Iheezo offers option for pain-free, efficient ocular surgery
Click Here to Manage Email Alerts
The only thing more satisfying than hearing from someone who is thrilled with the results of a recent cataract surgery is learning that the patient experienced no pain during the procedure.
Like my colleagues across ophthalmology, I am committed to these kinds of results, and that is why I am always on the lookout for the most effective ways to support my patients’ comfort in the operating room.
Fortunately, ocular surgeons have long had the ability to provide excellent anesthetic coverage during routine anterior segment procedures that take 25 minutes or less, such as cataract surgery, corneal transplants, Descemet’s stripping endothelial keratoplasty, Descemet’s membrane endothelial keratoplasty and IOL exchanges.
Over the past decade or two, we have achieved this with topical anesthetics, typically proparacaine, tetracaine and lidocaine. Used in combination with each other, intracameral lidocaine and/or “Shugarcaine,” which pairs lidocaine and phenylephrine, these medications have become the cornerstones of pain control during routine ocular surgeries. But surgeons should also be aware that their options expanded in September 2022, when the FDA approved Iheezo (chloroprocaine hydrochloride ophthalmic gel 3%, Harrow), the first topical anesthetic in 14 years to gain the green light for use in eye care.
While I keep the older workhorses on hand because they are crucial to pain control during longer, more complex procedures, I have been impressed with the effectiveness of Iheezo as a solo anesthetic during routine surgeries. In addition, I have found that this fast-acting, low-viscosity, preservative-free gel brings other benefits, from ocular surface hydration that lasts through an entire procedure to a favorable postsurgical side effect profile. And, as a separately billed medication, Iheezo can boost our revenues for cataract surgeries and other routine procedures.
Of course, all ophthalmic surgeons feel strongly about the treatment practices they have developed to help make their surgeries seamless. Yet, to ensure that they are providing the most efficient and effective experience for both patients and surgical teams, surgeons should consider the entire toolbox of topical anesthetics before settling on a strategy.
Refining pain control
To weigh all their options, surgeons need to be familiar with Iheezo.
Effective within 90 seconds and lasting an average of 21.5 minutes, its indicated dose is three drops before surgery, with surgeons free to reapply as necessary. I have put my own spin on that: a drop while the patient is in the preop area, another upon reaching the OR and then a “sneeze” of whatever gel remains in the single-use bottle just before surgery.
I have found that spreading that extra Iheezo around on the cornea keeps the eye hydrated throughout the procedure without any need for viscoelastic. That is much more efficient than our usual method of applying saline or balanced salt solution every 30 seconds or so.
In several case studies of Iheezo as a solitary procedural anesthetic, my patients have remained pain free; one was relaxed enough during cataract surgery to have a casual conversation with me about the fact that I raise chickens. But what struck me the most was the enthusiasm of our anesthesiologists, who were able to administer less sedation, including fewer narcotics, when Iheezo was applied. In addition to reducing exposure to potentially addictive substances, this lessened postsurgical nausea, enabling patients to go home sooner after their procedures.
By trading our standard anesthetics for sterile Iheezo in these cases, we also avoid using compounded drugs such as Shugarcaine, which can introduce the risk of contamination, and lidocaine gel, whose use in the eye is strictly off label.
Finally, unlike older topical anesthetics that sting upon initial administration, even when they are preservative free, Iheezo has not caused discomfort for any of my patients.
Striving for efficiency
As the only topical ocular anesthetic with a permanent J-code, Iheezo offers another advantage: It enables practices to invoice separately for the anesthesia they use during procedures. This can boost revenue, as reimbursement for Iheezo is above the flat amount practices are allowed to bill for procedures.
On the savings side of the ledger, Iheezo reduces surgical costs by eliminating the need for additional anesthetics during routine procedures. This also prevents waste, as we previously have needed to dispose of remaining proparacaine, tetracaine and/or lidocaine gel after these surgeries.
While my biggest challenge with Iheezo has been getting staff members oriented to a new protocol, we now have a system that works nicely. Because not all insurers cover Iheezo and we do not want our patients left with a bill, staff members from our business office check preoperatively to determine who is eligible. Then, they use a stamp to indicate eligibility on patients’ charts.
Making magic
As ophthalmologists, we are all dedicated to performing pain-free procedures that bring excellent results, a confluence I often describe as the magic of modern ocular surgery. But in reality, of course, there is nothing mystical about what we do. Ocular surgeons generate great outcomes by using the tools that best support our techniques and expertise, and that means staying informed and selecting wisely as our toolbox of topical anesthetics expands.
- References:
- Brandon Ayres. What is Iheezo and does it work? YouTube. https://www.youtube.com/watch?v=L0rn5_mPzIM. Published May 7, 2024. Accessed Sept. 25, 2024.
- Harrow announces U.S. FDA approval of Iheezo (chloroprocaine hydrochloride ophthalmic gel) 3% for ocular surface anesthesia. https://www.prnewswire.com/news-releases/harrow-announces-us-fda-approval-of-iheezo-chloroprocaine-hydrochloride-ophthalmic-gel-3-for-ocular-surface-anesthesia-301635251.html. Published Sept. 28, 2022. Accessed June 1, 2024.
- Highlights of prescribing information. https://www.iheezo.com/prescribinginformation.pdf. Revised September 2022. Accessed June 1, 2024.
- No-hassle reimbursement support. https://www.iheezo.com/reimbursement. Accessed June 1, 2024.
- For more information:
- Brandon D. Ayres, MD, co-director of the cornea fellowship program at Wills Eye Hospital in Philadelphia and a specialist in cornea and external disease at Ophthalmic Partners in Pennsylvania and New Jersey, can be reached at bayres@willseye.org.
Collapse
Read more about
Click Here to Manage Email Alerts