Eyeworld

EW CATARACT 23 February 2019 he said. "We start the day before surgery and continue it for 1 month after." If someone does get CME, Dr. Stiverson typically treats them for a minimum of 3 months until it's completely resolved. There's no evidence that any other type of NSAIDs is any more effective, he stressed, adding that while bromfenac seems to be more potent, there are no good studies indicating that it's more effective. "But I think the twice a day dosing is appealing," Dr. Stiverson said. "If and when that becomes generic, I think we would use that at Kaiser." Kevin M. Miller, MD, David Geffen School of Medicine, Uni- versity of California, Los Angeles, reserves NSAIDs for those at high risk for CME, also citing the lack of cost effectiveness with what he calls the shotgun approach. "For me, the cost effectiveness isn't there doing that approach," he said, adding that with the selective use approach, you limit the cost and toxicity to those patients most likely to benefit. For this he tends to prescribe ketorolac four times a day and assesses the patient again at 2 weeks postoperatively. "We do our final re- fraction at that point. If they're not at 20/20 acuity, we'll do an OCT," he said. "If they don't develop the disease, they're off the drops by 4 weeks out." As for pretreatment, he usually begins the NSAID 1 week before. "But for the majority, I don't pretreat," he said. Femtosecond laser-assisted cataract surgery is another matter. Dr. Miller finds without the NSAID a patient may be well dilated, but once the femtosecond laser is used, the pupil comes down and you can't get it back to the same size. "There's plenty of literature that says instilling an NSAID before the femtosecond laser will help reduce the post-treatment miosis," Dr. Miller said. "For my femtosecond patients, which constitutes 80–85% of my practice, they get one drop of an NSAID 30 minutes before surgery and that's it. They're not put on NSAIDs for long-term use." EW Editors' note: Dr. Donaldson has financial interests with Alcon (Fort Worth, Texas), Allergan (Dublin, Ireland), Bausch + Lomb (Bridgewater, New Jersey), and Johnson & Johnson Vision (Santa Ana, California). Dr. Miller has financial interests with Alcon, Johnson & Johnson Vision, and Carl Zeiss Meditec (Jena, Germa- ny). Dr. Dhaliwal and Dr. Stiverson have no financial interests related to their comments. Contact information Dhaliwal: dhaliwaldk@upmc.edu Donaldson: KDonaldson@med.miami.edu Miller: kmiller@ucla.edu Stiverson: rk.53stiverson@gmail.com 840 Walnut St., Philadelphia, PA 19107 | willseye.org | 877.289.4557 Wills Eye Hospital brings together leaders of every subspecialty in ophthalmology. It's a special place where "Skill with Compassion" is not just our motto, it's at our very core, our guiding principle. The world's home for ophthalmology. Jerry A. Shields, MD Ocular Oncology

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