Eyeworld

EW CATARACT 50 September 2015 Dr. Parekh said these options allow cataract surgeons the ability to adjust the overall postop regimen load for some patients by giving them some medications intraoper- atively, which may help reduce the need for the traditional 4–6 week period of postop drops. "I think ultimately that's where the country is going to go—a hybrid approach of some medications given intraoperatively and some given postoperatively," he said. The 3 Cs When determining which delivery method to prescribe to his patients, one of the things Dr. Parekh looks at is compliance potential in pa- tients. Age and lifestyle can make a difference in compliance, resulting in missed or irregular doses. He also looks at whether the patient is at a high risk for severe inflammation and whether the patient is at high risk for ocular surface issues, he said. "The 3 Cs are important: compliance, convenience, and cost-effectiveness. We don't want our patients burdened with $1,600 worth of drops postop, and we don't want them to spend money out of their pocket because the majority of patients undergoing cataract surgery around the country are Medicare patients," he said. One hurdle with new emerging technologies of delivering anti-in- flammatories is "who's going to pay for it," Dr. Parekh said. There's always a big push to put things in the premium channel, but the majority of Americans undergo- ing cataract surgery are not in the premium channel, they're in the "routine channel," where hopeful- ly their benefits cover the cost not only of the surgery but of the postop medications. "It may be an option to push things into the premium channel but [in my area], in New Jersey, pa- tients will say, 'If it's covered I'll do it, if it's not covered, I won't.' That's the black eye for innovation." EW Editors' note: Dr. Parekh has no finan- cial interests related to this article. Contact information Parekh: kerajai@gmail.com by EyeWorld staff The jury may still be out on some of these new delivery systems, but "there's definitely been disrup- tion in the market, and I think all the companies should be applauded for their efforts in innovation and helping our patients get the best outcomes possible in the most com- pliant, convenient, cost-effective way," Dr. Parekh said. Because there is not one deliv- ery system that's right 100% of the time for 100% of patients, having increased options to choose from is important. "We're going to have the ability to mix and match and adopt dif- ferent technologies to get the best outcomes for our patients because there's not one patient prototype, there are many patient prototypes; only when you customize care for each patient will all patients get the best outcomes," he said. different ways of delivering drugs to the eye, including intracameral and transzonular delivery of intraocular medication, Dr. Parekh said. "While that is a small minority, it's gaining more traction across the country and across the world, but it has not cannibalized the use of topi- cal postop medication," he said. To add to these drug delivery system options, Dr. Parekh said, "We're all excited to look at a postop regimen including punctal plugs that may deliver steroids and other anti-inflammatories to the eye in postop patients. "While there are none yet in the market, Ocular Therapeutix [Bedford, Mass.] should be complet- ing their studies later on this year, and we look forward to the data coming out of that and finding ways to adopt that technology in our current practices," he said. Going beyond topical postop regimens W hen it comes to cata- ract surgery, there's no doubt ophthalmology has come a long way across all platforms and all spectrums of the procedure in achieving better outcomes, said Jai G. Parekh, MD, MBA, chief eye surgeon and managing partner, Brar-Parekh Eye Associates, Wood- land Park/Edison, N.J., and chief of cornea and external diseases/director of the Research Institute, St. Joseph's Healthcare System, N.J. However, by the mere fact that any form of cataract surgery in- volves making a cut in the eye and removing the cataract, we still have the release of inflammatory media- tors requiring the use of anti-inflam- matory medication, not only to mit- igate cell, flare, and pain, but also to reduce corneal edema, he said. Dr. Parekh noted that topical therapy remains the most attractive way for getting drugs into the eye. While generics dominate topical therapy overall because of the rise in healthcare costs over the last couple of years, a lot of companies have come out with innovative postoper- ative medications, Dr. Parekh said. These include steroids and non-steroidals that are geared toward "being kinder" to the ocular surface while getting drugs into the eye in a much better fashion and reducing the actual regimen. There have been big strides in reducing medication regimens, Dr. Parekh said. Where before patients had to administer drops 4 times a day, now some of the more common branded ones are dosed at 2 times a day or even once a day. These improvements mean to- day's anti-inflammatories are better for the ocular surface overall, and good efficacy and better compliance can be achieved, he said. "Those are very important parameters in figuring out what kind of medications you should give postop," Dr. Parekh said. Beyond topical tools Topical treatments aside, there has been a lot of buzz recently about A new dawn in postop cataract anti-inflammatory treatment " We're all excited to look at a postop regimen including punctal plugs that may deliver steroids and other anti-inflammatories to the eye in postop patients. " –Jai Parekh, MD

• Cover