An intracanalicular dexamethasone insert (DEX) given to patients during cataract surgery “has the potential to become the new standard-of-care for management of post-surgical inflammation and pain,” according to an analysis of 3 sequential physician surveys published in Clinical Ophthalmology.
The device is a small insert designed to fit into the canaliculus. It offers a drop-free approach to controlling ocular inflammation and pain following cataract surgery. The DEX insert delivers a preservative-free steroid to the ocular surface for approximately 30 days. This approach “eliminates the potential for improper drop installation techniques, including missing the eye, and bottle tip contamination due to contact with ocular surface, eyelid or lashes,” the study authors report.
The surveys polled 42 ophthalmologists across 23 sites (ambulatory surgical center settings and outpatient clinical settings) in the US. The respondents reported their comfort level placing the inserts and satisfaction with their performance.
The 3 surveys were each delivered to the same group of pre-identified physicians to capture various experiences with the DEX. The first survey, given at baseline, prior to the physicians’ first DEX case, focused on baseline expectations of the device, including whether patients with comorbidities would benefit from DEX. Survey 2 was distributed to physicians 1 day after they completed a minimum of 5 DEX insertions following cataract surgery and asked about their user experience, ease of use, and satisfaction with the process. Survey 3, issued 30 days after at least 5 DEX insertions, asked about the physicians’ overall experience and satisfaction with DEX regarding patient outcomes. Finally, the participating physicians were interviewed about their experiences.
The survey questions used a 7- or 11-point Likert scale, with treatment satisfaction questions evaluated on a 7-point scale (1 being extremely dissatisfied and 7 being extremely satisfied), with a few multiple-choice, open-ended, or rank-formatted questions.
Most surgeons (87%) polled rated their overall experience with DEX administration after initial experience as easy (a score of 5, 6, or 7 on a 7-point Likert scale). In fact, their responses indicate that 90% felt comfortable administering DEX after a mean of 2.7±1.9 insertions (range 1 to 10; standard deviation).
Of those polled, more than 90% reported satisfaction with the inserts (a score of 5, 6, or 7 on a 7-point Likert scale) and 92% described their patients as being satisfied with the experience. Additionally, the third survey’s results show that 62.5% of physicians prefer DEX, 22.5% prefer traditional steroid drops, and 15.0% prefer another option (such as a combined treatment, nonsteroidal anti-inflammatory agents, or no treatment). Overall, 92.5% of the physicians said they planned to insert DEX in upcoming cataract surgeries.
For now, DEX is used in patients undergoing cataract surgery, but it may have applications in other procedures as well. This analysis indicates that surgeons believed DEX could also benefit patients undergoing pterygium surgery (37.5%), corneal surgery (30.0%), and refractive surgery (27.5%), and would benefit from the use of DEX to treat postoperative inflammation and pain.
In this research, most physicians (78.4%) inserted the DEX at the end of the surgery, with a minority placing it at the beginning of surgery (8.1%), immediately before the surgery in the office setting (2.7%), or the next day in the office setting (10.8%)
The analysis also uncovered that the physicians polled performed a mean 14.4 cataract surgeries on a typical surgical day and that of the surveyed physicians, 83.3% comanaged with an optometrist outside of their practice.
This research was limited in that it only included early experiences with the insert. Site selections for the study were not random and may not represent the entire ophthalmologist population. Also, physicians in this study treated a relatively low number of patients with DEX. Moreover, the study authors acknowledged accuracy could not be verified since the research was based on survey responses.
Disclosure: This study was supported by Ocular Therapeutix, Inc. Some study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Matossian C, Stephens JD, Rhee MK, et al. Early real-world physician experience with an intracanalicular dexamethasone insert. Clin Ophthalmol. Published online August 6, 2022. doi:10.2147/OPTH.S372440.