Monique Barbour, MD, highlights benefits of dropless protocol over traditional drops

Monique Barbour, MD, ABO

(Image Credit: Ophthalmology Times)

Patient experience has remained a key theme across innovations in cataract surgery—particularly when it came to simplifying postoperative care. At the 2025 ASCRS Annual Meeting in Los Angeles, Monique Barbour, MD, presented findings from a retrospective review comparing traditional topical drop regimens with a dropless cataract surgery protocol, offering compelling insights into clinical outcomes and patient comfort.

Barbour’s study evaluated 25 patients who received intracameral medications combined with a dexamethasone ophthalmic insert, eliminating the need for self-administered eye drops. Over a 4-week postoperative period, 96% of patients reported no discomfort, inflammation, or infection. In contrast, the traditional drop regimen required multiple daily applications for several weeks. Minimal and only minor adverse events (4% photophobia, 8% redness) were reported. A single patient each experienced an intraocular pressure spike of 20% from baseline, corneal edema, and anterior chamber cell and flare after 7 days.

While in Los Angeles, Ophthalmology Times spoke with Barbour, an ophthalmologist at Clear Vue Laser Eye Center in West Palm Beach, Florida, about her presentation, the evolution toward dropless procedures and their effect on patient outcomes, and her approach to patient care during and after the operative period.

Ophthalmology Times: Can you tell us a little bit about how those dropless procedures have evolved in recent years, and how are those changes improving patient comfort, safety, and outcomes?

Monique Barbour, MD: That's a great question. When I was in training, the procedure for cataract surgery involved a retrobulbar block and possibly a stay overnight in the hospital to recover. Since then, we have [developed] evolving techniques that now allow us to have safer and more efficient outcomes for cataract surgery. And when I say safety, I'm speaking of the kind of anesthesia that we used to use in cases. It was in the past, at times, general anesthesia, and we've now evolved to using, actually, topical medications—or the most recent advancement is now a paradigm shift towards dropless or drop-free cataract surgery. We have certainly evolved since those earlier times.

In addition to that, some of the anesthesia techniques involve the use of intracameral medications, which are medications that are injected directly inside of the eye to maintain the comfort of the patient, both intraoperatively and post operatively. In addition to that, we can combine this technique with oral sedation and, at times, IV sedation, but the trend now is towards oral sedation— [you get a] faster recovery, and it's safe.

If you could, walk us through your own protocol. When you're approaching the patient's needs, how do you determine what angle you're going to take? How are you going to make sure that they get the best outcome for their specific situation?

Well, it starts really before the patient arrives in the operating room. So it starts really with patient education, where we spend quite a bit of time letting the patient know what exactly is involved with cataract surgery. Once we bring the patient to the operating room, we are able to perhaps put on a little bit of music—kind of like comfort music to put the patient at ease and reduce their anxiety.

Prior to the start of the surgery, I used a compounded solution called Omidria. It is a mix of ketorolac and phenylephrine that is infused into the balanced salt solution bottle. For the entire case, while we are operating, the eye is continuously bathed in Omidria.

Following the surgery, and while the patient is still on the table, I use a compounded solution of moxifloxacin and dexamethasone that is produced by ImprimisRx, and it is injected immediately following the fake emulsification case. The next day following surgery, I use a dexamethasone intracanalicular implant for continuous drug delivery of dexamethasone, 4 mg for 30 days. In that way, the patient does not have to use topical medications at all for the duration of the post-op period.

So much of this is focused so far on patient comfort and patient experience. How is the shift away from using drops also enhancing efficiency and also efficacy outcomes?

I think that the efficiency, and this is a certainly the biggest paradigm shift that we've seen, is that we are able to reduce the cost of medications for our patients. The patients are more comfortable intraoperatively, so we don't have the patient moving about during surgery and requiring additional injections of say, versa and fentanyl. Post operatively, the patients are also more comfortable, and compliance is never an issue as to whether or not they receive their eye drops or weren't able to have access to their eye drops because of cost or insurance problems.

Transcript edited for clarity.

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REFERENCE

Barbour M. Retrospective Review of Patients Undergoing Dropless Cataract Surgery Compared to Those Receiving Traditional Topical Drop Presented at: ASCRS; April 25-28, 2025; Los Angeles, CA. SPS-108