The first step in this process is the early and active involvement of a technology champion.
One of the center’s founding surgeons, Eric D. Donnenfeld, MD, was an investigator in a phase II clinical trial for the phenylephrine and ketorolac injection 1%/0.3% and an author of several articles describing the results of clinical studies following its FDA approval.
He began to utilize the product routinely in his own cataract procedures, and by this example, became an advocate for its adoption among other surgeons at the center.
Recognizing that many of these physicians had other favored pre- and intraoperative regimens for controlling miosis, Dr. Donnenfeld conducted a “real-world” study with three colleagues at the center, comparing outcomes in 260 cases in which phenylephrine and ketorolac injection 1%/0.3% was used to 381 in which intracameral epinephrine was employed (prior to the commercial availability of phenylephrine and ketorolac injection 1%/0.3%) in a retrospective review.
Results of this study (presented at the 2016 meeting of the American Society of Cataract and Refractive Surgery) showed that use of the phenylephrine and ketorolac injection 1%/0.3% was associated with a four-fold reduction in complications, shorter case length, and less use of pupil expansion devices—all of which resulted in significantly improved patient outcomes, reduced surgical complications, and cost savings. Patients also had significantly greater improvement in uncorrected visual acuity on the first postoperative day than those who received epinephrine.