Eyeworld

48 | EYEWORLD | FALL 2026 ATARACT C day, drop vs. drop-free cataract surgery is likely to follow doctor preference, but she thinks as cataract surgery becomes more efficient and re- fractive-oriented, patients will begin prioritizing a low maintenance medical approach. referring optometrists sending patients in with knowledge and interest about drop-free cataract surgery. "It helped build the reputation that we were focused on the patient and what's best for them," he said. The tone of postop clinic visits has changed as well, Dr. LaBorwit said. "It be- came, 'How are you doing? How's your vision? How's your pressure?' It wasn't this whole chart, grid, and pictures of how they are using their drops." Dr. LaBorwit said his practice gained back the time of one full-time employee who was calling pharmacies before and after surgery and fielding patient drop questions. Dr. Larochelle said her patients have talked with friends preoperatively and come in hearing that the worst part of the surgery is taking drops for weeks postop. She said they're relieved when she tells them they likely won't have to deal with that after their surgeries. Taking a drop-free approach has also saved her time in clinic with patients. Dr. Bartlett said his patients love the conve- nience of a dropless approach. "I let them know that 25 years ago, I would ask patients to use three different eye drops—an antibiotic, a ste- roid, and a non-steroid—each four times a day; that's 12 drops daily. Now, for most people, it's zero drops," he said. "It's easier for them, espe- cially for folks who have problems with dexteri- ty or with a strong blink reflex, and I know that they are actually getting the medications. And it's easier for my staff, with no prior authoriza- tions for medications and easier instructions." One caution Dr. LaBorwit mentioned is that surgery centers need to make surgeons aware of any drug changes. He said if they go from using brand-name moxifloxacin to a generic, for example, the surgeon needs to know to confirm the right concentration is used, etc. Looking forward, Dr. Larochelle said that even though she hasn't had a lot of issues with unexpected IOP spikes due to the steroid—"I've only had one patient out of thousands"—it would be nice to have a steroid delivery system that could be removed instantly or in the clinic without reoperation if a spike were to occur. Dr. LaBorwit said he hopes that cataract surgeons don't wait for an FDA-approved option before moving forward with an intraocular anti- biotic. "I think more and more providers are go- ing to realize the data supports the groundswell and the benefits that go with it in the practice," he said. Dr. Larochelle said at the end of the continued from page 47 Is 'dropless' cataract surgery truly dropless? Dr. LaBorwit said the term "dropless" can be a bit misleading, as some practices pre- scribe antibiotics perioperatively. Patients are also getting a drop of betadine in their eye in preop. "There are many drops that play an import- ant role. There's good data from the mid- 90s from Harold Katz showing just three drops of Vigamox [moxifloxacin] back then would cut the bacterial load around the eye significantly. Then betadine is the gold standard. So, we can't ignore that there are other things going on to protect against inflammation and infection," he said. There are also drops that are employed postop if there is rebound inflammation, though it's still fewer drops than would be required if none were used intraoperatively. Dr. Larochelle said for some patients, such as those with diabetic retinopathy with a history of DME or an epiretinal membrane, even when she takes a dropless approach for the antibiotic and steroid, she'll still use a topical NSAID. She also said she'll avoid ste- roid injection for patients at risk for a steroid response, opting for drops instead. Dr. LaBorwit said there are some cases where he'll still include a postop drop. For example, he uses steroid drops in patients who have a history of glaucoma and could have a steroid response that needs to be quickly addressed/stopped. For patients with severe blepharitis or lagophthalmos, he'll prescribe an antibiotic drop because they can be at higher risk for infection. And if patients have a macular pucker, he'll prescribe a non-steroidal for extra protec- tion. "There's definitely patients who are still being told they need a drop or a few drops after surgery, but I would say more than 97% of patients are drop-free," he said. Relevant disclosures Bartlett: None LaBorwit: Alcon, RxSight Larochelle: None Contact Bartlett: bartlett@jsei.ucla.edu LaBorwit: sel104@me.com Larochelle: Marissa.Larochelle@hsc.utah.edu

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