EyeWorld Asia-Pacific June 2016 Issue

61 EWAP PHARMACEUTICALS June 2016 The dexamethasone punctal plug has a uorescent component that makes it possible to see in the eye. Source: Shamik Bafna, MD The injection of Tri-Moxi can reduce or eliminate the need for postoperative drops. Source: Adah Mahootchi, MD Inside look: New drugs for cataract surgery by Maxine Lipner EyeWorld Senior Contributing Writer Physicians discuss innovative medications for inside the eye during phacoemulsification W hen it comes to cataract surgery, one new approach gaining momentum is to add the medicine to the irrigating solution during the procedure or inside the eye after the lens has been replaced. The new drug Omidria (Omeros, Seattle) as well as dropless cataract surgery are making inroads. With the dropless approach, practitioners inject combination agents such as Tri-Moxi (triamcinolone and moxifloxacin, Imprimis, San Diego) and Tri- Moxi-Vanc (triamcinolone, moxifloxacin, and vancomycin, Imprimis) at the end of the procedure to forestall or minimize the need for postoperative medications. In addition, there is movement toward using a sustained-release dexamethasone punctal plug (Ocular Therapeutix, Bedford, Massachusetts) to treat inflammation related to cataract surgery. EyeWorld took a closer look at these. Focus on Omidria Richard Lindstrom, MD , adjunct professor emeritus, University of Minnesota, Minneapolis, routinely uses Omidria for his cataract patients. His rationale here is multifaceted. “Number 1, it works,” he said. “It helps maintain pupillary dilation during surgery and reduces discomfort during surgery and in the immediate postoperative period.” Number 2, he said, there is pass-through reimbursement. “This means that it costs my patients nothing and it costs me nothing,” Dr. Lindstrom said. As Thomas Gustafson, PhD , explained in the September 2015 issue of ASC Focus, 1 with transitional pass-through, in addition to paying for the facility fee, for a limited time (usually 3 years), Medicare offers additional reimbursement for innovative drugs, devices, and biologics. The idea is to allow access to these unique products, such as Omidria, initially without having to fit another expenditure into the usual facility fee payment. In Dr. Lindstrom’s view, another factor in the case for using Omidria is that it’s a chance to invest in innovation for practitioners like himself who advocate for new technologies. Part of Omidria’s appeal is that it helps maintain a larger pupil during surgery, Dr. Lindstrom explained. “It’s intended to retain pupillary dilation during surgery and reduce pain and discomfort during surgery and in the immediate postoperative period,” he said. “But we know that there is data in the literature to support a lower complication rate in patients who have larger pupils.” Also, if the patient is more comfortable, it makes for easier surgery. Because of what Omidria has to offer, a significant number of practitioners use this for their high-risk patients, Dr. Lindstrom noted. Such patients would include those with intraoperative floppy iris syndrome (IFIS) because these individuals are hard to dilate and have pupils that tend to come down during surgery. Still, in many cases it can be hard to tell ahead of time who will benefit. “The reality is that it’s sometimes hard to predict which patient is going to be difficult,” he said. However, not everyone is convinced that Omidria is the answer. Although it is off label, David F. Chang, MD , clinical professor of ophthalmology, University of California, San continued on page 62