Dr. Gary Foster – Fort Collins & Loveland, CO
I prescribe several eye drops after cataract surgery. These drops protect against infection, decrease inflammation, and keep you comfortable.
Antibiotic treaments are routinely administered after cataract surgery for the first few weeks. They are intended to help decrease the chance of infection…inside the eye.
Interestingly, there are no studies showing that antibiotic eye drops decrease the infection rate.
This is because the chance of getting an infection inside your eye following cataract surgery are very low, about one out of every 1,500 people nations wide. In my hands, it has been even rarer.
You would have to create a study with hundreds of thousands of patients in it with half getting antibiotics and half not getting antibiotics to prove a difference.
That study has never been done because you can’t find enough eye surgeons or patients willing to go without antibiotic medication.
Branded vs. Generic Antibiotic Medication
The good news is that after an antibiotic eye drop has been out for a long time it goes generic and is cheap to purchase. The bad news is that after an antibiotic eye drop has been out for a long time, the bacteria get used to them.
The bacteria become resistant to the antibiotic so that the drugs don’t work as well anymore. Alas, the better medications cost more. I would not recommend cutting a corner here. The latest generation medications are Besevance (fastest kill curve), Vigamox (no preservative and best eye penetration), and Zymaxid. These are my favorite eye drops after cataract surgery.
We want the immune system to react to your cataract surgery to help heal the incisions and prevent infection, but we don’t want the eye to over do it. When the immune system detects an insult, like surgery, it releases chemicals that cause swelling and others that can be toxic to the gentle structures of the eye. We want just the right amount of inflammation following your procedure. Eye Drops after cataract surgery help fine-tune the response level from your immune system.
Cystoid Macular Edema (CME)
Anti-inflammatory medication allow us to moderate and control the level of inflammation. This decreases the chance a complication called CME that occurs if inflammation and swelling reach the delicate center of your retina called the macula.
Steroidal Anti-Inflammatory Treatments
Cortisone is a steroidal anti-inflammatory. A number of different steroidal eye drops have been developed that work better than cortisone. They can raise the eye pressure in about 10% of patients that use them longer term so I like to stop these treatments at two to three weeks.
Generic steroidal topical treatments are available and work pretty well in the post cataract setting but their potency has been less predicable than the branded newer medications like Durezol that don’t need to be used as many times per day.
Non-steroidal Anti-Inflammatory Eye Drops (NSAIDs)
Ibuprophen is an example of a NSAID. Several different NSAID drops are available. NSAIDs decrease inflammation by a different pathway than the steroidal eye drops. Studies have shown that the effects of using a NSAID and a steroidal anti-inflammatory are additive. This means that it is helpful to use both types of anti-inflammatory medications to decrease the chance of CME.
I would likely ask you to use NSAID once a day for six weeks after your cataract surgery. There are older generic and NSAID that work well, but they tend to sting more and you have to use them more times per day. The new designer NSAIDS like Ilevro are comfortable for most and only have to be used once per day. It is important that you take you take your topical medications to help decrease the chances of infection and CME.
Eye Drop Calendar
We will provide you with an eye drop calendar to help remind you when it is time for your medication. It shows a picture of the drops you will be using and then has check boxes for each drop you should take every day. As you mark these boxes after each dose, it will help you stay right on track of your eye drops after cataract surgery so that you can achieve the most brilliant vision possible after your procedure.
Glaucoma and Cataract
If you have glaucoma, you will need to continue your glaucoma drops along with your cataract drops. Some patients without glaucoma will develop high pressure in their eyes during the healing phases. If this happens, your eye doctor will prescribe some pressure lowering for cataract removal recovery that you will take while your eye heals from the cataract surgery.
Cataract Eye Drops
Cataract eye drops have become more expensive is the last year. This comes from several factors. There are hundreds of different drug benefit plans. The drug companies have to make arrangements with each one of these plans to try to make the cost of their cataract eye drops affordable. Each year these arrangement change, so one year the cataract eye drops could be reasonable with your plan while the next they could be completely unaffordable. In some cases, the companies that own the branded cataract eye drops have also purchased the companies that make the generic cataract eye drops. They have then raised the price on the generics to almost the same as the branded products. Many of the companies have put out coupons to make the branded products reasonable, but many pharmacies will not accept the coupons if your have a Medicare part D plan, which often makes the drug more expensive if you have the insurance than if you didn’t and could use the coupons. I know that all sounds like a bad dream, only because it is.
If I can provide any other information about eye drops after cataract surgery, please schedule a time to meet with me or send me a note.