The cataract surgery process continues to become more refined.
Special to Ophthalmology Times®
Although the visual outcome may be the most important aspect of cataract surgery, a more complete measure of success is patients’ happiness with their experience every step of the way. We have conducted several surveys in my practice to understand patients’ perspective of their cataract surgery journey and the factors that go into their perception of the quality of their experience. In other words, what makes them happy and what makes them unhappy.
What our studies have found is that, when thinking about patients’ satisfaction with cataract surgery, they consider the whole process. This includes the preoperative visits, the consultation, the conversations with educators and counselors, and the end result. Patients report that the key in the equation is the time it took them to arrive at their desired outcome. When patients have difficulty taking their postoperative drops, it interferes with their overall perception of how well their procedure went.
We asked approximately 100 patients who were happy with their visual outcome at their last follow-up (approximately 90 days postoperatively) to reflect on their journey. At that time, our postcataract surgery drop regimen included an antibiotic, a nonsteroidal anti-inflammatory agent, and a steroid. The No. 1 area of dissatisfaction by far was related to their drop experience.
Patients complained about the inconvenience of going to the pharmacy, challenges obtaining the right medication, and difficulty remembering to take the medications, according to the prescribed regimen. When using a tapering dose of a topical steroid, it can be confusing for patients when the first and second eyes are not on the same dosing regimen. It is also worth noting that some patients have physical limitations that make it hard for them to instill their drops.
Patients were also troubled by the time it took for their vision to stabilize—they expected to have good vision after approximately 1 week. A common comment was, “My vision is great now, but for the first few weeks, it fluctuated.” In the survey, we found that patients expected postoperative vision to be unstable to begin with, because of a suboptimal tear film and dry eye inherent to the procedure, but they also expected it to stabilize rather quickly. When we add to that with preservative-containing topical drops, it introduces additional visual instability and potential for delayed stability.
To eliminate these patient pain points, we were excited to incorporate the drug-delivery platform, dexamethasone ophthalmic insert 0.4 mg (Dextenza; Ocular Therapeutix). This preservative-free intracanalicular insert, which is placed at the time of surgery, eliminates the need for a postoperative steroid drop.
We have found that patients are very happy to have 1 less drop in their regiment. In our early experience (approximately 30 patients), we used the insert in 1 eye only and our standard regimen in the other, with prednisolone acetate. More than 90% of patients said they experienced a significant improvement in overall comfort, ease of remembering their drop regimen, and time to visual acuity stabilization with the dexamethasone ophthalmic insert.
When using a steroid suspension dosed 4 times a day, it often takes longer for vision to stabilize. The eye can become more irritated, and therefore patients tend to experience a longer journey to a healthy ocular surface. In our practice, satisfaction increased greatly when we removed the topical steroid from the equation.
Patients are well aware of the amount of time they spend in the practice and on the phone with us. Patients who use the dexamethasone ophthalmic insert reported higher satisfaction, as they did not have to call back because of drop problems. Before using drug delivery, they may have not received the drops we had prescribed because of a pharmacy switch or lack of insurance coverage, causing office calls and frustration. Not to mention the time spent in the office, educating patients on postoperative drop instructions. When we eliminated the steroid drop, we found there was an average of 4 minutes of time saved per patient per visit.
Today we have advanced technologies that benefit every stage of cataract surgery. We are refining our surgeries, honing our skills, and achieving fantastic results. Why not refine our postoperative management, as well? By eliminating the postoperative steroid drop with the dexamethasone ophthalmic insert, we can ultimately get better quality vision with a quicker recovery.