When to Combine Glaucoma, Cataract Procedures: Leon W. Herndon Jr, MD

Cataract surgery in a patient with glaucoma can be an opportunity to address more than cloudy vision. At the American Academy of Ophthalmology 2026 Annual Meeting, Leon W. Herndon Jr, MD, a glaucoma specialist at Duke Health, describes how clinicians weigh combining cataract and glaucoma procedures to protect the optic nerve, lower intraocular pressure (IOP), and reduce reliance on eye-drop medications.

The choice depends on the individual. Clinicians consider glaucoma severity, whether the disease is progressing, and how consistently the patient can use medication. For mild to moderate glaucoma, minimally invasive glaucoma surgery may be an option alongside cataract surgery. More advanced disease may call for other procedures, such as trabeculotomy or a drainage tube. The appropriate approach is determined case by case.

Herndon Jr favors proactively treating manifest glaucoma when cataract surgery is planned, emphasizing that medication adherence can be difficult for patients. By contrast, patients with ocular hypertension—elevated eye pressure without documented glaucoma damage—may do well with cataract surgery alone, according to the discussion.

One concern is postoperative pressure elevation. Cataract surgery alone can be followed by IOP spikes, particularly in patients with moderate to severe glaucoma. Herndon Jr notes that these increases may place a vulnerable optic nerve at risk. Combining procedures may help manage pressure while addressing cataracts, though the choice of surgery should reflect each patient's clinical circumstances.

Surgical options have also changed. Herndon Jr contrasts today's minimally invasive techniques with the traditional choices available decades ago, including trabeculotomy and tubes, which could involve complications. Newer approaches, he says, provide ways to lower pressure and reduce medication burden.

The takeaway is that cataract surgery planning in glaucoma involves assessing the patient, not just the cataract. Disease stage, progression, medication adherence, and the risk of pressure spikes all inform whether a combined procedure is considered. A personalized discussion with an ophthalmologist can clarify the benefits, limitations, and risks of options.