EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1529000
42 | EYEWORLD | WINTER 2024 ATARACT C About the physicians Derek DelMonte, MD Carolina Eye Associates Greensboro, North Carolina Alice Epitropoulos, MD Ophthalmic Surgeons and Consultants of Ohio Columbus, Ohio by Ellen Stodola Editorial Co-Director in a manner that emphasizes the concerns the patient has with the reason it does not qualify as a true allergy," Dr. DelMonte said. For exam- ple, patients may cite an allergy to steroids, but steroid compounds are a natural and necessary product produced by the human body, so the described reaction is either due to a preserva- tive or other additive or simply a side effect. Steroids are actually used to treat true allergies due to their immune control properties, he added. While allergies to medications and mate- rials used in ophthalmic surgery are relatively uncommon, Alice Epitropoulos, MD, stressed the importance of certain considerations for ophthalmic surgeons. She pointed out that some cataract surgery patients may be sensitive or allergic to betadine, as well as to lidocaine or other anesthetics in the "caine" family. "We often hear patients claim they are allergic to betadine or iodine, but it's not al- ways a true allergy," Dr. Epitropoulos said. She explained that while patients may be sensitive to it, this doesn't necessarily contraindicate its use. In many cases, the procedure can continue as long as the betadine is rinsed off after the preparation. Dr. Epitropoulos explained that not using betadine could potentially increase the risk of infection, since it is the only treatment proven to reduce the risk of infection or endophthal- mitis before cataract surgery, and there are no good alternatives. "Usually, when the nurs- ing staff informs me the patient is allergic to betadine, I advise them to still proceed with the prep, but ensure the betadine is rinsed off after- ward. In the rare event of an allergic reaction, the patient is in a controlled setting with an IV, and we can manage it. I've never encountered a true, serious allergic reaction to betadine, but I'd rather handle an allergic reaction than deal with endophthalmitis." Dr. DelMonte agreed that allergies to beta- dine are commonly reported by patients, but large amounts of data strongly support the use of this product. "I think we should use betadine on just about everyone, whether they report a shellfish/contrast allergy or not," Dr. DelMonte said. "Oftentimes, the rash or swelling can be Allergies or intolerance to materials used in cataract surgery W hile true allergies to materials used during cataract surgery are generally uncommon, this is a topic that physicians may need to discuss with patients. Two physicians highlighted some of the key concerns they hear from patients and how they approach these concerns to identify real allergies versus intolerance to certain products. Patients often report an allergy to a product or drug used during cataract surgery, said Derek DelMonte, MD. "When I see this, the first thing I ask the patient is what the adverse reaction was. Unfortunately, there is a good deal of misunderstanding about the difference between a true allergy and an intolerance or simply a normal side effect of a medication, and figuring out which category the stated allergy is will help determine how to address the concern." A true allergy to an oral medication is considered a robust, whole-body reaction, a rash, trouble breathing, anaphylactic response, Dr. DelMonte said. For a topical medication, it would include severe hives, swelling, or redness that can spread with continued use. True aller- gies are usually only after an initial exposure, which has allowed the immune system time to build up a reaction, making it very unlikely to get a response after just one dose. Intolerances are much more common and include uncomfortable symptoms that are bothersome but do not illicit the true allergic response. This could include swelling without a rash, nausea/upset stomach, and headaches. These can occur with just one exposure and can sometimes be managed with adjusting the dose or method of administration. There are some side effects that are normal that might be uncomfortable to the patient. Examples include dilating agents that decrease reading vision for a time, epinephrine that caus- es the heart to beat faster, oral steroids that lead to excessive thirst or weight gain, and opioids that cause constipation. While these effects can be bothersome, it means the product is working as intended and is not necessarily something to avoid, he said. "Educating the patient on these differences can sometimes be tricky but can usually be done