Eye Surgeons Need Patients'
Complete Drug Profiles
BETHESDA, MD, 23 August 2006 — Even an
alpha-1-receptor blocker taken most recently as
five years ago can cause complications during
cataract surgery, according to one of the
ophthalmologists researching the apparent
"There seems to be some semipermanent effect of
the alpha-blockers, such as Flomax or tamsulosin,
on the iris muscles, said David F. Chang, speaking
on behalf of the American Academy of Ophthalmology
during a conference call yesterday with
The academy, along with the American Society of
Cataract and Refractive Surgery and the American
Urological Association, issued an advisory
(PDF) to patients taking "prostate drugs" and
awaiting cataract surgery.
Patients taking tamsulosin, terazosin,
doxazosin, or alfuzosin, the advisory states, must
inform their eye surgeon about that medication
before undergoing ophthalmologic surgery.
All four of those alpha-blockers treat benign
prostatic hypertrophy. The FDA-approved labeling
for terazosin and doxazosin also describe the
drugs' efficacy in the treatment of
Chang and fellow ophthalmologist John R.
Campbell reported in 2005 that Flomax, the
tamsulosin product marketed by Boehringer
Ingelheim Pharmaceuticals Inc., appears to block
the iris dilator muscle. The result is an iris
that tends to be floppy and a pupil that may
unexpectedly constrict during the middle of
cataract surgery rather than stay dilated. If not
anticipated by the surgeon, a floppy iris can lead
Boehringer Inhelheim issued a "Dear Doctor"
letter in November
2005 and revised the FDA-approved labeling for
Flomax. The other makers of alpha-blockers revised
their products' labeling as well.
Subsequent research led by Chang and reported
at a recent professional meeting found that
surgeons who learned of a patient's alpha-blocker
exposure before cataract surgery and modified
their technique had excellent results, according
to the advisory.
The three medical associations urged patients
to be more forthcoming about their drug therapies
when preparing for cataract surgery.
"Very often patients withhold information,
thinking...it's unimportant for the
ophthalmologist to be aware of their medications,"
said Samuel Masket, president of the American
Society of Cataract and Refractive Surgery. "The
other thing is that I think there's a degree of
sensitivity about the need for bladder-specific
medications, and not everyone feels comfortable
divulging that [information], particularly if they
don't have any idea that it would have potential
bearing on their surgery."
He said a patient's alpha-blocker use is often
discovered during cataract surgery, a procedure
that does not require the patient to be
"I think it's also somewhat cultural," said
Masket, who practices in Los Angeles. "As an
example, I take care of a large number of Russian
males. Virtually every Russian male over a certain
age is taking a uro-specific agent. I think they
tend to avoid prostate surgery in their community
as a rule."
Stopping the alpha-blocker therapy before
cataract surgery is not the answer, Chang
Not only does stopping the therapy possibly
complicate the prostatic condition, he said, but
the effect on the iris muscle does not
"We were very surprised to see that patients
who hadn't even taken the drug for one to up to
three or even five years can still show this
floppy iris problem during surgery," Chang said.
"So we now want to know even if patients have
taken the drug in the past and are no longer
taking it—that is still very pertinent."
—Cheryl A. Thompson