Eyeworld

regimen, the more likely patients are going to get confused about it." She prefers to use the brand name Prolensa because with this drug, she knows what she is getting, after about 10 years of experience with it. She finds that its infrequent dosing enhances compliance and comfort is increased. "It has anesthetic properties, so it is very comfortable to take," she said. Dr. Mamalis, on the other hand, tends to use generic NSAIDs for his patients. While he agrees that the brand-name agents have advantages, he finds that many of his patients do not have coverage for these. "In an ideal world, I would certainly recommend some of the newer NSAIDs that you don't have to use so often, but in my patient population, often the only medica- tion that's covered is a generic ke- torolac," Dr. Mamalis said. "This is efficacious, it works well, but it's 4 times a day, [and] it tends to burn a little more than some of the other drops." While Dr. Mamalis agrees that there is evidence that using a preop NSAID makes sense pharmacologi- cally, he finds this is not always practical. "I have difficulty getting my patients to adhere to that, so what we usually do is start the NSAIDs on the day of surgery," he said. "When we're giving them their preop dilat- ing and antibiotic drops, we will give them the NSAID at that time." In more vulnerable patients, including those with a history of uveitis or diabetes, Dr. Mamalis starts them on the NSAID a week prior to surgery with a slow taper. "We'll have them on a prolonged NSAID course following surgery that will often be several weeks long," he said. But in routine patients, he will stop the NSAIDs after 2 weeks. How- ever, he pointed out that in Utah, most of the patients that he treats are Caucasian and of Northern Euro- pean ancestry and tend to have less significant postop inflammation. "If I'm operating on patients who are Asian, Hispanic, or African American, they tend to have more inflammation postoperatively, so I may keep them on the NSAID longer before I taper them off," Dr. Mamalis said. Into the future Dr. Donnenfeld is very excited about the possibility of intracameral NSAIDs joining the armamentarium. Dr. Davis also looks forward to other delivery methods in the future for all postoperative drops. She hopes there will be ways to deliver combi- nations of medications after surgery to avoid complex drop regimens. "If there was some method in which we could inject something at the end of surgery that combines all of the medications so patients never have to take any drops or an insert that we could place in the conjuncti- val fornix that contained all the medication and would dissolve, I think that would be an improve- ment over what we have because older patients may not be very nimble," she said. "Some patients don't have a family member to help administer the drop, so the easier we can make it for them, the better." EW Reference Donnenfeld ED, Perry HD, Wittpenn JR, Solomon R, Nattis A, Chou T. Preoperative ketorolac tromethamine 0.4% in phacoemulsi- fication outcomes: pharmacokinetic-response curve. J Cataract Refract Surg. 2006 Sep;32(9):1474–82. Editors' note: Dr. Davis has financial interests with Bausch + Lomb. Dr. Donnenfeld has financial interests with Alcon, Allergan, and Bausch + Lomb. Dr. Mamalis has no financial interests related to his comments. Dr. Yoo has financial interests with Alcon, Allergan, and Bausch + Lomb. Contact information Davis: eadavis@mneye.com Donnenfeld: ericdonnenfeld@gmail.com Mamalis: nick.mamalis@hsc.utah.edu Yoo: syoo@med.miami.edu T. 800.461.1200 | www.innovativexcimer.com Improved Clinical Outcomes of CXL and PRK with Amoils Epithelial Scrubber Epithelial Removal Has Never Been Easier Corneal Xlinking, PRK & Advanced Surface Ablation E^YV_b]U`YdXU\Ye]bU]_fQ\Y^ only 5 - 7 seconds 1f_YTQ\S_X_\TQ]QWUd_ surrounding tissue =Y^Y]YjUd_dQ\`b_SUTebUdY]U >_^UUTV_bceRcUaeU^dcSbQ`Y^W Epithelial Removal Has Never Been Easier Epithelial Removal Has Never Been Easier Epithelial Removal Has Never Been Easier Cor PRK & Advanced face Ablation Sur neal Cor Xlinking, PRK & Advanced face Ablation Xlinking, PRK & Advanced face Ablation oved Clinical Outcomes of CXL Impr and PRK with Amoils Epithelial Scrubber face Ablation Sur oved Clinical Outcomes of CXL with Amoils Epithe face Ablation oved Clinical Outcomes of CXL elial Scrubber face Ablation ] b _ V Y ^ E only 5 - 7 seconds T Y _ f 1f ounding tissue surr Y ] Y ^ Y = ] U b ] e Y \ U X d Y ` U ] only 5 - 7 seconds U W Q ] Q T \ _ X _ S \ Q ounding tissue e T U S _ b ` \ Q d _ d U j Y ^ Y \ Q f _ ] _ d U U ] Y d U b e Y ] Y ^ Y = U U ^ _ > e T U S _ b ` \ Q d _ d U j Y ^ U e a U c R e c b _ V T U U ] Y d U b e W ^ Y ` Q b S c d ^ . 800.461.1200 | www.innovativexcimer T . 800.461.1200 | www.innovativexcimer .com . 800.461.1200 | www.innovativexcimer April 2014

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