Understanding When Cataract and Glaucoma Treatments May Be Combined
Cloudy vision, difficulty reading, and trouble seeing clearly at night can be signs of cataracts. For someone who also has glaucoma, these changes may raise an important question: should cataract surgery be performed alone, or should a glaucoma procedure be done at the same time?
The decision involves more than improving vision. Cataracts affect the eye’s natural lens, while glaucoma damages the optic nerve, often in association with elevated intraocular pressure (IOP). When both conditions are present, ophthalmologists must consider how to improve vision while protecting the remaining optic nerve function.
An October 22, 2026, report from The American Journal of Managed Care (AJMC) discussed this issue through an interview with Leon W. Herndon Jr, MD, a glaucoma specialist at Duke Health. Speaking in connection with the American Academy of Ophthalmology (AAO) 2026 Annual Meeting, Herndon explained how disease severity, medication adherence, and postoperative pressure changes can influence surgical planning.
How Cataracts and Glaucoma Affect the Eyes Differently
A cataract develops when the eye’s natural lens becomes cloudy. Common symptoms include blurred vision, glare from headlights, faded colors, and difficulty performing everyday activities that require clear sight.
Glaucoma affects the optic nerve, which carries visual information from the eye to the brain. Damage can cause permanent vision loss, often beginning with peripheral vision. Because glaucoma may progress without noticeable symptoms during its early stages, regular eye examinations are important even when vision seems normal.
These conditions require different treatment approaches. Cataract surgery removes the cloudy lens and replaces it with an artificial intraocular lens. Glaucoma treatment aims to prevent further optic nerve damage, most commonly by lowering IOP.
When both conditions occur together, treating the cataract may improve visual clarity, but it does not necessarily provide sufficient pressure control for someone with glaucoma. That is why some patients may benefit from having both conditions addressed during one surgical plan.
Who May Benefit From Combined Eye Surgery?
According to the AJMC discussion, the decision to combine procedures depends on the patient’s individual clinical circumstances. Ophthalmologists consider the stage of glaucoma, whether the disease is progressing, and how effectively the current treatment plan controls eye pressure.
Patients with mild to moderate glaucoma
For some people with mild to moderate glaucoma who need cataract removal, minimally invasive glaucoma surgery (MIGS) may be considered during the same operation. These techniques are designed to improve the eye’s ability to drain fluid and lower pressure, generally with a less invasive approach than traditional glaucoma operations.
The potential advantage is that patients may receive treatment for both conditions during one surgical session. Depending on the procedure and individual response, this approach may also reduce the need for glaucoma medications.
However, MIGS does not provide the same degree of pressure reduction in every patient. The suitability of a particular technique depends on the type and severity of glaucoma, the target pressure, and other findings from the eye examination.
Patients with advanced glaucoma
More advanced disease may require a different surgical strategy. The AJMC report identifies procedures such as trabeculotomy and the use of drainage tubes among the options that may be considered when greater pressure control is needed.
These approaches differ in how they help fluid leave the eye and in their potential risks. The surgeon must weigh the need for lower pressure against the possibility of complications, recovery requirements, and the patient’s overall eye health.
For someone with substantial optic nerve damage, even a temporary rise in IOP may be a concern. As a result, the appropriate surgical plan may differ considerably from that of a patient whose glaucoma is mild and stable.
Why Glaucoma Severity Matters Before Cataract Surgery
Not everyone with elevated eye pressure has glaucoma. This distinction is important when deciding whether an additional procedure is necessary.
Ocular hypertension refers to higher-than-normal IOP without documented glaucomatous damage to the optic nerve. A person with ocular hypertension may not require glaucoma surgery simply because cataract removal is planned.
In the AJMC interview, Herndon indicated that patients with ocular hypertension may do well with cataract surgery alone. By contrast, he favors proactively considering treatment for established glaucoma when a patient is already undergoing cataract surgery.
This does not mean that every person with confirmed glaucoma should automatically receive combined surgery. Instead, the distinction highlights why a complete assessment is necessary before choosing a procedure.
Doctors may evaluate the optic nerve, measure IOP, examine the drainage angle, and perform visual field testing. Optical coherence tomography (OCT) can also help assess structural changes in the optic nerve and retinal nerve fiber layer.
How Eye Pressure Spikes Can Influence Surgical Decisions
One concern highlighted in the AJMC discussion is a possible increase in IOP after cataract surgery. Such postoperative pressure spikes can be particularly concerning for people with moderate to severe glaucoma because their optic nerves may already be vulnerable to further damage.
Eye pressure can rise for several reasons following surgery, including temporary changes in fluid drainage or retained surgical material inside the eye. The significance of a pressure increase depends on its magnitude, duration, and the condition of the optic nerve.
For patients with established glaucoma, the surgeon may therefore consider whether treating the cataract and improving pressure control together could offer an advantage. The goal is to address the visual effects of the cataract without overlooking the risks associated with glaucoma.
Combined surgery is not a guarantee against postoperative pressure increases. Patients still need appropriate monitoring, and the care team must be prepared to manage pressure changes according to the patient’s clinical needs.
Medication Adherence Is Another Important Consideration
Glaucoma treatment often involves long-term management, including prescribed eye drops and regular follow-up appointments. Maintaining a consistent medication routine can be challenging for some people, especially when several medications or multiple daily doses are required.
Missed doses can interfere with pressure control and make it harder to protect the optic nerve. Some patients may also experience difficulty administering drops because of limited hand dexterity, complex schedules, or problems remembering each dose.
During the AJMC discussion, Herndon highlighted medication adherence as one factor that supports considering glaucoma treatment when cataract surgery is already planned. For appropriate patients, a combined procedure may reduce dependence on daily drops.
Nevertheless, patients should not assume surgery will eliminate their medications entirely. The outcome depends on the type of glaucoma, the procedure performed, the pressure achieved after surgery, and the individual’s response to treatment.
What Tests Help Determine the Right Procedure?
A comprehensive examination helps the ophthalmologist understand both the cataract and the glaucoma before recommending surgery. The assessment may include several tests, depending on the patient’s history and examination findings.
Tonometry measures intraocular pressure. Because a single reading may not fully describe a patient’s pressure pattern, the ophthalmologist may consider previous measurements and other clinical information.
Gonioscopy allows the doctor to examine the drainage angle where fluid exits the eye. This finding can help determine which glaucoma procedures are appropriate.
Visual field testing measures areas of vision loss, while OCT imaging helps identify structural damage to the optic nerve. Examination of the optic nerve and review of previous results can help establish whether glaucoma is stable or progressing.
The surgeon will also assess the cataract’s effect on vision, review current medications, and consider other eye conditions. Together, these findings help guide the choice between cataract surgery alone and a combined operation.
When to See an Eye Doctor
Arrange an eye examination if you experience persistent blurred vision, increasing glare, difficulty seeing at night, or gradual changes in your ability to perform everyday visual tasks. People with diagnosed glaucoma should continue their scheduled monitoring even if they do not notice any symptoms.
Seek urgent medical attention for sudden vision loss, severe eye pain, a red eye accompanied by blurred vision, or eye pain with headache, nausea, or vomiting. These symptoms can indicate an urgent eye condition and should not be assumed to be ordinary cataract progression.
If you have both cataracts and glaucoma, ask your ophthalmologist whether your glaucoma is stable, what pressure target is appropriate for your optic nerve, and whether combined surgery offers meaningful benefits in your specific case.
Planning the Next Step for Better Eye Health
The AJMC report featuring Leon W. Herndon Jr, MD, underscores that cataract surgery planning should account for the patient’s glaucoma status rather than focusing on cloudy vision alone. Disease severity, progression, medication adherence, and the possibility of postoperative pressure spikes all help shape the decision.
Modern minimally invasive techniques have expanded the options available to selected patients, while more advanced glaucoma may require other surgical approaches. Cataract surgery alone can remain appropriate in some cases, including certain patients with ocular hypertension who have no documented glaucoma damage.
Your next step: Schedule a comprehensive eye examination and bring a list of your current eye medications, previous eye pressure readings if available, and any changes in your vision. Ask your ophthalmologist to explain the benefits, limitations, and risks of each suitable surgical option before making a decision.
