Evaluation

- Patient and family history should be taken into consideration.

- Gonioscopy required for formal evaluation and diagnosis.

Intervention

Lens extraction can be offered as first line management.

- In place of peripheral iridotomy.

To prevent angle closure glaucoma progression, even in patients with clear lenses.

EAGLE Study

Compared clear lens extraction to peripheral iridotomy (standard)
Found those in the lens extraction group had...

- Lower rates of irreversible glaucomatous blindness progression
- Lower mean IOP
- Greater quality of life
- More cost effective management

Azuara-Blanco et al. The Lancet 2016.

EAGLE Study

Explanation

Non-Cataractous Lens

- Preipheral iridotomy provides aqueous outflow from ciliary body to anterior chamber.

Effectiveness is still dependent on patency of trabecular meshwork and canal of schlemm.

- The inherent shape of our native, non-cataractous, lens can still impede on the trabecular meshwork's patency - more than the shape of an implanted lens can (when placed properly).

Cataractous Lens

- As the cataract progresses, the lens thickens and pushes against the iris.

- This causes anterior displacement of the iris leading to narrowed angles and a shallow anterior chamber.

Increasingly narrowed angles are most commonly seen during the progression of Nuclear Sclerotic Cataracts.

Phakic

Anterior and posteriorly dislocated phakic lenses require surgical intervention

- Prevent secondary inflammation
- Provide anisometropic relief

An aphakic contact lens can be used if surgery is to be avoided.

Pseudophakic

- Lenses that are displaced may need urgent surgical intervention if causing damage to other structures (cornea, angle, retina)

Definition

- Patient's eyes have ≥ ~2.00 Diopter difference in refractive power.

- Resulting in clinically significant problems.

Common Presentation

- Blurred vision
- Eye strain
- Headache
- Binocular diplopia

Anisometropia is most common in Nuclear Sclerotic Cataracts.

Suggested Management

- Surgical intervention should be scheduled as soon as the cataract is visually significant.

Explanation

- Reduces risk of intra and postoperative complications associated with later stage cataracts.

°Consider additional postoperative prophylactic medication and/or prolonged course for patients on chronic immunosuppressants and immunomodulators.
‡Abx course completed, infection resolved, prior to preoperative appointment measurements.
*Lens induced inflammation and glaucoma are exceptions to these contraindications.