ARVO 2023: Implementing dropless cataract surgery to drop the cost

Ravi Parikh, MD, MPH, sat down with David Hutton, Managing Editor, Ophthalmology Times®, to discuss his presentation about adopting dropless cataract surgery to help reduce cost to both patients and the healthcare system at this year's ARVO meeting.

Video transcript

Editor’s note: This transcript has been edited for clarity.

David Hutton:

I'm David Hutton of Ophthalmology Times. The Association for Research in Vision and Ophthalmology recently held its annual meeting in New Orleans. I'm joined today by Dr. Ravi Parikh who presented "Drop It: Patient and Health System Savings From Dropless, Cataract Surgery Regimens." Thank you so much for joining us today. Tell us a little bit about this presentation.

Ravi Parikh, MD, MPH:

Thanks so much for having me. So, what our presentation and our study focused on was looking at post-cataract surgery. The prophylaxis to prevent and treat inflammation or postoperative swelling or postoperative infection. Instead of using topical eyedrops, which has a cost to both patients and the healthcare system. As well as difficulty in administering for some patients – to look at the cost implications of a droplet system, which has stronger evidence in some ways and also reduces costs for both the patient and the healthcare system.

So what we found is there's a lot of evidence that, to prevent infection, to inject intracameral moxifloxacin has been shown to reduce the rates of endophthalmitis significantly, and is by using that moxifloxacin, post-operative drops are no longer needed. And in conjunction with intracameral moxifloxacin, which many cataract surgeons are doing now, we also look at the potential cost savings of injecting subconjunctival triamcinolone which has also been shown to reduce inflammation and replace the need for a topical corticosteroid postoperatively.

We found that dropless, injection-based prophylactic medication regimens of intracameral moxifloxacin and subconjunctival triamcinolone from a 10 milligram per milliliter vial would reduce the costs to the health system by over 85% compared to the lowest cost topical drop regimen. Which would be prednisolone, Cateura lap and, and ofloxacin. We found that that would basically correspond to a total reduction of over $222 million per year to patients. and that would be about $42.85, per eye, savings per patient. Along with that, there's a significant benefit as far as also reduction in waste in terms of the environment for plastic, as well as for patients.

And there's a significant decrease in cost to the overall healthcare system by about $450 million. And this also reduces the need for patients to administer their drops and addresses any adherence issues as well. The next step for our research is looking at higher dose regimens of subconjunctival triamcinolone. To see if they would be equivalent to using a non-steroidal, anti-inflammatory to prevent postoperative cystoid macular edema. Right now, the dropless regimen does have a slightly higher risk of cystoid macular edema postoperatively.

However, there is significant debate whether a prophylactic non-steroidal, anti-inflammatory does actually prevent cystoid macular edema.

David Hutton:

Ultimately, what can this mean for ophthalmologists and the patients they treat?

Ravi Parikh, MD, MPH:

I think this is a good benefit for patients that might have difficulty in administering drops themselves. And I think this is a potential area where there can be significant savings to both the patient – as many patients have difficulty affording medications.

As well as to the healthcare system as a whole. I think one thing that's important is if it does become the typical and the norm for physicians to use dropless cataract surgery, then also the cost of the of the materials will also be reimbursed to the facilities as well. So it would be a benefit to every party involved.