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BID postoperative drops: Better compliance, better outcomes?
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How many of our patients who are prescribed eye drops for QID actually use them faithfully four times a day? According to studies of patient compliance, less than 50% of patients do. So how compliant are our postoperative cataract patients with a QID regimen of steroid, nonsteroidal and antibiotic?
With this question in mind, my practice partners and I recently switched our routine postoperative cataract regimen to three drops, all taken BID. Looking at pharmacokinetic data on available drugs, Ista's Xibrom (bromfenac ophthalmic solution 0.09%) is a nonsteroidal that is already indicated for BID dosing. Sirion's new Durezol (difluprednate ophthalmic emulsion 0.05%) has shown steroid potency nearly twice that of prednisolone acetate as well as dose consistency data that far exceeds the familiar suspension, so we felt comfortable using Durezol BID after surgery. As to an antibiotic, the best candidate seemed to be Vistakon's Iquix (levofloxacin 1.5%). Levofloxacin is a highly respected antibiotic among infectious disease specialists, and Iquix's concentration is three times higher than Vigamox's moxifloxacin 0.5% (Alcon) and five times more concentrated than Zymar's gatifloxacin 0.3% (Allergan).
We are now 3 months and several hundred patients into our new BID postop regimen, and we have yet to see (knocking wood) any complications related to our postoperative regimen. Furthermore, we feel much more confident that our patients are actually getting the drops we're prescribing. Patients love the new regimen too, because it allows them the freedom to go about their day without having to drag along eye drops.
I encourage readers to comment on their own approaches to simplify postoperative management.
Dr. Hovanesian is a consultant to Allergan, Bausch & Lomb, Inspire, Ista and Sirion. He has no financial interest in Vistakon.