Internal Goniotomy
Internal goniotomy is part of a group of procedures known as minimally invasive glaucoma surgery. It is particularly well suited to patients with mild to moderate glaucoma who are undergoing cataract surgery.
Cataracts are one of the most frequent reasons people notice a gradual decline in their vision as they get older. They often develop so slowly that many people adapt without realising quite how much clarity has been lost, until everyday tasks like driving, reading, or recognising faces become more difficult than they used to be.
Inside each eye sits a clear, flexible lens just behind the pupil. In youth, this lens is transparent and helps to sharply focus light onto the retina. Over time, natural age-related changes cause the lens proteins to clump and the lens itself to become increasingly cloudy. This clouding is called a cataract.
As the cataract develops, light is scattered rather than passing cleanly through the lens, which reduces contrast and sharpness and often changes colour perception. Cataracts can affect one eye more than the other, or both together. They do not spread from one eye to the other, but the ageing process often affects both lenses over time.
In the early stages, cataracts may cause only subtle changes. People often notice that lights appear more glaring, driving at night feels less comfortable, and colours seem less vivid. Over time, vision can become generally misty or blurred, with difficulty reading small print even with otherwise up-to-date glasses.
Some people find that their spectacle prescription changes more often than expected or that one eye no longer matches the other. Fine detail becomes harder to see and stronger lighting is needed for reading, close work, or hobbies. In more advanced cataracts, vision may feel as though you are looking through a fogged-up window, and daily activities become significantly affected.
The vast majority of cataracts are age-related and develop as part of the natural ageing process of the lens. However, there are several other recognised causes and risk factors. These include diabetes, prolonged or high-dose steroid use, previous eye injury or surgery, and high levels of ultraviolet exposure over many years. Smoking has also been associated with an increased risk of cataract formation.
In rare situations, cataracts can be present from birth or develop in childhood due to genetic conditions, metabolic disorders, or other medical problems. These are usually identified and managed separately.
Cataracts are diagnosed during a full eye examination. Vision is measured using a standard eye chart and each eye is assessed individually. A detailed microscope examination, known as slit lamp examination, allows the lens to be viewed directly so that any clouding, its location, and its density can be documented.
At the same time, the ophthalmologist will check the health of the cornea, retina, and optic nerve to ensure there are no additional causes for visual symptoms. If cataract surgery is being considered, further measurements are taken to calculate the power of the artificial lens that will replace the cloudy one.
You should seek specialist advice when cataracts begin to interfere with the things that matter to you. This might be difficulty driving at night, struggling to read or use screens, finding shopping or cooking more challenging, or simply feeling less confident in unfamiliar environments.
There is no need to wait until cataracts are “ripe” or severely advanced. In fact, timely assessment allows surgery to be discussed and planned calmly, and often makes surgery technically easier. If you notice that your vision has changed and glasses are no longer providing the clarity you expect, a specialist cataract assessment is appropriate.
Internal goniotomy is part of a group of procedures known as minimally invasive glaucoma surgery. It is particularly well suited to patients with mild to moderate glaucoma who are undergoing cataract surgery.
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