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Cataract Surgery and Flomax

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Posted 11/20/2020 12:13 AM (GMT 0)
Well I started Flomax at the startup of my 5 sessions of CyberKnife in April, and now 7 months later I have cataract surgery scheduled for the 24th. Researching online I see where I will be at risk for IFIS, (linked below). My opthmalogist says "no worry". Anyone had this experience? Should I not worry?

https://bceye.com/flomax-complications-cataract-surgery/

"The condition is called intraoperative floppy iris syndrome (IFIS) and is characterized by a small pupil (making cataract surgery more difficult as it forces the cataract surgeon to operate through a smaller opening) and sudden constriction of the pupil during surgery. Stopping Flomax, or other alpha-blockers, does not seem to reduce the risk of developing complications from the drugs."
Posted 11/20/2020 1:29 AM (GMT 0)
My eye surgeon took my floppy irises in stride at my cataract procedures. I wasn't asked about Flomax before surgery, during which my surgeon commented on my IFIS. After my first eye, the surgical nurse asked if I took Flomax, which I did at the time. I think I read that IFIS is seen in about 2% of procedures. I had excellent results in both eyes, BTW.

If your eye doc isn't your surgeon, you can call your eye surgeon's office and discuss it with a nurse. What you don't hear is that men who have ever taken Flomax can't have cataract surgery.

Djin
Posted 11/20/2020 3:18 PM (GMT 0)
I didn't have IFIS but was asked several times by the cataract doc and office staff about whether or not I had ever taken Flomax. Now I know why.

BTW, which lenses are you choosing? I took distance only and it has worked out well. I use readers for the newspaper, books and the computer but other than that no issue. Previously I had multi-focal contacts so was tempted to get the multi-focal lens but...I heard too many stories about issues with those lenses so chickened out.

Jim
Posted 11/20/2020 3:37 PM (GMT 0)
I chose distance for both eyes (as I had with my contacts) and I use glasses for reading and the piano. My sister did monovision (one eye corrected for distance and one for close vision), as she had with her contacts. This is OK for many activities, but for extended reading or distance viewing, I think she still has 2 pairs of glasses. I too ruled out multifocals. I also paid the extra fee to have the incisions made by laser -- not because I didn't trust the doc to mark it by hand, but because the laser did a number of additional cornea relaxation incisions, which cut my astigmatism by about half.

Djin
Posted 11/20/2020 3:43 PM (GMT 0)

DjinTonic said...
I chose distance for both eyes (as I had with my contacts) and I use glasses for reading and the piano. My sister did monovision (one eye corrected for distance and one for close vision), as she had with her contacts. This is OK for many activities, but for extended reading or distance viewing, I think she still has 2 pairs of glasses. I too ruled out multifocals. I also paid the extra fee to have the incisions made by laser -- not because I didn't trust the doc to mark it by hand, but because the laser did a number of additional cornea relaxation incisions, which cut my astigmatism by about half.

Djin

I also considered the mono-vision but as a tennis player I was warned that this might be a problem. Actually I could still do mono-vision (as could you) with one reading contact lens. I just decided that the readers were not a real issue so abandoned the contacts for good. It's good to know that I can now play the piano though...I'll start that right away...

Jim

P.S. I also went with the laser.
Posted 11/20/2020 5:17 PM (GMT 0)
Thanks DT. It is nice to know the IFIS is only a 2% occurrence.

I have not been asked about near, distance, mono, etc. lenses. The doc says I have a astigmatism, and the surgeries will still leave me with my 20/40 vision. When I was younger my glasses were just corrected for that, and not until I got older did I switch to bifocals, and then no line progressive lenses. I wonder if I need to contact the doc's office and find out what I am getting, and if I have a choice.
Posted 11/20/2020 5:27 PM (GMT 0)
I was asked about Flomax when I had my cataract surgery and when I told them I was on Rapaflo, they said that was fine. Either there's a difference in how Rapaflo works versus Flomax, or perhaps it's just new enough that it's not on their radar screen.

manich: you will definitely get a choice on the type of lenses and you should spend some time thinking about what will best suit you. Also, if you have the laser assisted surgery--an upsell that's not always covered by insurance--that can help correct your astigmatism.

FWIW, I chose near vision lenses. I've always been moderately near-sighted so I'm used to wearing glasses for distance viewing, while not needing glasses to read. (At least until I got older and needed reading glasses.) I had the impression it was a pretty unusual choice based on the reactions of some of the folks in the eye surgeon's office.
Posted 11/20/2020 5:42 PM (GMT 0)

manich said...


I have not been asked about near, distance, mono, etc. lenses. The doc says I have a astigmatism, and the surgeries will still leave me with my 20/40 vision. When I was younger my glasses were just corrected for that, and not until I got older did I switch to bifocals, and then no line progressive lenses. I wonder if I need to contact the doc's office and find out what I am getting, and if I have a choice.

Not to alarm you, but if your surgery is scheduled for the 24th you should have been asked about lens options some time ago. It's a big decision and also the costs are different if you choose a "premium" lens like a multi-focal. Your doc or surgery scheduler should have had a long discussion with you about this and provided material to help you decide. You should check with them ASAP. Also, you might want to check with friends or acquaintances who have had the procedure; not all eye doctors are created equal and you want a good one given they are messing with your eyesight.

Jim
Posted 11/20/2020 6:24 PM (GMT 0)
I missed the fact that your surgery is scheduled for the 24th until Jim pointed that out. Yes, this is a super big deal--to the point that you should consider delaying your surgery date.
Posted 11/20/2020 6:55 PM (GMT 0)

manich said...
Thanks DT. It is nice to know the IFIS is only a 2% occurrence....

Sorry if I was unclear: The 2% is of all procedures. I think it may be very high in those who have used Flomax.

Djin
Posted 11/20/2020 8:34 PM (GMT 0)
Checked with his asst and was told I am getting the single focus lense and will still need glasses for my 20/40 astigmatism. I was never asked if I wanted the out of pocket procedures that would help correct the astigmatism. That is ok since I like wearing glasses. They help hide my "eye baggage".

He is a very predominate ophthalmologist with the largest ophthalmology group in my area. So I guess I will trust him on the lense, and the IFIS risk.
Posted 11/20/2020 8:45 PM (GMT 0)

manich said...
Checked with his asst and was told I am getting the single focus lense and will still need glasses for my 20/40 astigmatism. I was never asked if I wanted the out of pocket procedures that would help correct the astigmatism. That is ok since I like wearing glasses. They help hide my "eye baggage".

He is a very predominate ophthalmologist with the largest ophthalmology group in my area. So I guess I will trust him on the lense, and the IFIS risk.

Manich, a "single focus lens" could be near vision single focus or distance vision single focus. Or you could get the previously mentioned mono-vision or multi-focus. You should also decide whether or not you want your astigmatism fixed. You should decide these things given your habits and preference. This is not a decision made by the doctor it is a decision made by the patient with the doctor's guidance. You should have a discussion with the office re the pluses and minuses of each so that you can make an informed decision. Pls. forgive me for saying this but it sounds like you are being a bit passive in this process...your eyes and eyesight are a big deal and you will be living with this decision for the rest of your life. Know your options and make an educated decision...don't let it "just happen".

Jim
Posted 11/20/2020 8:55 PM (GMT 0)
If you get single vision lenses, you will still be wearing glasses--if they're far vision, you'll need reading glasses and vice versa. The exception would be if you got one close focus and one far focus lens.

I had mild astigmatism and since I had that corrected as part of the surgery, I actually see better than I have in my entire life right now.
Posted 11/20/2020 9:18 PM (GMT 0)
I am currently on flowmax
Will need catarct surgury at some time in the future bout 5 yr out
Should i consider another option other than flowmax my eye doc does not think its a big issue
What are the odds i will develop ifis and is it revesable if i go off flowmax
Posted 11/20/2020 9:19 PM (GMT 0)
Here is a related article. https://www.aao.org/clinical-statement/flomax-patient-advisory Denis
Posted 11/20/2020 9:38 PM (GMT 0)
My understanding is that once you were on Flomax for any duration, the risk remains even after you stop. I believe surgeons have a number of interventions to counter floppy iris during surgery.

Djin
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