A lot of people over 60 find out they have two eye problems at once. The lens has gone cloudy, and the pressure inside the eye has been creeping up for years. Most of them assume it means two separate operations, two recoveries and twice the worry.
It often doesn’t. Dr Sherif Ekram, a British-Egyptian consultant ophthalmic surgeon with more than 18 years in practice, spends much of his time on exactly this overlap. His training is with the Royal College of Ophthalmologists in the UK, he holds the FICO qualification from the International Council of Ophthalmology, and he works across cataract, glaucoma and laser refractive surgery. (In the UK, surgeons are addressed as “Mr”. Patients in Egypt and the Gulf know him as Dr Sherif Ekram.)
Here is how he approaches these combined cases, and what patients can ask before they agree to anything.
One operation or two?
Removing a cataract tends to lower eye pressure a little on its own. In some types of glaucoma, especially where the drainage angle is narrow, it lowers it a lot. So the cataract operation is often part of the glaucoma treatment, not a separate event.
For mild to moderate open-angle glaucoma, a surgeon can add a minimally invasive glaucoma device (MIGS) during the same cataract procedure. It goes in through the same small incision and adds only minutes. Advanced glaucoma is different. Pressure targets are lower, and a trabeculectomy or a tube implant may be the safer route, sometimes done in a second sitting. Dr Ekram’s view is that the stage of the glaucoma decides the plan. Convenience comes second.
The lens question most people never hear about
Premium lenses get the marketing. Multifocal lenses can free people from reading glasses, but they split incoming light, and that costs some contrast. A healthy eye barely notices. An eye whose optic nerve is already damaged by glaucoma can notice a great deal, especially at night.
This is where his refractive training earns its place. For many glaucoma patients he leans towards a monofocal or an extended depth of focus (EDOF) lens, with a toric version when there is astigmatism to correct. Some patients can still go without glasses most of the day. Some can’t, and he would rather say that before surgery than explain it afterwards.
Checking for the eyes that need extra care
Some eyes are harder to operate on than they look. Pseudoexfoliation, a condition common in glaucoma patients, weakens the fibres that hold the lens in place. Previous eye surgery, a small pupil or a thin capsule all raise the risk of complications. Dr Sherif Ekram looks for these signs in the clinic, writes them into the plan, and tells the patient plainly what they mean. When an eye needs a retina specialist on standby, or a different surgeon altogether, he says so.
Patient safety comes before the theatre schedule. That sounds obvious, but it is the part of the consultation patients rarely get to see.
Five questions worth asking your surgeon
- What stage is my glaucoma, and does that change which operation you’d recommend?
- Will you treat the pressure during the cataract surgery, or later?
- Is a multifocal lens a good idea with my optic nerve, or should I consider EDOF or monofocal?
- Do my eyes show any signs that raise the surgical risk?
- If something goes wrong during the operation, who is available to deal with it?
A good surgeon will answer all five without getting defensive. If any answer is vague, ask again.
About Dr Sherif Ekram
Sherif Ekram is a consultant ophthalmic surgeon working between the UK and the Middle East. His practice covers cataract surgery, glaucoma surgery and laser vision correction. He teaches regularly and was listed as an international guest speaker at the Academia Syria 2026 ophthalmology meeting in Damascus.
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