Dr Inder Paul Singh, MD, president of The Eye Centers of Racine and Kenosha, Wisconsin and consultant and speaker for Ocular Therapeutix, has conducted several surveys in his practice to understand patients’ perspective of their cataract surgery journey and the factors that go into their perception of the quality of their experience. His finding show that, although the visual outcome may be the most important aspect of cataract surgery, a more complete measure of success is patients’ happiness with their experience at every step of the way.
Dr Singh’s studies have found that, when thinking about patients’ satisfaction with cataract surgery, they consider the whole process. This includes the preoperative visits, the consultation, the conversations with educators and counsellors, and the end result. Patients report that the key in the equation is the time it took them to arrive at their desired outcome. When patients have difficulty taking their postoperative drops, it interferes with their overall perception of how well their procedure went.
When patients have difficulty taking their postoperative drops, it interferes with their overall perception of how well their procedure went
Pain Points Along The Way
Dr Singh asked approximately 100 patients, who were happy with their visual outcome at their last follow-up (approximately 90 days postoperatively), to reflect on their journey. At that time, the post-cataract surgery drop regimen included an antibiotic, a nonsteroidal anti-inflammatory agent, and a steroid. The number one area of dissatisfaction by far was related to their drop experience.
Patients complained about the inconvenience of going to the pharmacy, challenges obtaining the right medication, and difficulty remembering to take the medications, according to the prescribed regimen. When using a tapering dose of a topical steroid, it can be confusing for patients when the first and second eyes are not on the same dosing regimen. It is also worth noting that some patients have physical limitations that make it hard for them to instil their drops.
Patients were also troubled by the time it took for their vision to stabilise – they expected to have good vision after approximately one week. A common comment was, “My vision is great now, but for the first few weeks, it fluctuated.” In the survey, Dr Singh found that patients expected postoperative vision to be unstable to begin with, because of a suboptimal tear film and dry eye inherent to the procedure, but they also expected it to stabilise rather quickly. When preservative-containing topical drops were added, it introduces additional visual instability and potential for delayed stability.
To eliminate these patient pain points, Dr Singh incorporated the drug-delivery platform, dexamethasone ophthalmic insert 0.4 mg (Dextenza; Ocular Therapeutix). This preservative-free intracanalicular insert, which is placed at the time of surgery, eliminates the need for a postoperative steroid drop.
Losing a Drop, Gaining Satisfaction
The survey found that patients are very happy to have one less drop in their regiment. In early experience (approximately 30 patients), Dr Singh used the insert in one eye only and the standard regimen in the other, with prednisolone acetate. More than 90% of patients said they experienced a significant improvement in overall comfort, ease of remembering their drop regimen, and time to visual acuity stabilisation with the dexamethasone ophthalmic insert.
When using a steroid suspension dosed four times a day, it often takes longer for vision to stabilise. The eye can become more irritated, and therefore patients tend to experience a longer journey to a healthy ocular surface. In Dr Singh’s practice, satisfaction increased greatly when he removed the topical steroid from the equation.
Patients are well aware of the amount of time they spend in the practice and on the phone with their optometrist. Patients who use the dexamethasone ophthalmic insert reported higher satisfaction, as they did not have to call back because of drop problems. Before using drug delivery, they may have not received the prescribed drops because of a pharmacy switch or lack of insurance coverage, causing office calls and frustration. Not to mention the time spent in the office, educating patients on postoperative drop instructions. When the steroid drop was eliminated, Dr Singh found there was an average of four minutes of time saved per patient per visit.
Honing Procedure and the Experience
Today there are advanced technologies that benefit every stage of cataract surgery. By eliminating the postoperative steroid drop with the dexamethasone ophthalmic insert, better quality vision with a quicker recovery can be achieved.
Original article published by Ophthalmology Times.
