Glaucoma is the leading cause of irreversible blindness worldwide and disproportionately impacts racial and ethnic minority groups in the United States. In 2022, an estimated 4.22 million US adults (1.62%) had glaucoma, including 1.49 million (0.57%) with vision‑affecting disease, with notable demographic and geographic disparities reported.1
In 2025, clinical management of glaucoma is more sophisticated than ever—but also more complex—due to the coexistence of comorbidities like cataracts, the growing need for individualized care, and the demands for improved efficiency and outcomes in both diagnosis and surgery.
Fortunately, the digital transformation of ophthalmology has ushered in a new era of glaucoma care. Advanced technologies such as integrated imaging platforms, AI-enhanced diagnostics, and digital surgical planning tools are now helping clinicians streamline workflows, personalize treatment, and improve monitoring.2
These tools not only support better decision-making and patient engagement but are also becoming essential for the nuanced care of glaucoma patients—especially those undergoing concurrent cataract surgery.2
We spoke with Matteo Sacchi, MD, about the benefits of using digital tools to streamline clinical workflows and improve practice efficiency.
What is the biggest clinical challenge when co-managing glaucoma and cataract?
The co-management of cataract and glaucoma is a common clinical challenge, as these two conditions frequently coexist, particularly in elderly patients. The key challenge lies in recognizing that glaucoma should guide clinical decision-making, including surgical planning and post-operative follow-up.
Cataract surgery can potentially compromise vision in glaucoma patients due to the risk of post-operative intraocular pressure (IOP) spikes. Patients with advanced disease or specific phenotypes, such as pseudoexfoliative glaucoma, are particularly at risk. However, even those at earlier stages may experience significant IOP elevations after surgery.
Patients with cataract and early-stage glaucoma can often be safely managed with cataract surgery alone (phacoemulsification), provided that close monitoring is ensured. In contrast, patients with more advanced glaucoma may benefit from a combined procedure (cataract and glaucoma surgery), which can provide better long-term IOP control.
A thorough pre-operative assessment is essential to evaluate disease severity, anticipate surgical risk, and select the most appropriate approach. Ultimately, the key message is that glaucoma patients undergoing cataract surgery require a dedicated and individualized approach, based on careful pre-operative planning and tailored to the specific clinical scenario, in order to optimize outcomes.
What pre-operative digital tools do you use for imaging technologies, visual field data integration, AI, and EMR-based risk flagging?
The pre-operative assessment is crucial when managing coexisting cataract and glaucoma. A comprehensive data collection is necessary before surgery to plan a tailored, appropriate approach. This includes IOP values, glaucoma phenotype, angle configuration, stage of disease, and both functional and structural progression.
Digital tools such as optical coherence tomography (OCT) and visual field testing are key instruments we routinely use to assess the stage and progression rate of glaucoma. OCT anterior chamber analysis additionally provides a unique opportunity to evaluate angle anatomy, which is critical when planning cataract surgery in glaucoma patients.
Today, we benefit from integrated platforms that collect data from visual fields, OCT, and fundus imaging. We are progressively transitioning toward a comprehensive, integrated digital workflow that centralizes multimodal data to enhance pre-operative planning and streamline clinical decisions.
Digital tools that enhance pre- and post-operative evaluations
The ZEISS Glaucoma Workflow, for example, incorporates diagnostic and treatment data—including selective laser trabeculoplasty (SLT) laser interventions performed with the ZEISS VISULAS green system—into a unified digital ecosystem.
These platforms can also incorporate clinical information—such as medication regimens and IOP values—allowing dynamic and continuous patient monitoring. They also provide longitudinal analysis of structural and functional parameters, enabling clinicians to view at a glance the evolution of optic nerve and visual field status over time.
Moreover, these tools enhance patient–physician communication, as patients can easily visualize disease progression. This fosters greater engagement in shared decision-making. There is growing interest in the application of artificial intelligence (AI) to glaucoma management, particularly in the post-operative setting.
AI-based models are currently being explored to predict post-operative progression and to stratify surgical risk more accurately. This is a rapidly evolving field, and emerging data are expected to further improve clinical decision-making and personalized care in the context of cataract surgery for glaucoma patients.
Do you use digital platforms for post-surgical monitoring?
Yes, digital platforms are extremely valuable for post-surgical monitoring in glaucoma patients. They allow us to continue tracking both structural and functional parameters after surgery, ensuring continuity of care and timely detection of any changes. New platforms such as FORUM Glaucoma Workplace provide integrated analysis of structural (OCT) and functional (visual field) data.
This simultaneous evaluation is particularly helpful in identifying early signs of progression, even in cases where there is a mismatch between structural and functional findings—a common scenario in nearly 50% of patients.
The statistical analysis tools included in these platforms enable clinicians to assess disease trends with greater accuracy and simplicity. In addition, they allow us to input key clinical data such as the type of surgery performed, therapeutic regimen, and IOP values at various follow-up time points.
This results in a comprehensive and longitudinal view of the patient’s status, offering meaningful support for decision-making in post-surgical scenarios. Overall, these digital tools enhance our ability to personalize glaucoma care and improve outcomes after cataract or glaucoma surgery.
What digital workflow enhancements do you utilize as far as surgical planning software and/or integrated diagnostic platforms?
A key element in pre-operative planning, especially in patients with coexisting cataract and glaucoma, is the accurate selection of the intraocular lens (IOL). For years, we have relied on the ZEISS IOLMaster platform as a gold standard for IOL power calculation.
The latest generation, ZEISS IOLMaster 700, equipped with swept-source OCT technology, enables posterior corneal surface analysis, fixation check, and the use of advanced formulas such as Barrett True K. These features ensure high accuracy, even in patients with previous refractive surgery.
Moreover, its biometric data can be integrated into a dedicated digital cataract surgery workflow, streamlining pre-operative planning, lens selection, and post-operative data collection—further enhancing surgical precision and efficiency.
Have intra-operative guidance tools altered your surgical workflow?
Intra-operative guidance tools have significantly impacted my surgical workflow. This is an exciting and rapidly evolving field, with new technologies being introduced regularly.
Today, cataract surgery with toric IOLs can be supported by digital systems that assist with accurate intra-operative alignment and rotation of the lens, enhancing precision and outcomes. Intra-operative OCT is also becoming increasingly valuable, particularly in vitreoretinal and corneal transplant surgery, offering real-time anatomical feedback during the procedure.
Moreover, the adoption of 3D surgery and immersive, augmented visualization systems is driving a paradigm shift—from conventional optical and microscope-based surgery to digital platforms. Digital surgery is truly revolutionizing ophthalmic procedures. We are just beginning to appreciate its full potential.
One major advantage is in medical education; as a University Hospital surgeon, I see firsthand how digital systems enhance teaching through improved visualization and shared viewing. Another benefit is image optimization; digital platforms allow continuous enhancement of intra-operative images, tailored in real time to the surgeon’s needs, which improves safety and surgical performance.
What advice do you have for an ophthalmologist who is interested in adding any of the digital tools?
Today, many digital tools are available, each tailored to different ophthalmic subspecialties. First, the choice should be guided by your area of expertise—for example, a cornea specialist may benefit from tools different from those used by vitreoretinal or glaucoma surgeons. Select the technology based on your clinical goals and interests.
Consult with experts and industry representatives: international meetings are great opportunities to meet peers, exchange ideas, and identify solutions that best meet your specific needs. Finally, test the tool in your operating theatre. Hands-on demos are essential to understand how a new device performs in real clinical practice.
What are the 3 key takeaways?
First, from a clinical point of view, managing coexisting cataract and glaucoma requires a tailored approach. Surgical planning—whether cataract surgery alone or combined with glaucoma surgery—must consider the glaucoma phenotype and disease stage. In combined cases, the most appropriate glaucoma surgical technique should be thoughtfully selected. Close post-operative monitoring is essential to detect IOP spikes early.
Additionally, digital platforms have become an integral part of our daily clinical practice. They enable the collection of a broad range of data—clinical, imaging-based, structural, functional, and therapeutic—and support an integrated digital workflow. This improves clinical decision-making by increasing accuracy, saving time, and offering a unified interface for both clinical evaluation and patient engagement.
And finally, we are living through a time of rapid and profound transformation. Digitalization, 3D technology, augmented reality, and now artificial intelligence are reshaping the way we work and think. As clinicians, we must remain open to this change, approach it with curiosity, and—most importantly—seek a deep understanding of these innovations.
Only by doing so can we fully harness their potential and ensure that technology enhances, rather than replaces, the core values of our medical profession.
In conclusion
As this experience illustrates, digital tools have redefined how we assess, plan, and monitor patients with glaucoma—especially when surgical intervention is required.
They help us integrate multimodal data, refine risk stratification, and track structural and functional changes with greater accuracy over time. More importantly, they enhance the clinician’s ability to personalize care, improve safety, and increase both efficiency and patient satisfaction.3,4
