Associations advise cataract patients on risks of alpha-blockers

The American Society of Cataract and Refractive Surgery (ASCRS), American Academy of Ophthalmology, and American Urological Association all encouraged cataract patients to talk about medications, mainly alpha-blockers, used for benign prostatic hyperplasia and certain types of lower urinary tract symptoms before undergoing cataract surgery.

Both a retrospective and prospective study of 1,600 patients identified Intraoperative Floppy Iris Syndrome during cataract surgery in patients using tamsulosin HCl (Flomax, Boehringer Ingelheim Pharmaceuticals Inc.). In cataract surgery, a large pupil is obtained by using dilating drops that stimulate the iris dilator muscle. Investigators found that tamsulosin appears to block this iris muscle, leading to troublesome behavior of the iris during eye surgery. The iris tends to be floppy and the pupil may suddenly constrict during the middle of surgery. Investigators found that this syndrome also affects patients who have been off the medication for 2 years.

David F. Chang, MD, one of the study’s investigators, is part of an ASCRS task force committed to developing recommendations for surgical techniques to be used during cataract surgery on patients taking tamsulosin or other alpha-blockers. The academy will include this information in its evidence-based Preferred Practice Pattern guide for cataract care.

“Flomax is an excellent prostate medication, and there is no need for patients to avoid it or stop taking it out of concern over eye problems,” said Dr. Chang. “However, the key is for patients to inform their ophthalmologist when they are taking this or any other prostate drug prior to eye surgery.”

Other drugs in the alpha-blocker class include terazosin HCl (Hytrin, Abbott Laboratories), doxazosin mesylate (Cardura, Pfizer Inc.), and alfuzosin HCl (Uroxatral, Sanofi-Synthelabo). The alpha-blocker drugs are all regarded as being safe and effective for the treatment of urinary symptoms due to prostate enlargement without harming the eyes.