Second Sight

Treating glaucoma during cataract surgery enhances benefits with no added risk.

Even at 85, Joan Herrold still helps others. She’s part of a church group that fashions mats for the homeless out of plastic grocery-store bags. Joan’s role is to cut up the bags and roll them into balls, like yarn. Someone else crochets the balls of plastic into the mats.

Joan Herrold has her cataracts removed and iStent inject® inserted for her glaucoma by Dr. Q. Jocelyn Ge at Premier Eye Clinic in Port Orange and Ormond Beach.

Joan’s successful surgeries are allowing her to once again help the homeless.

A Pennsylvania native, Joan needs good vision to do her part of the project, but she struggled since childhood with bad eyes. Last fall, a duo of eye conditions forced her to visit an accomplished ophthalmologist for specialized treatment.

“I had worn glasses since I was in second grade, up until the 1980s, when I got contact lenses,” Joan recalls. “Then I wore contacts for many years. My lenses were corrected for monovision. The left eye was for reading, and my right eye was for distance.

“My vision didn’t change much over the years. My only problem was I had glaucoma. I put drops in my eyes in the morning and evening, and I did that for nearly eighteen years. The drops kept my eye pressure at a normal level.

“Then as I got older, I developed cataracts. I kept going to the eye doctor, but they kept telling me my cataracts weren’t ready for surgery.”

In 2017, Joan developed an eye condition that required special attention. Her regular doctor referred her to board-certified ophthalmologist Q. Jocelyn Ge, MD, PhD, at Premier Eye Clinic. Joan has been impressed by Dr. Ge’s sensitivity as well as her expertise since then.

Over time, Joan began experiencing particular difficulties with her vision, which were most evident when driving at night. She saw halos around lights and had problems reading street signs. These symptoms, Dr. Ge told her, are classic signs that her cataracts had advanced.

“Upon examination, I realized Joan had cataracts that were causing her symptoms,” Dr. Ge verifies. “She was also dependent on corrective lenses. We decided it was time to perform surgery to remove her cataracts and reduce her dependence on glasses and contact lenses.

“In addition, Joan had a long history of glaucoma. There are different types of glaucoma. Joan had the most common type, open-angle glaucoma, and for years, she took eye drops to control the pressure in her eyes.

“But now, there is a technology called iStent inject® that is inserted at the time of cataract surgery. The iStent inject benefits people with open-angle glaucoma by decreasing eye pressure and reducing or eliminating the need for eye drops.
I recommended it for Joan.”

Lowering Pressure

The iStent inject is made of titanium and is very biocompatible. The miniature device, measuring 0.3 mm, works as an artificial shunt inserted into the drainage system of the eye to improve outflow and lower the pressure. Each iStent inject comes with two stents, and they are inserted separately to enhance the pressure-lowering effect.

“Think of the eye as a closed chamber,” Dr. Ge instructs. “There is a part in the eye that continuously pumps fluid into the eye, which increases pressure. There is another area where fluid flows out of the eye, called the trabecular meshwork. Proper balance of inflow and outflow maintains a healthy pressure level. If the outflow is compromised, pressure rises, and you have glaucoma.

“We can now treat glaucoma using a brief procedure performed at the time of cataract surgery. During this procedure, the trabecular meshwork is accessed, and the iStent inject is inserted into its delicate tissue. This opens up a new channel, allowing for more outflow of fluid. The iStent inject is FDA approved for injection only at the time of cataract surgery.

“With lower eye pressure, patients can often discontinue using prescription eye drops,” Dr. Ge continues. “That is a huge benefit because eye drops can have side effects. For example, some can cause asthma, change blood pressure or heart rate. They can also be toxic to the surface of the eye, cause eye irritation and make dry eye worse. Eye drops can also be cost prohibitive.”

The procedure to place the iStent inject is a minimally invasive glaucoma procedure, or MIG. It doesn’t take very long and is extremely safe. In fact, there’s no added risk to the patient by adding the iStent inject procedure to the end of cataract surgery. The risk of the combined procedures is the same as that of cataract surgery alone, which is minimal.

 Joan Herrold has her cataracts removed and iStent inject® inserted for her glaucoma by Dr. Q. Jocelyn Ge at Premier Eye Clinic in Port Orange and Ormond Beach.


“Adding the iStent inject procedure to cataract surgery has multiple benefits for patients,” Dr. Ge asserts. “They are able to see better with their cataracts removed and new lens implants, and their eye pressure is lowered with the stents, so they don’t have to use as many eye medications long term. And the beauty is, there is no added risk to them.”

No More Glaucoma Medication

With her open-angle glaucoma, Joan was a perfect candidate for the iStent inject. She decided last October to have the devices put in, and they were inserted while she underwent cataract surgery in early December. Cataract surgeries, when both eyes need it, are usually done a few weeks apart to achieve the best possible outcome for the patient, and this was the case with Joan.

Just as it was with her contact lenses, Joan was corrected for monovision during the procedures. She achieved excellent results from the combined cataract and glaucoma surgeries, stating afterward that her vision was much better.

“My cataract surgeries were successful,” Joan raves. “I went back to Premier Eye Clinic the day after each surgery, and both times, Dr. Ge was very happy with what she saw. I see fine now, and everything’s brighter.”

The iStent inject was also successful in lowering Joan’s eye pressure.

“Before her iStent inject, Joan’s eye pressure, even while using medicated eye drops, was eighteen in her right eye and twenty-one in her left eye,” Dr. Ge notes. “Normal pressure is considered between ten and twenty-two, but every person has their own normal pressure. Joan was on the high side, even with medication.”

“My eye pressure since the procedure is down to eleven in one eye and twelve in the other,” Joan states. “I’m not using any eye drops for my glaucoma now, which is great because I don’t have to remember to do it.”

Joan was impressed by Dr. Ge when she initially met her in 2017. Her positive opinion of the kind ophthalmologist and her staff grew even stronger after her recent experience at Premier Eye Clinic.

“Dr. Ge is wonderful,” Joan enthuses. “She’s a very knowledgeable and very quiet, interesting person. Her staff was extremely informative. They answered all my questions and explained everything about the procedures. Everybody was really great. I highly recommend Dr. Ge and Premier Eye Clinic.”

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    • Premier Eye Clinic

      Premier Eye Clinic provides comprehensive eye examinations and treatment for patients of all ages. Their board-certified ophthalmologist is highly experienced in advanced cataract surgery using a "no injection, no stitch, no patch" tech... Read More

    • Q. Jocelyn Ge, MD, PhD

      Q. Jocelyn Ge, MD, PhD, received her medical degree from the Vanderbilt University School of Medicine and her PhD from the University of California. She completed her internship at the University of Tennessee Medical Center and her o... Read More