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July consultation #2
Just as the surgical landscape for glaucoma has changed significantly, our approach to the disease has as well. Simply stated, glaucoma management has become more interventional. Decreasing drop burden is now a goal at a time when ocular antihypertensive medication options are numerous. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Authors: Arsham Sheybani, Iqbal Ike K. Ahmed Tags: Consultation Section: Glaucoma Source Type: research

July consultation #3
The patient has visually significant cataracts and glaucoma that is much worse in the left eye than the right eye. The easiest part of this case is the decision to remove the cataracts. Cataract surgery alone can lower IOP; however, in this case, the patient is on maximum medical therapy, so cataract surgery alone will probably not be enough to achieve a target pressure unless medications are used. Because the patient tolerates medications well and has been relatively stable over the last 2 years, we do not have to lower the IOP significantly, nor are we compelled to eliminate medications. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Authors: John P. Berdahl Tags: Consultation Section: Glaucoma Source Type: research

July consultation #4
This older man has cataracts in both eyes with mild-to-moderate glaucoma in the right eye and more severe glaucoma in the left eye. Similar to my initial recommendation,1 I would perform cataract surgery with a MIGS procedure in both eyes. I would use a monofocal IOL in both eyes. I would not use a multifocal or depth-of-focus IOL in either eye, and I would not do even a mild degree of monovision. If this patient has significant astigmatism in either or both eyes, I would recommend a toric IOL. Femtosecond laser –assisted cataract surgery would be an option for either eye, but he will do well with a manual procedure as w...
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Authors: Reay Brown Tags: Consultation Section: Glaucoma Source Type: research

July consultation #5
Our glaucoma patients are no longer satisfied with spectacle dependence at all distances, surgically induced astigmatism, months long recovery, significant risk for complications, or a procedure that would require them to take multiple glaucoma drops postoperatively. Although, we remind them daily that despite all the advances we have, there is still no magic cure, their expectations are still exceedingly high. Our main goal is to reduce their dependence on drops while offering a quick and safe visual recovery. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Authors: Eric D. Donnenfeld, Valerie Trubnik Tags: Consultation Section: Glaucoma Source Type: research

July consultation #6
I am happy to revisit the case of a 79-year-old man with visually significant cataract and moderate POAG in the right eye and severe POAG in the left eye. We are reminded that he is having difficulty driving at night. I am also concerned about his visual field loss progression in the recent past, despite the fact that his visual field examinations have been relatively stable over the past 1 to 2 years. However, given the amount of optic nerve damage and corresponding visual field loss, the current IOP level is too high in both eyes, despite maximum tolerated medical therapy. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Authors: Leon Herndon Tags: Consultation Section: Glaucoma Source Type: research

July consultation #7
The visual fields indicate that this patient has moderate-to-advanced cupping of both optic nerves with more severe cupping in the left eye. Maximum medical therapy over the past 1 to 2 years has resulted in a reduction in the IOP that allowed for disease stabilization. He also has visually significant cataracts in both eyes and wants better CDVA. Therefore, as I did in my initial response,1 I would recommend a monofocal 1-piece acrylic IOL. If significant astigmatism were present in either eye, a toric IOL would have been my recommendation. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Authors: Malik Y. Kahook Tags: Consultation Section: Glaucoma Source Type: research

July consultation #8
This patient has marginal IOP control with advanced glaucomatous cupping and field loss on maximum medical therapy in both eyes, though worse in the left eye. Cataract removal is indicated to improve vision and assist with lowering the IOP. In line with my initial recommendation,1 I would place a standard monofocal IOL (or a toric IOL, if justified by the extent of astigmatism). I would still recommend against placing a multifocal IOL because it would compromise functional vision given the extent of the glaucomatous loss. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Authors: Richard A. Lewis Tags: Consultation Section: Glaucoma Source Type: research

July consultation #9
This patient has a left eye with severe glaucoma and cataract and a right eye with moderate glaucoma and cataract. The IOP readings are borderline at best, and our patient is using three topical medications. Fixation in the left eye is threatened, and the CDVA in the left eye might be limited by glaucoma damage. Therefore, preventing an IOP spike might be critical to this patient ’s outcome. Although the precise value is not given, the left eye would appear to have at least 15 dB of field loss. As in my initial recommendation,1 I would address the left eye first because its condition is more time sensitive. (Source: Jour...
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Authors: Nathan M. Radcliffe Tags: Consultation Section: Glaucoma Source Type: research

Editor ’s Comment
With this edition of GLAUCOMA CASE CONSULTATION SECTION, I thought it would be instructive to present a case of coincident cataract and glaucoma that had been previously presented, to determine whether practice patterns have changed in the 4 to 5 years since the initial review.1 The clinical scenario is presented to the very same panel of experts and is identical to the previous presentation. However, notably, the recommendations have changed, especially in the more damaged left eye. In contrast, the preferred management in the less damaged right eye is similar to previous recommendations. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Authors: Thomas W. Samuelson Tags: Consultation Section: Glaucoma Source Type: research

Photo Award
Category: Slitlamp Photography –3rd Place (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Source Type: research

Editorial Board
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Source Type: research

Masthead
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Source Type: research

Table of Contents
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Source Type: research

Visual Acuity Chart
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Source Type: research

Effect of central hole location in phakic intraocular lenses on visual function under progressive headlight glare sources
To analyze the effect of the central hole location in the V4c implantable collamer lens (ICL) on the quality of vision, including progressive headlight glare simulation and quality of life. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 27, 2019 Category: Opthalmology Authors: Elena Mart ínez-Plaza, Alberto López-Miguel, Itziar Fernández, Francisco Blázquez-Arauzo, Miguel J. Maldonado Tags: Article Source Type: research