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    The effect of drug pricing on cataract surgery

    Dropless or less drops may improve cost, convenience, compliance


    Complications with postop medications

    The same concerns that arise for cataract patients affect LASIK patients as well. An estimated annual 700,000 LASIK patients nationwide are also subjected to several weeks of required drops that must be administered multiple times a day.8 As with cataract and other ocular surgery patients, this regimen creates a variety of reported compliance concerns, including problems with instillation and dosage, confusion, cost, and convenience.9-10 As optometrists, many of these concerns fall under our jurisdiction as we assume care for patients at one day post-procedure and often prescribe the required medications. Therefore, if the surgeon recommends a certain medication and problems arise with insurance or cost, it is often the comanaging doctor’s responsibility to find an alternative.

    Related: An OD shares his perspective of his own cataract surgery

    While LASIK is private pay, insurance companies do occasionally cover the cost of the medications. When they do not, patients are often shocked by the cost involved. Having already paid thousands for the surgery, they are not prepared for the additional cost that is necessary for required medications. Many patients are compliant and will purchase the branded, and therefore more expensive, drops, but others are unable to assume the extra cost.

    In these cases, generic formulations can be a viable option. Generics are not our preference as they can cause side effects with less efficacy. They also may introduce a slight toxicity to the corneal epithelium that could delay healing or minimize the immediate “wow factor” effects of the surgery. Additionally, generic ophthalmic steroids require vigorous shaking in order for the suspensions to mix properly and get the best effect, a necessity some patients may not be willing or able to do. However, when obtaining the branded medications is not possible, generics do provide a cost effective alternative.

    Next: Combined or lessdrops approach

    Bret Fisher, MD
    Bret Fisher, MD is a private practitioner in Panama City, Florida, USA.
    Gene Wong, OD, FAAO
    Gene Wong, OD, FAAO, practices at The Eye Center of North Florida in Panama City, FL.


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