Crystalline lens and glaucoma: Clinical interactions, mechanisms, and surgical decisions

Purpose: To review and synthesize current evidence regarding the clinical interactions between the crystalline lens and glaucoma, including their impact on diagnosis, progression, and surgical decision-making. Methods: A narrative review of PubMed and Scopus (2000–2024) was performed using keywords related to glaucoma, cataract, lens extraction, angle closure, OCT, and visual fields. Results: The crystalline lens may (1) interfere with glaucoma diagnosis by reducing the reliability of imaging and visual field tests, (2) contribute causally to lens-induced glaucomas such as phacomorphic, phacolytic, or those associated with spherophakia and ectopia lentis, and (3) influence glaucoma treatment and surgical planning. Cataract surgery improves optical coherence tomography and perimetric accuracy, deepens the anterior chamber, and can reduce intraocular pressure, especially in angle-closure disease. However, risks include postoperative pressure spikes and possible compromise of filtering surgery. Evidence supports clear lens extraction in selected cases of primary angle-closure glaucoma, while its role in primary open-angle glaucoma is more limited. Conclusion: The crystalline lens plays a central role in the pathophysiology, diagnosis, and treatment of glaucoma. Individualized evaluation of lens status and anterior segment anatomy is essential for optimal patient management.