Cataract Surgery Can Be Glaucoma Cure
Twenty-plus years ago, I attended a continuing education seminar near Dallas where one of the speakers was a professor from the University of Houston College of Optometry. He began by saying something to the effect that, “the more we learn about glaucoma, the less we know.” He then followed up by stating that glaucoma may be several different diseases lumped together under one name. He continued by discussing open angle glaucoma, closed angle glaucoma, normal pressure glaucoma, and so on.

When I Googled a definition for glaucoma, I first got, “A condition of increased pressure within the eyeball, causing gradual loss of sight.” Further down was the medical dictionary definition: “a group of eye diseases characterized by damage to the optic nerve usually due to excessively high intraocular pressure (IOP).” And another entry stated, “a common eye condition in which the fluid pressure inside the eye rises because of slowed fluid drainage from the eye.” There are lots of other entries basically saying the same things. But, other than closed angle glaucoma, there is not much about the cause of glaucoma. The “cause” is listed as unknown or, at best, increased inflow or decreased outflow of fluids.

Drs. Brooks J. Poley, Richard L. Lindstrom, Thomas W. Samuelson, and Richard R. Schulze, Jr., have identified one cause of increased IOP and a way to reduce it. It is established that the crystalline lens continues to grow throughout one’s entire life.^1,2 This “lens growth repositions the anterior lens capsule and the anterior uvea (iris and anterior ciliary body) forward, compressing the trabecular meshwork and the canal of Schlemm, so intraocular pressure elevates.”³ This becomes ocular hypertension and usually glaucoma thereafter.

They did retrospective reviews and found that phacoemulsification with intraocular lens implantation did in fact significantly lower IOP. An obvious conclusion is that, “the aging crystalline lens may be a major cause of ocular hypertension and glaucoma,” and lens exchange surgery certainly has the potential to delay or prevent the development of adult glaucoma.⁴ Further, their studies “suggest phaco/IOL can be an effective treatment for glaucoma eyes if a target IOL of 18mm Hg following surgery is deemed adequate.”⁵

Sight Gags by Scott Lee, O.D.

Prior to meeting Dr. Poley, I had not heard of nor read in any of our journals that lens exchange could be a first-line treatment for ocular hypertension and/or adult glaucoma. This appears pretty straightforward, so why haven’t I been hearing and reading about it? There is no way that I could know the answer to that question. However, I am not shy about guessing:

• The FDA has not given its blessing to phaco/IOL as an approved treatment for ocular hypertension and/or glaucoma. Therefore, it does not have the important “standard of care” designation.
• While numerous meds are prescribed and procedures performed “off label,” the medical community is often slow to accept something totally different from what it has been doing.
• The glaucoma pharmaceutical industry generates at least $3 billion-plus, and lens exchange surgery could make a big dent therein.
• There would be a far smaller need for “glaucoma specialists” (M.D.s, D.O.s, and O.D.s) and many would lose their income for managing glaucoma patients.

All activity has some risk. This includes phaco/IOL surgery. Phaco/IOL surgery is the most frequently performed surgery in America, and the risk seems to be miniscule. Many refractive surgeons have stated that they believe phaco/IOL surgery yields better outcomes than LASIK and PRK.

It has been stated that everyone who lives long enough will develop cataracts (impossible to either prove or disprove), so if one is interested in refractive surgery, why have two surgeries? While there are currently only three progressive/bifocal/ accommodating FDA-approved IOLs, there are many others in the pipeline, with more to follow. Add in the avoidance of glaucoma, and phaco/IOL surgery appears very attractive. So attractive, in fact, that I believe in 10 or 15 years, refractive surgery will shift from LASIK/ PRK to phaco/IOL. LASIK/PRK provides excellent results for either distant or near vision, but not both.

Phaco with multifocal IOL implantation provides excellent near and distant vision, prevents ocular hypertensive eyes from converting to glaucoma eyes, lowers intraocular pressure in eyes with glaucoma, and removes the cataract from those who live long enough for it to develop.
—John Clark Moffett, O.D.
Carrollton, Texas

1. Mann I. Developmental Abnormalities of the Eye. Philadelphia: JP Lippincott; 1957:298-9.
2. Adler FH. Physiology of the Eye, Clinical Application. St Louis: CV Mosby; 1950:247-53.
3. Poley BJ, Lindstrom RL, Samuelson TW, Schulze R Jr. Small Incision Cataract Surgery and Glaucoma. In: Johnson SM, ed. Cataract Surgery in the Glaucoma Patient. New York: Springer; 2009: 35.
4. Poley BJ, Lindstrom RL, Samuelson TW, Schulze R Jr. Intraocular pressure reduction after phacoemulsification with intraocular lens implantation in glaucomatous and nonglaucomatous eyes: evaluation of a causal relationship between the natural lens and open-angle glaucoma. J Cataract Refract Surg. 2009 Nov;35(11):1946-55.
5. Poley BJ, Lindstrom RL, Samuelson TW, Schulze R Jr. Small Incision Cataract Surgery and Glaucoma. In: Johnson SM, ed. Cataract Surgery in the Glaucoma Patient. New York: Springer; 2009: 47.

Eyesight and the Eye Chart
Would you believe that the eye chart that was introduced more than 150 years ago (1862 to be exact) is still present in every medical office in the world! It is still being used as a screening device for seeing disorders. Before the Snellen eye chart was developed, there was no means to measure what the eyes could see at great distances.

But it is the same 150+ year-old eye chart that is still being used to determine seeing problems of the young and old. How far away one can see has very little to do with today’s school problems, computer problems or work problems. The eye chart is a monocular test for far-away seeing. It has little to do with reading difficulties. It does give a false sense of security in what the two eyes can see.

Can you imagine any other assessment for health screening that uses a test that is more than 150 years old and presents mostly false positives for what it tests?

According to an NIH study, even trained health screeners still miss 30% of children’s vision disorders. Amblyopia, strabismus and refractive errors were consistently missed during the study’s screening process.

Can you imagine what the eye chart cannot do?
—Sol Tannebaum, O.D.
Olympia Fields, Ill.

Vision in Preschoolers Study Group. Preschool vision screening tests administered by nurse screeners compared with lay screeners in the vision in preschoolers study. Invest Ophthalmol Vis Sci. 2005 Aug;46(8):2639-48.

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