Current And Future Role Of Dropless After Cataract Surgery: An International Yofs-Study

The use of postoperative eyedrops has disadvantages such as treatment burden, adherence, and a negative impact on the environment. While topical antibiotics are now often replaced by their intracameral application, control of postoperative inflammation is usually achieved using steroid and/or non-steroidal eye drops. However, postoperative anti-inflammatory drops can be replaced safely with a dropless after cataract surgery (DACS) regimen. This study aimed to evaluate current practice patterns and attitudes of cataract surgeons towards DACS.

Cataract centers in 19 countries; mainly centers in Europe and the USA.

A cross-sectional survey questionnaire (23 items) was developed and distributed by the Young Ophthalmologists for Sustainability (YOFS), a working group of the European Society of Cataract and Refractive Surgeons (ESCRS). Evaluated aspects included the current postoperative management of routine cataract patients, experience with DACS, and perspectives on DACS. A Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) was used to assess perceived barriers to performing DACS.

In total, 208 responses were collected. Most participants perform 250-500 cataract surgeries annually, and 92% routinely use intracameral antibiotics. While more than 90% had heard of DACS, only 19% have ever performed DACS, and 75% of the latter perform DACS currently. Surgeons without (current) DACS experience perceived more barriers than respondents performing DACS which included an assumed higher risk of inflammation (2.9 vs. 1.8) and increased intraocular pressure (2.7 vs. 2.4), and perceived lack of evidence (2.9 vs. 1.6). 76% of surgeons stated that patients would likely prefer not to use eye drops. Most respondents believed that DACS will be standard of care for either some (28%) or most (39%) patients without ocular comorbidities.

Currently, DACS is not widely performed for patients undergoing routine, uncomplicated cataract surgery. Centers performing DACS are primarily based in the US. Overall, DACS is expected to play a relevant role in the future and appears to be advantageous from various viewpoints.