Expert Testimony: Cataract Surgery and Eye Pressure

Expert testimony may be needed when the subject is cataract surgery and eye pressure.

Quite often, patients who undergo cataract surgery also have preexisting glaucoma. In glaucoma the pressure is elevated unless it is controlled by medication or by a surgical procedure. A variety of medications exist to control eye pressure. Some are used just once a day, other used as much as four times a day. Expert testimony for cataract surgery and eye pressure can discuss the use and effectivess of glaucoma medications in the presence of advancing cataracts.

Medications to control elevated eye pressure may be maintained up until the time of cataract surgery and restarted shortly after the procedure. Patients who undergo cataract surgery may also have had a filter procedure such as trabeculectomy or laser procedure such as selective laser trabeculoplasty (SLT) before cataract surgery to maintain normal intraocular pressure. Expert testimony for cataract surgery and eye pressure can help understand the indications of medications and procedures to control intraocular pressure.

If pressure is elevated despite maximally tolerated or practical application of medications, than an ophthalmologist may may elect to perform a procedure to reduce eye pressure at the same time of cataract surgery. Many ophthalmologists will also consider combing cataract surgery with eye pressure surgery in patients with moderate to severe optic nerve damage or visual field loss. Combining both procedures is also considered in cases of advanced glaucoma, even when intraocular pressure is controlled, to prevent intraocular pressure spikes in eyes susceptible to further damage from glaucoma.

When cataract surgery is accompanied by a procedure to reduce intraocular pressure, it is often referred to as a combined procedure. For many patients combined procedures are an opportune time to maximize pressure reduction while improving vision. Filter procedures such as trabeculectomy and valve procedures such as an Ahmed valve may be constructively incorporated in cataract surgery to permanently reduce eye pressure. In some cases, the effectiveness of trabeculectomy or glaucoma valve may result in levels of intraocular pressure that minimize or eliminate the use of medications to maintain normal eye pressure.

Alternatively surgery to reduce intraocular pressure may be performed after cataract surgery as part of a two-stage process. For example, a surgeon may first remove a cataract since cataract surgery alone may reduce intraocular pressure by a modest degree. An ophthalmologist may consider individual circumstances including level of intraocular pressure, status of the optic nerve, and the presence of visual field defects before commiting to a two-stage procedure. In select cases, an ophthalmologist may elect to perform selective laser trabeculoplasty (SLT) as an adjunct treatment if intraocular pressure is not well controlled after cataract surgery.

Expert testimony for cataract surgery and eye pressure may involve discussion of potential risks and complications of surgical procedures to reduce intraocular pressure. A meaningful discussion between the patient and the physician may be very helpful for patients to understand options for treatment and their possible risks. Fortunately, the risk of developing a severe complication with many of the most common glaucoma procedures are rare.

Expert testimony from a qualified ophthalmologist is valuable when assessing cataract surgery and eye pressure. Advanced techniques have been developed to reduce the risk of complications and improve surgical outcomes. Patients benefit by having better control of their eye pressure and ophthalmologists benefit by the gratification of maximizing the best outcomes for their patients.

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