There is a drug side effect that is adversely affecting the treatment of cataracts by making the surgery more difficult and increasing the likelihood of surgical complications.
The drug causing this ubiquitous problem is FLOMAX.
FLOMAX works to relieve the symptoms of benign prostatic hypertrophy by relaxing smooth muscle. It’s an alpha-1 adrenergic antagonist, and has a particular affinity for the sub-type alpha-1A receptors.
But as a side effect, it reduces the function of the radial iris dilator muscle, which is also specifically sensitive to alpha-1A adrenergic receptors.
Most of the tasks of cataract surgery are performed behind the pupil. As a rule, cataract surgery is safer with a large, dilated pupil because it improves the surgical exposure.
Unfortunately, the deleterious effects related to FLOMAX and eye surgery are often irreversible. It not only reduces pupil dilation, but there is a loss of dilator tone combined with tissue atrophy of the iris, resulting in INTRAOPERATIVE FLOPPY IRIS SYNDROME, also known by the acronym of IFIS (Cataract & Refractive Surgery Today, April 2005, pp 64-68).
Until just one year ago, this was an unrecognized syndrome. It was fortuitously discovered by an eye surgeon in California, David Chang, at the University of California at San Diego.
Since that time, eye surgeons have had to make drastic modifications in technique to compensate for tiny pupils while at the same time preventing iris tissue from prolapsing through even the tiniest surgical incisions. The result is a longer and often more traumatic surgery, with an increased rate of complications.
Other oral medications for prostate hypertrophy can have a similar effect, but because they are not specific to alpha-1A adrenergic receptors, their effect is less severe. These include HYTRIN, CARDURA AND UROXATRAL. Another medication for BPH that has a different mechanism of action is AVODART.
We therefore recommend the following for your patients that you are treating for benign prostatic hypertrophy or other etiologies of urinary retention symptoms:
- In patients that have not yet undergone cataract surgery that have BPH or another etiology of urinary retention, we recommend a consultation for cataract surgery PRIOR to instituting therapy.
- In patients with cataracts that are unwilling to consider cataract surgery prior to institution of therapy or in those patients that do not yet have cataracts, we recommend considering an alternative therapy to FLOMAX if other medications without specific activity against alpha-adrenergic-1A receptors are deemed safe for your patient.
While we utilize the most advanced surgical techniques available to facilitate the best outcomes in these cases, we thought it was important to communicate to you regarding this important matter, so that you can more thoroughly evaluate the best course of action for your own patients.
As always, we welcome your comments and inquiries. Our new office address is Huntington Eye Care, 755 Park Avenue, Suite 100, Huntington NY 11743, just one building north of The Atrium.
Sincerely,
Charles I. Bloomgarden, M.D.
Paul L. Krawitz, M.D.
Dr. Paul Krawitz has performed thousands of No Stitch-No Shot-No Patch Cataract Surgery. He will personally take the time to thoroughly evaluate your unique situation and to speak to you about all of your options. As of April 14, 2006, Dr. Krawitz is the only ophthalmic surgeon in Suffolk County, Long Island to be certified in monofocal lens implants, multi-focal lens implants such as ReZoom, and accommodative lens implants such as Crystalens. To make an appointment for a consultation and see the difference that personal attention and an experienced surgeon makes, call us at (631) 223-0400.
The following article was written by Dr. Krawitz and reprinted by numerous publications for its clarity and completeness. |
