A 1-drop approach to cataract surgery that utilizes intracameral instillation of dexamethasone and moxifloxacin, can reduce patient-reported pain, activity interference, and out-of-pocket costs, according to survey results published in the Journal of Cataract & Refractive Surgery. The researchers compared patient experiences with the conventional 3-drop regimen and an approach that adds a sustained release form of the 2 drugs at the time of surgery, and only relies on patients to instill a nonsteroidal anti-inflammatory drug (bromfenac).

The prospective clinical study randomized participants to 3-drop or 1-drop treatment regimens — 1 for the first eye, and the alternate for the second. Thirty patients undergoing routine cataract removal were recruited at 2 private clinics. Investigators examined whether participants preferred traditional therapy with prednisolone acetate 1%, moxifloxacin 0.5%, and bromfenac 0.07%; or intracameral delivery of 500 mcg moxifloxacin 0.5% and dexamethasone suspension 9% near surgery’s conclusion with 30-day bromfenac topical treatment. 

Participants took the Comparison of Ophthalmic Medications for Tolerability (COMToL) questionnaire, a validated survey, 2 weeks after each post-surgical therapy initiation. Of the 29 patients who completed all protocols, mean age 74±6.3 years, 28 preferred the 1-drop treatment (P <.001). Comments included that a single eyedrop was “easier” in general, there was “nothing to remember,” and “fewer drops” were needed. Patients reported the average unreimbursed expense for 3-drop therapy was $139.20±$69.10, and for 1-drop treatment $40.90±$65.60. 


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Medication cost was an item added to the end of COMToL, as well as a pain-related question —“Please rate the severity of discomfort caused by your eye medicines at their worst point.” Those receiving 3-drop therapy rated post-surgery pain as follows: 27% no pain, 15% mild pain, 46% moderate, 12% severe pain. Individuals in the 1-drop group reported less discomfort: 57% no pain, 26% mild pain, 13% moderate, and 4% severe pain. Researchers speculate that preservatives in topicals for pain and inflammation contain preservatives and may have contributed to ocular surface irritation.

Notably, summed ocular inflammation score for the 1-drop group at day 7 was .53±0.46 compared with the 3-drop cohort at 0.92±0.71 (P <.002). Mean intraocular pressure (IOP) at any point, and macular thickness at 28 days remained comparable for both regimens. Regarding uncorrected visual acuity (UCVA), this measure was significantly better in the 1-drop cohort at post-op day 1 (P <.000013), but by 28 days, best corrected visual acuity (BCVA) was similar between the 2 sets (P >.36). Activity interference — driving at night, reading the newspaper or other materials — was significantly improved with 1-drop therapy, according to the survey results.

Treatment adherence significantly differed. For patients undergoing 3 drops; 9 did not miss any doses, 6 “rarely” missed, 10 missed eyedrops a “few times,” and 1 missed “fairly often,” compared with those obtaining 1-drop treatment who missed 0 doses (P <.0001). These results concur with prior research showing that simplified regimens foster patient compliance.

This study was conducted from December 2019 to November 2020. A limitation was the relatively small population sample. Further, pharmaceutical pricing can vary between geographic regions. Conversely, a strength was the clear-cut documentation of solid patient preference for 1-drop post-surgical treatment plan.

Disclosure: This research was supported by  Eyepoint Pharmaceuticals, Inc., and Research InSight, LLC. Please see the original reference for a full list of disclosures.

Reference

Hovanesian JA, Donnenfeld ED. A Randomized, Prospective Clinical Study Evaluating Dexamethasone Intraocular Suspension 9% vs Prednisolone Acetate 1% in Controlling Postoperative Pain and Inflammation in Patients Undergoing Bilateral Sequential Cataract Surgery. Journal of Cataract & Refractive Surgery. Published ahead of print on Jan. 18, 2022. doi:10.1097/j.jcrs.0000000000000887