Initiative aims to educate primary care physicians better about intraoperative floppy iris syndrome

August 1, 2008

Before prescribing alpha blocker treatment, a primary care physician (PCP) should consider involving the cataract surgeon when treating a patient with a known diagnosis of cataract. So says an educational statement that is part of an initiative by the American Society of Cataract and Refractive Surgery and the American Academy of Ophthalmology launched to further educate PCPs about the connection between alpha blockers, such as tamsulosin (Flomax, Boehringer Ingelheim Pharamceuticals), and intraoperative floppy iris syndrome during cataract surgery.

Key Points

Most urologists already are aware of intraoperative floppy iris syndrome (IFIS), a complication that can occur during cataract surgery and that has been associated with the alpha blocker drugs frequently prescribed for benign prostatic hyperplasia (BPH), David F. Chang, MD, told Ophthalmology Times. Often, however, urologists do not see patients who have BPH until the condition fails to respond to medical therapy, he added. Most new prescriptions for alpha blocker treatment of BPH or hypertension, Dr. Chang said, are written by primary care physicians (PCPs), and, unfortunately, knowledge of the alpha blocker/IFIS connection is not as widespread among PCPs and their patients as it is among ophthalmologists and urologists.

More than 90% of respondents to a recent survey by the American Society of Cataract and Refractive Surgery (ASCRS) Cataract Clinical Committee indicated that a need existed for better education of prescribing physicians regarding alpha blockers and IFIS. (For more information about the survey, see "IFIS continues to challenge cataract surgeons, survey finds".)

"Based on this clear consensus, we asked the American Academy of Ophthalmology [AAO] to collaborate with ASCRS in launching an educational campaign about IFIS and alpha blockers directed toward PCPs," Dr. Chang, chairman of the ASCRS Cataract Clinical Committee, told Ophthalmology Times. "Both AAO and ASCRS agreed that this was important information to get out both to ophthalmologists and to prescribing doctors."

The campaign includes a one-page, jointly issued "educational update statement" written for prescribing physicians.

In part, the statement says: "In a patient with a known diagnosis of cataract, prescribing physicians may wish to consider involving the patient's cataract surgeon prior to initiating nonemergent, chronic tamsulosin or alpha blocker treatment. Options might include an eye exam or having either the patient or the prescribing MD communicate with the cataract surgeon. Patients should also be encouraged to report any prior or current history of alpha-1 antagonist use to their ophthalmic surgeon prior to undergoing any eye surgery."

That last point aims to address the potential concerns of patients who already are taking alpha blockers, according to Dr. Chang. "It is important to reassure these patients that the prognosis of cataract surgery remains excellent, as long as the eye surgeon is forewarned about their medication history."

The statement also points out that IFIS still can occur even after patients have discontinued tamsulosin therapy for more than a year, however. "We are trying to explain that it isn't the case that we simply can stop the drug to avoid IFIS altogether," he said.

Reaching out to PCPs

"The leadership of both the American College of Physicians [ACP] and the American Academy of Family Physicians [AAFP] have been supportive of sharing this information with their members," said Dr. Chang, who also is a clinical professor of ophthalmology at the University of California, San Francisco.

In July, the ACP and the AAFP made the statement and the ASCRS survey results available to their members (125,000 and 93,000, respectively) through their usual news channels and their Web sites. The timing of the effort coincided with the expedited publication of the survey results in the Journal of Cataract and Refractive Surgery (2008;34:1201-1209).

Thomas A. Oetting, MD, chairman of the cataract/anterior segment section of the AAO Practicing Ophthalmologists Curriculum panel, told Ophthalmology Times, "The most exciting thing about [the initiative] is that we're trying to reach out to other specialties based on something that we're noticing in our world."

He praised Dr. Chang and the ASCRS Cataract Clinical Committee for working to communicate the message via the educational statement.

"From the point of view of a member of ASCRS, I'm proud that David and the [committee] pushed past all of the barriers to collect the data and then share this information with other specialties," said Dr. Oetting, also professor of clinical ophthalmology, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City. "The AAO hopes to help ASCRS spread this important information to prescribing physicians in other specialties."