Through the Lens of Time: Delayed Presentation and Outcomes in Lens-Induced Glaucoma

Abstract

Background: Lens-induced glaucoma (LIG) is still a major cause of irreversible blindness in developing countries, largely because of delayed treatment and diagnosis. Although surgery is largely successful in managing intraocular pressure (IOP), the visual outcomes are highly variable. Dispersed information is presented in previous literature, and this thorough synthesis is thus needed. Aim and Objective: The present systematic review and meta-analysis was undertaken with the purpose of investigating the question: "To what extent does delayed presentation impact the control of intraocular pressure and visual outcomes in patients with lens-induced glaucoma?" Methods: According to PRISMA guidelines, we systematically searched 2014–2023 studies reporting LIG with outcomes of IOP control, visual acuity, and clinical patterns. The inclusion criteria were observational studies with either prospective or retrospective data with post-operative outcomes. The data were synthesized for meta-analysis with pooling and heterogeneity was evaluated (I²), bubble meta-regression adjusting for sample size relationships. Finally, 10 studies were included and 7 articles were considered for meta-analyses. Results: Ten trials encompassing 527 patients were included. Phacomorphic glaucoma was responsible for 63.5% of LIG. Preoperative intraocular pressure (IOP) was 45.7 ± 8.3 mmHg, and postoperative IOP was lowered to 17.8 ± 3.9 mmHg. Visual acuity ≥6/18 post-operatively was obtained in 52.7% in aggregate, increasing in early presenters to 61%. Meta-regression demonstrated a positive correlation between study size and outcome (R² = 40% for VA, 28% for IOP control). Heterogeneity was moderate to large (I² = 22–66%), and Egger's test showed small-study effects in visual acuity outcomes (p = 0.04). Conclusion: Early surgery in LIG greatly enhances prognosis, yet delays still detract from visual prognosis despite surgical control of IOP. Public health interventions need to ensure maximal early detection and access to cataract treatment to avoid this avoidable cause of blindness.