Eyeworld

EW CATARACT 77 April 2016 likely to spare the ocular surface. "Prolensa and Ilevro are gentler on the ocular surface than the gener- ics," he said. "With the generic ke- torolac, which many people are now getting because that's all that's on the formulary, it's not uncommon to have to stop or reduce the drop after a week because of increasing punc- tate keratopathy." If the patient is complaining of increasing stinging or burning from the drops, it's a sign to look carefully at the cornea for punctate keratopathy and stop the drop if necessary, Dr. Wittpenn said. Cost factor Not everyone is convinced that prophylactic use of NSAIDs is of value. William Myers, MD, health system clinician, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, and in private practice, Skokie, Illinois, said that when he underwent his training, around 1980, no one pretreated with topical agents for CME. If a patient had a problem in the first eye, an oral NSAID might be used, but for the most part this wasn't treated un- til there was an actual issue. "Treat- ment generally solved the problem," Dr. Myers said. "Within 6 months, a high percentage would usually get better whether they were treated or not, but more would respond when they were treated." That's the basis for why all nonsteroidals are used today, Dr. Myers said. "My personal feeling is that all of these topical nonsteroidals are incredibly expensive," he said, adding that even for generics it's not uncommon for them to cost close to $100 a bottle, with most patients ultimately needing 2 bottles. Mean- while, he thinks that oral NSAIDs are as effective as the topical ones, if not more so. In Dr. Myers' view, oral agents are not inferior to topical ones and are safer for the surface of the eye. "They might be riskier in patients who have gastrointes- tinal disease, but the vast majority of patients don't have a history of gastritis or ulcers," he said. "Those people have low rates of trouble tak- ing medicines like naproxen." Such medicines would cost under $10 a bottle and would last for awhile, he pointed out. Intraoperative use In addition to using prophylactic drops, the intracameral NSAID Omidria (phenylephrine and ke- torolac, Omeros, Seattle) is making inroads. "Omidria is now the only FDA-approved product where you can put the nonsteroidal in the eye," Dr. Wittpenn said. "It got approved based on its ability to maintain pupillary dilation combined with phenylephrine and decreased pain." While the studies don't sort out which element does which, they did Call your local sales rep or BVI customer service at 1-866-906-8080. Visit us at www.beaver-visitec.com Beaver-Visitec International, Inc. | 411 Waverley Oaks Road Waltham, MA 02452 USA US patent # 8,900,136. Additional US and international patents pending. BVI, BVI Logo and all other trademarks (unless noted otherwise) are property of a Beaver-Visitec International ("BVI") company © 2016 BVI A simple, safe and innovative solution for intraoperative small pupil expansion • Gentle on iris and other intraocular tissue • Iris quickly returns to natural shape post surgery • Easy insertion and removal Visitec ® I-Ring ® Pupil Expander Amar Agarwal MS, FRCS, FRCOphth "The I-Ring eases pupillary woes with good folding — unfolding; engaging — disengaging of the iris in small pupil and IFIS cases." Visit us at ASCRS Booth 519 continued on page 78

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