Premium Intraocular Lens Selection in Patients With Glaucoma: A Clinical Review

ABSTRACT

Glaucoma frequently coexists with cataract, but glaucomatous functional loss, ocular‐surface disease, anatomical abnormalities, and treatment‐related refractive variability may reduce tolerance of premium intraocular lenses. This narrative review critically appraises evidence relevant to lens selection in glaucoma. Central visual‐field status, contrast sensitivity, fixation, disease stability, anterior‐segment anatomy, intraocular pressure control, topical treatment, previous or anticipated glaucoma surgery, and lifetime progression risk should inform decision‐making. Enhanced monofocal lenses may improve intermediate vision while preserving distance vision and functional reserve in selected patients with ocular hypertension, preperimetric glaucoma, or early, stable open‐angle glaucoma. Selected extended depth‐of‐focus lenses may be considered when central visual function is preserved, whereas toric lenses require regular, repeatable astigmatism and stable capsular‐zonular support. Current evidence does not support routine multifocal lens implantation in established glaucoma. Selection should remain individualised, evidence‐calibrated and supported by explicit counselling about uncertainty, dysphotopsias, future progression and possible refractive change after glaucoma surgery.