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| Medical Societies Issue Advisory to Cataract
Patients Taking Prostate Medications |
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| FAIRFAX, Va., Aug. 22 /PRNewswire/ -- The American Society of Cataract
and Refractive Surgery (ASCRS), the American Academy of Ophthalmology
(Academy) and the American Urological Association (AUA) today advised
patients taking certain drugs to treat prostate enlargement to inform their
eye surgeon about these medications before undergoing eye surgery. These
drugs can potentially cause complications during cataract surgery. However,
preliminary results of a new study found that these patients can still have
successful surgery if their surgeon knows they are taking or have taken
these drugs and alters the surgical technique.
Advisory
Tamsulosin (Flomax(R)) is the most commonly prescribed drug for
prostate enlargement, or benign prostatic hyperplasia (BPH). By
facilitating more complete emptying of the bladder, Flomax decreases the
need to urinate during the middle of the night. However, Flomax and other
similar systemic drugs called alpha-blockers can potentially cause
difficulty during cataract surgery, particularly if the eye surgeon has not
been forewarned. For this reason, ASCRS, the Academy and AUA advise
patients who are taking or have taken alpha-blocker prostate drugs such as
Flomax, to inform their ophthalmologist before surgery. Other drugs in this
alpha-blocker class include, terazosin (Hytrin(R)), doxazosin (Cardura(R)),
and alfuzosin (Uroxatral(R)). The alpha-blocker drugs are all regarded as
being safe and effective for the treatment of urinary symptoms due to
prostate enlargement without harming the eyes.
The effect of Flomax(R) on cataract surgery:
In 2005, David F. Chang, MD, and John R. Campbell, MD, completed both a
retrospective and a prospective study of 1,600 patients and identified a
new problem that occurs during cataract surgery in patients using Flomax.
They called the condition Intraoperative Floppy Iris Syndrome (IFIS).
The iris, the part of the eye that gives it its color, opens and closes
in response to varying light levels. Because the iris is located in front
of the cataract, the pupil (opening in the iris) must be widely dilated in
order to perform the surgery. A large pupil is obtained by using dilating
drops that stimulate the iris dilator muscle. Chang and Campbell found that
Flomax appears to block this iris muscle, leading to troublesome behavior
of the iris during eye surgery. The iris tends to be floppy and the pupil
may suddenly constrict during the middle of surgery. If the iris problems
are not anticipated or prevented, there is an increased risk of having
surgical complications. Interestingly, they still found IFIS in some
patients who had been off the medication for two years. "Flomax does not
affect vision or eye health," Dr. Chang said. "But it impairs the dilator
muscle in the iris, and during cataract surgery the pupil needs to stay
dilated."
Following the publication of Chang and Campbell's findings, and after
receiving corroborative reports from other ophthalmologists, the U.S. Food
and Drug Administration (FDA) instituted a new label warning for Flomax and
other alpha-blocker drugs that reads: "The patient's ophthalmologist should
be prepared for possible modifications to their surgical technique." In
2005, frequent discussion among ophthalmic surgeons of problems posed by
patients on Flomax resulted in the formation of an ASCRS task force,
chaired by Dr. Chang, which developed recommendations for surgical
techniques to be used during cataract surgery on patients taking Flomax or
other alpha-blockers. The Academy will be including this information in its
evidenced-based Preferred Practice Pattern(R) guide (PPPs) for cataract
care. These PPP guides are followed by ophthalmologists worldwide.
Multi-center study of cataract surgery in Flomax patients
To assess the effectiveness of these techniques, a large multi-center
trial was undertaken at 10 centers around the country. More than 160
cataract surgeries were performed on patients taking Flomax using these
modified techniques. Dr. Chang reported the preliminary results at the
recent ASCRS Annual Symposium in San Francisco. The study demonstrated that
if the surgeon knew about the Flomax use in advance, and if the modified
surgical techniques were used, the surgical success rate was excellent and
the complication rate was not increased in comparison to surgery on
non-Flomax patients. Final results of the study will be presented at the
Academy's Annual Meeting in November.
Several important conclusions can be drawn from this study, according
to Dr. Chang. "Although the drug can make cataract surgery more difficult,
if the surgeon knows in advance that the patient is or has taken Flomax or
another alpha-blocker drug, then appropriate techniques can be used that
provide excellent results," he said. "Flomax is an excellent prostate
medication, and there is no need for patients to avoid it or stop taking it
out of concern over eye problems. However, the key is for patients to
inform their ophthalmologist when they are taking this or any other
prostate drugs prior to eye surgery. This is not something that you would
ordinarily think to tell your eye doctor."
Background
Cataracts and prostate enlargement are both very common age-related
conditions. In men, enlargement of the prostate typically begins around age
55. The condition prevents complete emptying of the bladder, which in turn
increases the frequency of urination. Urologists treat prostate enlargement
through the use of drugs and, if needed, surgery. Alpha-blockers, such as
Flomax, relax muscles in the enlarged prostate in order to improve urinary
outflow. This decreases the need to urinate as frequently and allows men to
sleep uninterrupted for longer periods.
Cataracts are a progressive clouding of the lens of the eye and are the
most common age-related cause of worsening vision. Ophthalmologists treat
cataracts by surgically removing the cloudy natural lens and replacing it
with a clear artificial lens implant.
Conference Call Information:
When: Tuesday, Aug. 22, 2006
1:00 p.m. EDT/ 10:00 a.m. PDT
Note: To ensure that the call begins on time, please dial-in 5
minutes early
Where: (800) 311-6662 (US Media)
(719) 457-2696 (International Media)
3444175 (Confirmation Code)
The American Society of Cataract and Refractive Surgery is an
international educational and scientific organization whose 9,100 member
ophthalmologists specialize in cataract and refractive surgery. The
American Society of Ophthalmic Administrators, with over 2,000 members,
represents ophthalmic practice professionals who specialize in
reimbursement, marketing, and business management. For more information,
visit our website, http://www.ascrs.org/.
The American Academy of Ophthalmology is the voice of ophthalmologists
and their patients in Washington, D.C., and is the world's largest
organization of eye physicians and surgeons with more than 29,000 members.
http://www.aao.org/.
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