prevented in every case, an import-
ant possibility might be the poten-
tial to reduce the number of eye
drops needed after surgery. "Maybe
we don't have to use postop topi-
cal nonsteroidals because pain and
inflammation would be less," he
said, adding that if this was reduced,
even a steroid might not be needed
afterward.
Now that Omidria has found
a pathway through the FDA, Dr.
Mah thinks other treatments that
are delivered through balanced salt
solution will likely follow, whether
those are steroids, nonsteroidals, or
antibiotics.
"I think we're going to see the
door open for a new route for these
medications," he said. EW
Editors' note: Dr. Kim has financial
interests with Omeros. Dr. Lindstrom
has financial interests with Alcon,
Bausch + Lomb (Bridgewater, N.J.),
Allergan (Irvine, Calif.), and Omeros.
Dr. Mah has no financial interests
related to his comments.
Contact information
Kim: terry.kim@duke.edu
Lindstrom: rllindstrom@mneye.com
Mah: mah.francis@scrippshealth.org
were first discovered in the eye.
When an incision was made in a
rabbit eye, the pupil constricted and
fibrin poured into the eye and in-
flammation resulted, which turned
out to be secondary to prostaglandin
mediated inflammation. The same
thing occurs in the human eye,
although to a lesser extent than in
the animal eye," Dr. Lindstrom said.
"This prostaglandin mediated miosis
and inflammation can be blocked by
nonsteroidal anti-inflammatories, so
they put ketorolac in as well."
Dr. Kim said the ketorolac en-
hances pain relief for patients. "We
all know the value of the NSAID in
terms of reducing pain after cataract
surgery," he said. "But we've never
seen ketorolac delivered into the an-
terior chamber as an FDA-approved
product." It will be interesting to see
the effects of this delivery on CME
prevention and protection, Dr. Kim
said.
From a financial perspective,
CMS will allow for pass-through
reimbursement of Omidria. This
means practitioners can bill CMS,
outside the bundled APC payment,
based on the average selling price for
the product plus 6%, or 4.3% during
the current sequester period. Such
transitional pass-through reimburse-
ment typically remains in place for
around 2–3 years.
Going forward, Dr. Mah thinks
because miosis does not need to be
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Now that Omidria has found a
pathway through the FDA, Dr.
Mah thinks other treatments that
are delivered through balanced
salt solution will likely follow.
"I think we're going to see the
door open for a new route for
these medications," he said.
