Eyeworld

2 | SUPPLEMENT TO EYEWORLD | DECEMBER 2019 Edward Holland, MD The impact of pain and inflammation continued from page 1 P ain is the most common adverse event associated with cataract surgeries. A clinical study of 306 patients measuring pain and sat- isfaction immediately after cat- aract surgery showed that 37% had mild to moderate pain and 34% required oral medications to manage it. 1,2 Postop pain was the most significant predictor of patient dissatisfaction and was associated with low surgical experience quality ratings. The most common cause of decreased visual acuity after cataract surgery is cystoid macular edema (CME). Patients with postop inflammation have physical limitations that prevent proper instillation. In a study evaluating eye drop administration by cataract patients who did not have expe- rience with eye drops, 31% had trouble instilling them and 92% instilled them incorrectly. 4 New frontier Novel ideas and innovative solutions are emerging that will offer us new ways to prevent and manage postoperative pain and inflammation. Approximately 2 decades ago, we had to prescribe 3 drops 4 times a day for 1 month. We have made signifi- cant strides in eliminating that regimen. Better drops are being developed with less frequent dosing, as well as combined drops, intraoperative drops and injections, and sustained-release technologies. Sustained-release drug delivery options need to be easy to place in the eye and remove, tolerable, consistent, and cos- metically invisible but easy to identify. This will be especially important not only for cataract patients, but for patients with chronic eye disease, such as dry eye and glaucoma. n References 1. Porela-Tiihonen S, et al. Postopera- tive pain after cataract surgery. J Cata- ract Refract Surg. 2013;39:789–98. 2. Fung D, et al. What determines patient satisfaction with cataract care under topical local anesthesia and monitored sedation in a commu- nity hospital setting? Anesth Analg. 2005;100:1644–50. 3. Vandenbroeck S, et al. Prevalence and correlates of self-reported nonad- herence with eye drop treatment: the Belgian compliance study in ophthal- mology. J Glaucoma. 2011;20:414–21. 4. An JA, et al. Evaluation of eyedrop administration by inexperienced pa- tients after cataract surgery. J Cataract Refract Surg. 2014;40:1857–61. Dr. Holland is director of the Cornea Service at the Cincinnati Eye Institute and professor of ophthalmology at the University of Cincinnati. He can be contacted at eholland@holprovision.com. improving the cataract patient experience: Minimizing pain and inflammation while reducing the need for topical drops a higher risk of corneal edema. Risk factors for CME include diabetes or other autoimmune disorders, inflammatory condi- tions, glaucoma, intraoperative floppy iris syndrome, and ret- inal vascular disease. Complex cases with longer ultrasound and irrigation times and surgical complications are associated with an increased risk of in- flammation. Unmet need Traditionally, we have managed pain and inflammation with postop eye drops, increasing the dose in patients at risk for inflammation. Topical steroids were convenient and historically inexpensive. Steroids also are direct, noninvasive, and less likely to cause systemic effects. In addition, they provide good coverage, if patients use them. However, clinical studies have shown that patients do not use 40–50% of prescribed drops. 3 Patients may believe they do not need them, find the drops uncomfortable, or have Less than 30% instill anti-inflammatory agents intraoperatively as an injection or by adding it to the irrigating solution (9% always use; 18% sometimes use), and more than a third reported that they will never use these options. Eighty-six percent are confident or very confident that combining corticosteroids and NSAIDs can reliably treat postoperative inflammation and control pain after routine cataract surgery. We gathered insights from a panel of experts, who discussed ways to manage pain and inflammation associated with cataract surgery. They shared their experiences with intracameral dexamethasone, a dexamethasone intracanalicular insert, nanotechnology loteprednol, and other treat- ment options. n Reference 1. ASCRS Clinical Survey, 2018. Dr. Donnenfeld practices with Ophthalmic Consultants of Long Island and Connecticut and is a clinical professor of ophthalmology at New York University and a trustee at Dartmouth Medical School. He can be contacted at ericdonnenfeld@ gmail.com. By Edward Holland, MD

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