Floppy Iris Syndrome
The intraoperative floppy iris syndrome was first reported by Drs. David Chang and John Campbell in 2005. This major discovery showed that the most common prostate medications (such as Flomax) cause iris problems during cataract surgery that can lead to many complications if the surgeon does not anticipate them. Dr. Chang has done extensive clinical research and is considered one of the world authorities on how to avoid and manage these problems.
- Healthday/US News 2009 (Dr Chang quoted)
- Patient Advisory June 2009
- EyeSmart 2009
- Patient Advisory 2009
- Patient Advisory August 2006
- All About Vision (see blue side bar “Special Alert for Men”)
2006 Flomax Press Releases
- Medical Societies Issue Advisory to Cataract Patients Taking Prostate Medication, PR Newswire (Aug 2006)
- Drug linked to cataract surgery problems, CBS News (Aug 2006)
- Drug linked to cataract surgery problems, NY Times (Aug 2006)
- Prostate Drug Use May Mean Cataract Surgery Change, Health Day News (Aug 2006)
- Prostate drug complicates cataract surgery – Fox News (Aug 06)
- Alpha-blocker prostate drugs cause long-term complications for eye health, cataract surgery, News Target (Aug 2006)
- Full Coverage: Drug linked to Cataract Surgery, AP story (Aug 2006)
Prostate drugs, such as Flomax, can complicate cataract surgery.
By David F. Chang MD
Two of the most common but normal aging ailments are cataracts and enlargement of the prostate. The former produces a gradual blurring of vision, while the latter causes men to urinate more frequently due to incomplete emptying of the bladder. The most commonly prescribed drug for urinary symptoms from an enlarged prostate is Flomax, which relaxes the prostate muscles to improve urinary outflow and emptying of the bladder.
How does Flomax affect my eyes?
Surprisingly, Flomax also affects the iris muscles inside the eye during cataract surgery … a condition called the “intraoperative floppy iris syndrome” (IFIS). Normally, a widely dilated pupil gives the eye surgeon the best view during the cataract procedure. However, Flomax can cause the iris to be floppy and the pupil to unexpectedly constrict during surgery. Particularly if the surgeon is not anticipating this, IFIS can lead to surgical complications. Flomax belongs to the class of prostate drugs called alpha blockers, which also includes Uroxatral, Hytrin, and Cardura. Alpha blockers are also used to treat high blood pressure, kidney stones, and urinary symptoms in women, and all of these drugs can potentially cause IFIS during cataract surgery.
What should patients do?
If you are already taking these drugs, you do not need to stop them. Alpha blockers otherwise do not harm your eyes, but you must inform your ophthalmologist that you are taking them (or have taken them in the past) prior to having any eye surgery. Fortunately, the prognosis for cataract surgery is still excellent because the forewarned ophthalmologist can take compensatory steps to perform the operation successfully.
If you have cataracts and are thinking about taking a medication to treat urinary symptoms, such as from an enlarged prostate, you may wish to first consult with an ophthalmologist. Depending upon individual factors, such as how advanced your cataract is, an ophthalmologist can discuss the timing of cataract surgery, and which prostate medications are less likely to cause IFIS.
Why should I tell my ophthalmologist if I take or have taken medicine for an enlarged prostate?
Researchers have found that medications called alpha-blockers used to treat the symptoms of an enlarged prostate – such as Flomax, Hytrin, Cardura and Uroxatral — can create a risk of complications during cataract surgery. Even if it has been several years since you have taken one of these medications, the risk of complications may still exist. Women are also prescribed alpha-blockers for certain urinary symptoms.
How does Flomax impact cataract surgery?
Alpha-blockers relax muscles in the enlarged prostate to improve urinary flow. This decreases the need to urinate as frequently at night. These same medications also appear to interfere with the muscles that control the iris, the internal structure that gives the eye its color. The pupil, or the dark opening in the center of the iris, must be dilated (or opened widely) to allow the surgeon to operate on the cataract, which sits behind iris in the eye.
In patients who are taking or have taken Flomax or other alpha-blockers, the iris may not stay dilated during surgery. If the iris problems are not anticipated or recognized, there is an increased risk of surgical complications. Flomax does not affect vision and does not pose any other problems with eye health.
Can I still have cataract surgery if I take Flomax?
Yes. If ophthalmologists know that a patient is taking an alpha-blocker or used to take one, they can modify the surgical techniques used during cataract surgery to reduce — but not completely eliminate — the risk of complications.
Should I stop taking Flomax before cataract surgery?
Consult with your ophthalmologist. Some surgeons may recommend stopping the medication for several weeks prior to surgery, but there is also evidence that the modified surgical techniques may not require patients to stop.
- American Academy of Ophthalmology ONE network – Chang video
- Tamsulosin-intraoperative floppy iris syndrome link is urged to be considered by primary care physicians (Ophthalmology Times, August 2009)
- Does Flomax Deserve a “Black Box” Warning?(Ophthalmology Management, August 2009)
- Tamsulosin use linked with postop cataract surgery complications (Ocular Surgery News, July 2009)
- IFIS … in general medical journals (EyeWorld, July 2009)
- Why BPH treatment can complicate cataract surgery (EyeWorld, July 2009)
- ASCRS & AAO seeking to better educate prescribing physicians about IFIS (EyeWorld, July 2009)
- AAO, ASCRS update advisory urging patients to disclose tamsulosin use (Ocular Surgery News, June 2009)
- ASCRS IFIS white paper provides most recent information (EyeWorld, December 2008)
- Severity determines intraoperative floppy iris syndrome management approach (Ophthalmology Times, November 2008)
- Anticipate silodosin-IFIS link, surgeon says (Ophthalmology Times, November 2008)
- Alpha-blocker, iris syndrome link still a concern (Ophthalmology Times, September 2008)
- Consider cataract effects before prescribing alpha blockers (Ophthalmology Times, August 2008)
- ASCRS survey shows that IFIS is still a surgical challenge (EyeWorld, July 2008)
- ASCRS survey results prompt IFIS education campaign (Ocular Surgery News, July 2008)
- ASCRS survey details risks of alpha-blockers, IFIS (Ocular Surgery News, July 2008)
- Numerous strategies may be needed to control IFIS (Ophthalmology Times, June 2008)
- Arsenal of strategies enables safe surgery in IFIS eyes (Ophthalmology Times, April 2008)
- State of the art: Intraoperative floppy iris syndrome (Ocular Surgery News, March 2008)
- Pearls for managing IFIS (EyeWorld Supplement September 2007)
- Benedetto Strampeli Medal Lecture: Proper planning, precautions allow safe cataract surgery in IFIS case (Ocular Surgery News, May 2007)
- Range of severity of IFIS requires varied management strategies (Ocular Surgery News, March 2007)
- Alternative strategies successful in managing IFIS (Ophthalmology Times, February 2007)
- Range of severity of IFIS requires varied management strategies (Ocular Surgery News, January 2007)
- Groups issue advisory about alpha-blockers, iris syndrome (Urology Times, October 2006)
- Associations advise cataract patients on risks of alpha-blockers (Ophthalmology Times, September 2006)
Two Studies Link Flomax to IFIS (Ophthalmology Management, July 2005)
Intraoperative Floppy Iris Syndrome
- Managing IFIS with iris retractors (Cataract & Refractive Surgery Today, September 2006)
- Joint AAO & ASCRS Press Release (August 2006)
- American Urological Association Press Release (August 2006)
- Physician groups urge patients to disclose Flomax use to cataract surgeons (Ocular Surgery News, August 2006)
- Eye Surgeons Need Patients’ Complete Drug Profiles (American Society of Health System Pharmacists, August 2006)
- Patients Still Not Getting the Message on Flomax and Cataract Surgery – Academy Member Alert
- Anticipation key to managing IFIS (Ophthalmology Times, June 2006)
- The Information Superhighway — Guest Editorial (EyeWorld, April 2006)
- Stopping the Flopping: Managing IFIS (Review of Ophthalmology, March 2006)
- The Flomaxinators take the cataract Challenge Cup (Ocular Surgery News, March 2006)
- Cataract surgery affected by tamsulosin (American Society of Health System Pharmacists, November 2005)
- Dear Doctor letter (Boehringer Ingelheim Pharmaceuticals, November 2005)
- FDA approves Flomax labeling change (Ocular Surgery News, November 2005)
- FDA Approves Label Change for Flomax Following Report of Cataract Surgery Complications (American Academy of Ophthalmology, Nov 2005)
- Eliciting tamsulosin treatment history key for predicting IFIS (Ophthalmology Times, October 2005)
- Floppy iris requires special management (Eurotimes, October 2005)
- Relatory Matters: Floppy Iris Syndrome (Eurotimes, October 2005)
- Journal of Cataract & Refractive Surgery Article (JCRS, April 2005)
- The Intraoperative Floppy Iris Syndrome (Cataract & Refractive Surgery Today, April 2005)
- Managing Floppy Iris Syndrome (Ophthalmology Management—April 2005)
- Study Will Assess Flomax and Floppy Iris (Review of Ophthalmology, March 2005)
- FDA studies intraoperative cataract complication, prostate drug (Ophthalmology Times, March 2005)
- ASCRS Team to Investigate Flomax—Urinary Drug May Cause Cataract Surgery Complication (Ophthalmology Management—March 2005)
- Beware Floppy Iris During Phaco (EyeNet, March 2005)
- ASCRS Forms Flomax Working Group (American Society of Cataract & Refractive Surgery, February 2005 )
- Perspectives in Lens & IOL Surgery Surgeons report—a new small pupil syndrome caused by Flomax (Eyeworld Magazine, January 2005)
- Flomax use in male cataract patients associated with floppy iris (Ocular Surgery News, January 2005)
- ASCRS Issues Physician Advisory on Flomax (American Society of Cataract & Refractive Surgery, January 2005 )
- American Family Physician – Chang editorial 2009
- American Academy of Family Physician (AAFP News Now 2008) – Chang Interview
- Educational Update Statement for Prescribing MDs (AAO/ASCRS) 2008
- American College of Physicians (ACP Internist 2008)