI and many more.

Mr Dimitriou was awarded Level 2 Clinical Excellence Award in 2019 in acknowledgement of his efforts to bring those new technologies to everyday clinical practice for the benefit of his cataract and glaucoma patients. To schedule a consultation with Mr Dimitriou, visit his Top Doctors profile.