Eyeworld

109 EW RESIDENTS October 2015 laser-assisted cataract surgery: main inducer. J Refract Surg. 2015 Feb;31(2):78–81. Contact information Weikert: mweikert@bcm.edu Only healthy patients were includ- ed; those with a history of alpha- blocker use, pseudoexfoliation, prior iritis, and cases of femtosecond laser-assisted cataract surgery were excluded. Patients in these groups have a greater risk of intraoperative miosis and often create difficulty for cataract surgeons. Excluding these patients led to low external validity and results that are less generalizable to the overall population. It would be interesting to see an additional trial comparing OMS302 to standard pupillary expanding devices, such as Malyugin rings and iris hooks, in these difficult patients. Another weakness of this study is that the treatment group was compared to a control group in which no intraop- erative pupillary dilation measures were used. While it is true there is no gold standard for optimizing in- traoperative pupillary mydriasis, the current standard of care includes the use of either one or a combination of phenylephrine in the balanced salt solution bottle, intracameral lidocaine, and intracameral epi- nephrine. The results of this study would be more relevant if they had compared OMS302 with the current standard of care. Lastly, one must consider the cost-to-benefit ratio of OMS302. The reimbursement for cataract surgery continues to decline, and as a result, hospitals and ambulatory surgery centers are attempting to balance proper patient care with the cost of each surgery. This study proves the pupil stays dilated and there is less postoperative pain using phenyleph- rine and ketorolac in the balanced salt solution bottle. But does this provide a financially justifiable bene- fit? Would making this medication the gold standard lead to decreased overall healthcare costs due to decreased complication rates or reduced need for pre- and postoper- ative medications? Or rather, would this medication be better suited for use in a smaller percentage of high- risk cases? In summary, we think this was a well-designed study that proves the effectiveness of phenylephrine and ketorolac in the balanced salt solu- tion bottle for intraoperative mydri- asis and postoperative pain fol- lowing cataract surgery in healthy, low risk patients. The argument for using OMS302 could be made much stronger with additional studies comparing it to the standard of care, demonstrating its utility in difficult cataract cases, and also proving its cost-effectiveness. EW References 1. Mirza SA, Alexandridou A, Marshall T, Stavrou P. Surgically induced miosis during phacoemulsification in patients with diabetes mellitus. Eye (Lond). 2003 Mar;17(2):194–9. 2. Hashemi H, Seyedian MA, Mohammadpour M. Small pupil and cataract surgery. Curr Opin Ophthalmol. 2015 Jan;26(1):3–9. 3. Guzek JP, Holm M, Cotter JB, et al. Risk fac- tors for intraoperative complications in 1000 extracapsular cataract cases. Ophthalmology. 1987 May;94(5):461–6. 4. Schultz T, Joachim SC, Stellbogen M, Dick HB. Prostaglandin release during femtosecond

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