Is It Possible To Have No Drops After Cataract Surgery?
Wouldn’t it be great to get rid of drops following cataract surgery? Of course it would. And there are actually ways in which this can be achieved.
Special medications exist to eliminate or reduce the need for eye drops after cataract surgery. At the end of cataract surgery, your cataract surgeon can inject antibiotic medication and place a special steroid in or around the eye. This can reduce the burden of eye drops after cataract surgery.
But this “dropless” cataract surgery does have some limitations. There isn’t a way to completely eliminate all of the eye drops that are usually used after cataract surgery without any trade-offs at all. But despite that, much can already be done.
What Medication Is Needed For Cataract Surgery?
As quick and as safe as cataract surgery is, it is still a surgery. And as with any surgery there are certain post-operative risks or concerns. Because of this, medication is used to reduce the risk of these concerns.
There are two medications which are necessary after cataract surgery:
- Antibiotics to prevent infection
- Steroid medication to reduce inflammation
There is also another medication frequently used which is help but not entirely essential
- A NSAID to improve comfort and prevent swelling
Typically, a patient will take the antibiotic for a week and the steroids and NSAID for up to a month after cataract surgery. (see also How Often To Use Eye Drops After Cataract Surgery)
The problem with eye drops
Eye drops aren’t necessarily BAD, but they aren’t as foolproof as what it may seem like. There are issues with taking eye drops.
Have you ever forgotten to take a dose of any of your medications? No? Oh stop kidding around.
Remembering to take every dose of your medication is a tall task. But this becomes an even more difficult task when you increase the frequency of the medication to four times a day. It can be done, but that doesn’t make it any less difficult.
But on top of remembering to use your eye drops four times a day, it is also difficult to actually put an eye drop in your eye. It sounds easy on paper, but it really does come with a learning curve. It is way too easy to completely miss the eye trying to put eye drops in your eyes. The eye drop bottle can be difficult to squeeze properly to allow just a single drop to come out. Squeezing too hard causes too many extra eye drops and causes you to run out of medication too early. Using eyedrops is especially problematic if you have any difficulties with your hands such as arthritis or tremors.
Overall, eye drops, while they work, aren't an ideal solution.
Dropless Cataract Surgery As A Solution
Instead of prescribing all of those eye drops after cataract surgery, what if doctors instead placed medication in or around the eye which took care of all those medication requirements?
That would make it possible to have no drops after cataract surgery!
So what can be done?
What actually prevents infection after cataract surgery? Surprisingly, antibiotic eye drops actually have a very small role.
Infections are rare after cataract surgery. And much of this is because of a few factors:
- Cataract surgery, like all surgeries is done under sterile conditions in a sterile operating environment.
- Betadine antiseptic is used to clean the eye and skin around the eye and kill any bacteria that could potentially lead to an infection.
- Because the “water” inside the eye is being constantly produced and drained out, it is difficult for bacteria to gain a foothold if some actually do wind up in the eye.
But as surgeons, we are always looking to improve safety and increasingly, injecting antibiotics inside the eye at the end of cataract surgery has been shown to reduce the risk of infection even more.
So if all that is done to prevent infections after cataract surgery, why are eye drops needed?
Well, adding additional antibiotic eye drops after cataract surgery probably helps lower that infection risk even more. Thus, many surgeons still continue to prescribe antibiotic drops after cataract surgery.
In addition, in the United States, there are some barriers to injecting antibiotic medications at the end of cataract surgery; namely, there is no FDA approved indication to use any antibiotics for that purpose. Surgeons can still use the antibiotic medication (through something called off-label use), but it’s up to the surgeon and surgery center to get the correct medication in the correct concentration. There is no off-the-shelf medication that can be used for this purpose.
Steroid eye drops are used longer after cataract surgery than antibiotic drops. Thus, eliminating the need for these eye drops can provide a significant benefit. And eliminating steroid eye drops can be done!
There are two different ways:
- The steroid can be injected into the eye following cataract surgery. Typically if this is done, the steroid dissolves and won’t last for the weeks it is needed after cataract surgery. But a special preparation of the steroid called DEXYCU prevents it from mixing like oil in water to allow it to dissolve slowly over time.
Droplet of DEXYCU placed within the eye following cataract surgery; DEXYCU, the DEYCU logo, and the EyePoint logo are registered trademarks of EyePoint Pharmaceuticals, Inc. ©2022 EyePoint Pharmaceuticals, Inc. All Rights reserved. ImprimisRx is a registered trademark of Harrow Health, Inc. ©2022 ImprimisRx. All rights reserved. 1000 Aviara Parkway, Suite 220 Carlsbad, CA 92011 / Used With Permission
- Instead of the steroid being placed into the eye, it can be placed around the eye. Within our eyelids are tiny holes and drains near our nose called punctum. Tears drain out of these holes into our nose. A very common way to treat dry eye is by putting a small dissolvable plug into these holes. This keeps more tears on the eye. But this same technology can be used to deliver medication. Tiny plugs filled with steroid medication called Dextenza can be used at the end of cataract surgery. These plugs slowly release their steroid medication over time.
Both of these two methods can eliminate the need for steroids after cataract surgery.
Unfortunately, there are currently no ways to deliver NSAID medication to the eye after cataract surgery without using an eye drop. Eliminating all eye drops from cataract surgery would involve eliminating this medication.
But an NSAID may not be entirely necessary after cataract surgery.
One of the main reasons an NSAID is given after cataract surgery is to prevent swelling of the retina. And an NSAID is effective at reducing that chance of swelling.
But if swelling does develop, it typically goes away spontaneously or with treatment anyway. In the long term, regardless of swelling or not, there isn’t much of a difference between whether a NSAID was given or not.
So in the scheme of things, an NSAID is mostly effective at improving the speed of recovery but not changing any long term results. (but NSAIDs also do help improve the short-term discomfort after cataract surgery).
Having cataract surgery without a need for eye drops is in some ways already reality. Steroid eye drops can be completely eliminated with special steroid formulations. While an antibiotic eye drop may be helpful, antibiotic injections can help more. Eventually, the burden of eye drops after cataract surgery may one day be a thing of the past.
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