Eyeworld

Advanced therapeutic and surgical options to eliminate post-cataract surgery inflammation and pain 2 by Terry Kim, MD prove its clinical benefits, and adoption of the technology would interfere with patient flow, take additional time, and reduce efficiency. Expert insights In this supplement, our expert colleagues share their insights and experiences regarding the advanced therapeutic and surgi- cal options that will help us re- duce inflammation and achieve excellent visual outcomes from cataract surgery. Dr. Lindstrom is founder of Minnesota Eye Consultants, and adjunct professor emeritus at University of Minnesota. He can be contacted at rllindstrom@mneye. com. percent write prescriptions for brand-name NSAIDs only; 41% of those who do not use brand names cited cost barriers for patients, and 11% of those who do not use brand names think there is not a difference in efficacy. Twenty-three percent think substituting a generic drug for a brand-name drug at the pharmacy does not impact patient outcomes and safety significantly. On average, 5% of respon- dents' patients have femto- second laser-assisted cataract surgery; however, respondents predicted that this will increase to 12% in 3 years. When participants were asked about barriers to adoption of femtosecond laser-assisted cataract surgery, some respond- ed that it is not a viable eco- nomic model for their practices, there is not enough data to beyond artificial tears. Further- more, they think an average of 20% of patients develop OSD symptoms after cataract surgery even though they had no symp- toms before surgery. When asked whether they begin anti-inflammatory and pain control with intraoperative instillation of anti-inflammatory agents as an injection or by add- ing it to the irrigating solution during surgery, less than 15% reported that they always use intraoperative anti-inflamma- tories, and 38% indicated that they will consider intraoperative anti-inflammatories in the next 12 months. Although other medical fields largely use generic medi- cations, ophthalmologists still prescribe numerous branded drugs. The survey revealed that 44% of prescriptions are writ- ten for branded drugs. Fifty weeks after surgery, and nearly a third (31%) discontinue them in 2 weeks or less. Nearly 25% reported that 6% or more of their patients have 1+ cells/flare or greater 3 to 7 days after cataract surgery. Respondents indicated that low to moderate intraocular inflammation can significantly affect variability in visual acuity and quality of results, vision recovery time, and patient com- fort and satisfaction. Fifty-two percent use ste- roids primarily to control ante- rior chamber inflammation, and 73% prescribe nonsteroidal an- ti-inflammatory drugs (NSAIDs) for CME prophylaxis. Respondents think that less than 20% of their cataract surgery patients present for their preoperative consult with sufficient ocular surface disease (OSD) to require treatment True impact of ocular inflammation and pain on outcomes in cataract surgery continued from page 1 Postoperative inflammation and pain can reduce surgical outcomes and patient satisfaction B ecause modern cat- aract surgery is now considered refractive surgery, 20/40 postop- erative visual acuity is no longer an acceptable goal. Today's cataract patients usually work, are independent, and use mobile devices, requir- ing good functional vision as quickly as possible after surgery. They also have high expecta- tions when paying out-of-pock- et expenses for a premium IOL and/or femtosecond laser-assist- ed procedure. Although technologic advances have enabled us to deliver better outcomes, it is critical to manage inflammation and pain and mitigate these risk factors to achieve greater visual outcomes and patient satisfac- tion after surgery. Postoperative inflammation A peer-reviewed prospective case series of 126 patients Terry Kim, MD showed that 8.4% of patients with early-onset postoperative inflammation experienced early and late complications after " Our advanced technology and techniques cannot address the inflammation and pain that can compromise visual, anatomic, and satisfaction outcomes after cataract surgery. " –Terry Kim, MD

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