Ophthalmologists update advisory on alpha-blockers

The American Society of Cataract and Refractive Surgery (ASCRS) and the American Academy of Ophthalmology have jointly issued an educational update about cataract surgery complications associated with systemic alpha-blockers based on the recent publication of two studies.

The update comes more than 6 years after the two groups teamed with the AUA to raise awareness that all alpha-blockers can impair pupil dilation and cause intraoperative floppy iris syndrome (IFIS).

However, the preponderance of evidence indicates that the alpha-blocker tamsulosin (Flomax) is more likely to cause severe IFIS than non-selective blockers such as terazosin (Hytrin), doxazosin (Cardura), and alfuzosin (Uroxatral), the organizations said in a press release.

A new study published in Ophthalmology (2014; 121:829-34) comparing the relative frequency and severity of IFIS with tamsulosin and alfuzosin found that tamsulosin was more likely to cause severe IFIS.

In addition, results from a survey of primary care physicians published in the Journal of Cataract and Refractive Surgery (2014; 40:679-80) showed that only 35% of the physicians surveyed knew about alpha-blockers affecting cataract surgery and only half of them (17%) factored this into treatment considerations. The vast majority (96%) desired more information on the association.

“ASCRS and the Academy ask prescribing physicians to consider whether the patient has cataracts and may need surgery when initiating non-emergent alpha-blocker treatment. Patients with known cataracts may wish to consider earlier surgery or starting with a non-selective alpha-blocker first,” the organizations said.

“Considering the prevalence of both cataracts and benign prostatic hyperplasia, many ophthalmologists worry about the increasing numbers of challenging IFIS cases as our population ages. Managing the side effects and complex interactions of a lengthy medication list is challenging. We welcome the opportunity to be a resource for physicians who prescribe alpha-blockers, in an effort to reduce cataract surgery complications for our mutual patients,” said ophthalmologist David F. Chang, MD, a co-author on both studies.

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