Eyeworld

48 | EYEWORLD | MAY 2020 by Rich Daly Contributing Writer DEVICE FOCUS ATARACT C and considerations like the type of surgery, medical history, allergies, risk factors, and affordability. "We always try to ensure the patients choose the most efficacious therapy first and then find ways to help make that as affordable as possible for each patient," Dr. Chu said. "In our experience, it is very difficult to generalize a therapy regimen across the board to every pa- tient because of the new complex landscape." Dr. Goldberg previously preferred brand- name drug products, but as prices increased sharply over the last 10 years, his practice started to look for alternative solutions, such as compounding. He has become a regular user of a compounded combination of topical antibiotic, steroid, and NSAID (prednisolone/ gatifloxacin/bromfenac, OMNI, OSRX). Advantages of this approach include improved compliance by patients, preventing health plans or pharmacies from changing or denying prescribed medications, and eliminat- ing "extensive staff time to deal with all of the medication callbacks" from health plans, Dr. Goldberg said. "We felt empowered and in control again, using the compounded medicine," Dr. Gold- berg said. "It made it so much easier to use and beneficial for patients." Subsequent research showed that inflam- mation was reduced in patients treated with the compounded combination. In a randomized, S urgeons have seen an increase in the number of medications and drug de- livery vehicles for cataract surgery, and more options are expected soon. Damien Goldberg, MD, uses topical antibiotic, steroid, and NSAID therapy postop, because the research literature supports the combination of steroid and NSAIDs to reduce CME, he said. Antibi- otics, of course, are critical to fight infections after cataract surgery. "The combination has been shown to be more effective than each agent alone in some studies," said Y. Ralph Chu, MD. As for delivery of the drug combination, Dr. Goldberg said, options are emerging for ophthalmologists to place it directly inside the eye. "For now, most ophthalmologists have general confidence in topical therapies as an ef- fective and cost-effective means of protection," Dr. Goldberg said. The main disadvantage of using topical therapy, Dr. Chu said, has been patient com- pliance; the increasing cost of medications has restricted access to many new therapies for some patients. Some cataract surgeons have begun to use injections of a corticosteroid and fluoro- quinolone (dexamethasone/moxifloxacin HCI, OMNI, OSRX, an affiliate of Ocular Science), while Dr. Goldberg has started to use Dexten- za (dexamethasone, Ocular Therapeutix), an intracanalicular corticosteroid insert placed in the punctum. "It's exciting that all of these things are starting to come out," Dr. Goldberg said. "The biggest barrier with these new therapies is how everything is going to be paid." Payment limitations from health plans has limited Dr. Goldberg's use of the newer delivery options. Surgeons and patients have many post-cat- aract medical options for topical therapy, Dr. Chu said. His practice educates patients about the available choices and helps them tailor a treatment regimen based on their specific needs Drug options proliferate for cataract surgery patients About the doctors Damien Goldberg, MD Partner Wolstan & Goldberg Eye Associates Torrance, California Y. Ralph Chu, MD Founder, medical director Chu Vision Institute Bloomington, Minnesota "It's exciting that all of these things are starting to come out. The biggest barrier with these new therapies is how everything is going to be paid." —Damien Goldberg, MD

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