Eyeworld Daily News

54 | EYEWORLD DAILY NEWS | MAY 6, 2019 ONSITE by Stefanie Petrou Binder, MD EyeWorld Contributing Writer glaucoma, also in the form of contact lenses, punctal plugs, and ring inserts. Mucus penetrating technology using nanoparticles is another option to reduce pain that is used by Inveltys (loteprednol, Kala Pharmaceuticals), with FDA approval in 2018. Smaller particle size can penetrate tissues better and decrease dosage, according to Dr. Holland. Omidria (Omeros) is a recent drug combination (phenyleph- rine/ketorolac), added to ophthal- mic irrigating solution and applied intracamerally, that was developed to prevent postop pain, while also maintaining pupil size and preventing miosis intraoperatively. According to Denise Visco, MD, York, Pennsylvania, postop pain, photophobia, and rebound iritis were significantly lower in patients given Omidria compared to topi- cal loteprednol patients. William Wiley, MD, Cleveland, thinks that compounded products help patients avoid the major "pain points" associated with drops: prescriptions, drug cost, pharma- cy call backs, and postoperative instructions. A triple combination drop can eliminate pain, "pain points," can be combined with a depot of steroid (sub-Tenon's, plug, or anterior chamber appli- cation), allows for easy once a day dosing, and can help eliminate CME and endophthalmitis. It is easy to say, "One drop per day." Editors' note: This event was supported by EyePoint Pharmaceuticals, Imprim- isRx, Ocular Therapeutix, and Omeros Corporation. penetration into the eye, and costs were the downsides. Data revealed that 31% of patients undergoing cata- ract surgery had difficulty insert- ing drops and 92% used improper techniques for drop installation. The session's panelists agreed that drops have to be reduced. Keys to success include drugs that are easy to place and remove, are cosmetically invisible, tolerable, with consistent, sustained effica- cy, and can be used in multiple disease states. One approach to minimize topical drops is offered by the Dexycu (dexamethasone suspension, EyePoint Pharmaceu- ticals), a novel, bioabsorbable drug delivery product for intracameral placement. Dr. Donnenfeld noted that therapeutic levels could be maintained for up to 21 days with a single administration, with guar- anteed compliance, precise dosage, and no topical toxicity or systemic absorption. Intracanalicular dexameth- asone shows similar promise in elderly, postop patients with "drop phobia," according to Alice Epitropoulos, MD, Colum- bus, Ohio, who maintained that the slow release and around the clock delivery of dexamethasone provided by the Dextenza plug (Ocular Therapeutix) reduced pain, inflammation, patient error, and noncompliance. It delivers a tapered dose over 30 days, is easy to insert and is resorbed (no removal necessary), preservative free, and provides punctal occlu- sion that benefits dry eye. Positive patient feedback from more than 900 participants shows high com- fort, convenience, and efficacy to reduce pain. Other sustained release strategies are in development for allergic conjunctivitis and tient satisfaction; 50% prescribed NSAIDs for 4 weeks postop while 18% didn't use NSAIDs at all; more than 70% prescribed steroids for 4 weeks postop; and less than 30% used intraoperative anti-inflammatory agents. Postop- erative pain is associated with low ratings of the quality of surgery, according to co-moderator Ed- ward Holland, MD, Cincinnati, who said that pain was the most common adverse event after cataract surgery, with moderate to severe pain reported in 35% of patients. While traditional manage- ment uses postoperative topical eye drops, which are convenient (what we know), inexpensive (his- torically), noninvasive, have low systemic side effects, and a more rapid onset of action/smaller dose than systemic drugs, Dr. Holland maintained that adherence (com- pliance), ocular surface toxicity, A ttendees were in no rush to leave the San Diego Convention Center on Saturday eve- ning as they streamed into ballroom 20D to attend an EyeWorld CME Education event on "Im- proving the Cataract Patient Experience: Minimizing Pain and Inflammation While Reducing the Need for Topical Drops." The session's co-moderator Eric Donnenfeld, MD, Rockville Cen- tre, New York, noted that nearly 90% of last year's ASCRS Clin- ical Survey respondents agreed that inflammation affected visual quality, recovery time, and pa- One drop per day Dr. Epitropoulos presents on intracanalicular dexamethasone at an EyeWorld CME Education event. T he 2019 ASCRS ASOA Annual Meeting marks the 7th annual ASCRS Clinical Survey. The 2019 survey builds on the success of prior surveys, in which thousands of ASCRS members participated. While many surveys yield important data, the ASCRS Clinical Survey is unique in that it assesses key clinical opinions and practice patterns of ASCRS members to guide education- al activities. Participants will also be entered into a raffle for prizes. The survey asks ASCRS members key questions relating to current issues they regularly face. The goal is to obtain opin- ions and practice patterns from a significant percentage of the membership. The ASCRS Clini- cal Committees then review and interpret the results and make recommendations for future educational programming. ASCRS members can com- plete this survey in 15 minutes. The survey tool will permit Participate in the 7th annual ASCRS Clinical Survey members to identify their pre- ferred category of questions and will include about 60 questions on various topics. Physicians can complete the survey in two different ways. • Physicians can go to ascrs2019.questionpro.com until May 31 to take the sur- vey at their convenience. • Physicians can take the ASCRS Clinical Survey in the Sails Pavilion of the San Diego Convention Center today. Representatives will hand participants a tablet to complete the survey. While taking the survey, participants can sit comfortably, charge up personal devices, and enjoy a cup of coffee. This fall, a supplement will be published in EyeWorld with a summary of the key findings from the survey. In addition, future presentations and publi- cations will be developed based on the survey data and identified education needs in the coming year.

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