Among the best ways of addressing narrow angles in patients with some degree of cataract development is doing cataract surgery. In our podcast with Johnny Gayton MD, he explained the logic behind this and he was instrumental in bringing this technique to light. As the cataract develops, the crystalline lens increases in anterior-posterior dimension, becoming thicker. In cataract surgery we replace this 4.5+ mm thick cataract with an IOL that is very thin (1 mm or so) and this allows the angle to open wide. It also restores a deeper anterior chamber and addresses the patient’s underlying refractive error (typically a high degree of hyperopia). It’s a win all around. This video shows the gonioscopic view of the angle before and immediately after cataract surgery and the results are impressive.
