Compounded Meds Are the Way to Go
By Gary Wörtz, MD; Featured in Cataract & Refractive Surgery Today
In my opinion, the biggest factor in determining the best pre- and postoperative medication regimen for cataract surgery is simplicity. Faced with multiple medications in different bottles requiring different administration schedules, patients can become confused. This can lead to patients’ lack of adherence to designated regimens, whether intentional or not.
For this reason, I prefer compounded drops. In particular, the fixed combination of the steroid prednisolone acetate 1.0%, the antibiotic gatifloxacin 0.5%, and the NSAID bromfenac 0.075% is my go-to drop. Following cataract surgery, patients are prescribed Omni q.i.d. for the first 2 weeks postoperatively and then b.i.d. for the following 2 weeks. With this regimen, in more than 5,000 consecutive cataract surgeries, I have seen no increase in inflammation, including macular edema, and no incidence of endophthalmitis.
Other companies offer similar compounding pharmaceuticals. Surgeons should review each product and determine which combination is best for them. The use of compounded drops simplifies things for patients, who no longer must distinguish between tiny bottles and attempt to comply with a complex drop regimen. It also simplifies things for the practice staff.
Some steroid products have been granted pass-through status. Although these long-acting depots represent another novel approach to improving patient compliance, I feel that navigating the bureaucratic process necessary to take advantage of these products is a hassle and too time-consuming, especially when good alternatives exist.
Gary Wörtz, MD:
- Private practice, Commonwealth Eye Surgery, Lexington, Kentucky
- Founder and Chief Medical Officer, Omega Ophthalmics
- Member, CRST Executive Advisory Board
- Financial disclosure: Cofounder and shareholder (Omega Ophthalmics)