EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/387844
by Terry Kim, MD Reducing the impact of cataract surgery stress Eliminating or reducing the risk of postop inflammation is key to improving patient satisfaction L ow-to-moderate inflamm - tion after cataract surgery can significantly impact p - tient comfort. 1 Postop pain was the most significant predictor of patient dissatisfaction, and postop pain was associated with low ratings of the quality of the surgical experience. The 2013 ASCRS Clinical Survey, which included responses from more than 1,000 ASCRS members, found respondents "strongly agree" that postop inflammation can i - pact variability in visual acuity and quality results (29%), and visual recovery time is adversely impact- ed when postop inflammation is present (42%). 2 The percentage of respondents who "agree" with the statements is similar. Results were similar for 2014 (see Table 1). Further, the 2013 results found more than half of respondents noted using both nonsteroidal anti-infla - matory drugs (NSAIDs) and cortico- steroids to block the inflammato y cascade is warranted after cataract surgery. Yet in 2014, 47% of respon- dents said they do not preload with NSAIDs, and only 40% use both NSAIDs and steroids on postop day 1. 3 My personal preference when planning for an uncomplicated cataract surgery includes the use of both a corticosteroid and an NSAID on every patient. As I operate at 2 different facilities, my preop and postop treatment regimen differs based on the facility. At the univer- sity setting, I prescribe moxifloxacin 0.5% and nepafenac 0.1% prior to dilating drops the day of surgery, and moxifloxacin 0.5% three times daily for 1 week, prednisolone acetate 1% three times daily with a weekly taper, and 0.1% nepafenac three times daily until the bottle is empty. At the ambulatory sur- gery center, I prescribe besifloxacin 0.6% and bromfenac 0.07% prior to dilating drops the day of surgery, and besifloxacin 0.6% twice daily for 1 week, loteprednol gel 0.5% twice daily for 3 weeks, and bromfenac 0.07% once daily until the bottle is empty. Today's cataract patient expects excellent vision on postop day 1 (20/20 or better); delivering on these expectations requires excellent surgi- cal skills as well as a highly effective regimen to facilitate healing and decrease postop inflammation 4 For example, numerous NSAIDs have been approved for the treat- ment of pain and inflammation after cataract surgery, 5–10 and although an off-label indication in the U.S., Accreditation Statement This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American Society of Cataract & Refractive Surgery (ASCRS) and EyeWorld. ASCRS is accredited by the ACCME to provide continuing medical education for physicians. Educational Objectives Ophthalmologists who participate in this course will: • Identify the true impact of ocular inflamm tion levels on outcomes in refractive cataract surgery, including variability in visual acuity and quality results, delayed visual recovery, and patient comfort and satisfaction; • Describe strategies to prevent edema and relieve pain by maximizing the penetration of anti-in- flamm tory agents into target tissues, including key vehicle parameters, dosage, interventional timing and duration, and patient adherence; and • Discuss the clinical impact of various levels of ul- trasound energy during cataract surgery and the amount of reduction available with laser cataract technology for specific types of p tients. Designation Statement The American Society of Cataract & Refractive Surgery designates this activity for a maximum of 0.5 AMA PRA Category 1 Credits.™ Physicians should claim only credit commensurate with the extent of their participation in the activity. Claiming Credit To claim credit, participants must visit bit.ly/1CNa3f7 to review content and download the post-activity test and credit claim. All participants must pass the post-activity test with a score of 75% or higher to earn credit. Alternatively, the post-test form included in this supplement may be faxed to the number indicated for credit to be awarded, and a certific te will be mailed within 2 weeks. When viewing online or downloading the material, standard internet access is required. Adobe Acrobat Reader is needed to view the materials. CME credit is valid through March 31, 2015. CME credit will not be awarded after that date. Notice of Off-Label Use Presentations This activity may include presentations on drugs or devices or uses of drugs or devices that may not have been approved by the Food and Drug Administration (FDA) or have been approved by the FDA for specific uses onl . ADA/Special Accommodations ASCRS and EyeWorld fully comply with the legal requirements of the Americans with Disabilities Act (ADA) and the rules and regulations thereof. Any participant in this educational activity who requires special accommodations or services should contact Laura Johnson at ljohnson@ascrs.org or 703-591-2220. Financial Interest Disclosures Steven J. Dell, MD, has received a retainer, ad hoc fees, or other consulting income from: Abbott Medical Optics, Allergan, Bausch + Lomb, Ocular Therapeutix, Optical Express, Presbyopia Therapies, and Tracey Technologies. He has an investment interest in Presbyopia Therapies and Tracey Technologies. Terry Kim, MD, has received a retainer, ad hoc fees, or other consulting income from: Alcon Laboratories Inc., Bausch + Lomb, Ivantis, Kala Pharmaceu- ticals, Ocular Systems Inc., Ocular Therapeutix, Omeros Corporation, PowerVision Inc., Shire, and TearScience. Keith A. Walter, MD, has received a retainer, ad hoc fees, or other consulting income from: Bausch + Lomb and Ocular Systems Inc. He is a member of the speakers bureau of Abbott Medical Optics and Bausch + Lomb. Dr. Walter received royalty income or derives other income from Ocular Systems Inc. Sonia H. Yoo, MD, has received a retainer, ad hoc fees, or other consulting income from: Abbott Medical Optics, Alcon Laboratories, Allergan, Bausch + Lomb, Bioptigen, Carl Zeiss Meditec, OptiMedica Corporation, and Transcend Medical. She has received research funding from Abbott Medical Optics, Allergan, Avedro, and Genentech. Staff coordinators Brad Fundingsland, Laura Johnson, and Beth Marsh have no ophthalmic- related financial interests to dis lose. Terry Kim, MD Reducing the impact of cataract surgical stress by mitigating inflammation and reducing ultrasound energy Supplement to EyeWorld October 2014 Percentage of respondents who "strongly agree" or "agree" that low-to-moderate inflammation after cataract surgery can significantly impact … 2013 (n=1,041) 2014 (n=1,501) Variability in visual acuity and quality results 71% (29%) 86% (41%) Visual recovery time 81% (42%) 90% (47%) Patient comfort and satisfaction 83% (42%) 93% (55%) Table 1. ASCRS Clinical Survey results *=Percentages in parentheses represent the number of respondents who responded "strongly agree." Supported by an unrestricted educational grant from Bausch + Lomb continued on page 2