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

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.