Can Prostate Drugs, Like Flomax, Complicate Cataract Surgery?
Many men will experience enlargement of their prostates as they age, a condition known as benign prostatic hyperplasia (BPH). This condition can lead to more frequent urination due to incomplete emptying of the bladder. By age 70, almost all men will have some prostate enlargement. This is why many men wake up regularly throughout the night to go to the washroom or limit their water consumption before bed.
The most commonly prescribed class of drugs for benign prostatic hyperplasia are alpha-blockers. These medications relax the muscles near the prostate and relieve the pressure on the urethra, which allows urine to flow more easily.
Some of the most common alpha-blockers used for BPH are:
terazosin
doxazosin
tamsulosin (Flomax)
silodosin (Rapaflo)
alfuzosin (Xatral)
In Canada, Flomax (tamsulosin) is usually the first drug prescribed for men with mild to moderate urinary symptoms from BPH, partially because it is now available in low-cost generic forms.
How Does Flomax Affect My Eyes and Cataract Surgery?
Flomax affects the iris muscle inside the eye, leading to a unique eye condition known as intraoperative floppy iris syndrome or IFIS. Currently, it's believed that Floppy Iris Syndrome occurs during 2% of all cataract surgeries.
Normally, a widely dilated pupil gives the cataract surgeon the best view during the procedure. However, Flomax can cause the iris to be floppy, leading to prolapse. The pupil can also constrict unexpectedly during surgery.
If the cataract surgeon is not anticipating this, intraoperative floppy iris syndrome can lead to serious surgical complications. These complications can cause permanent pupil deformity, glare and light sensitivity.
It's Always Important to Tell Your Eye Doctors About Your Medications.
Please don't assume that we know everything that you're on. Always keep an up-to-date medication list and bring it to your appointments. Your pharmacist can often provide this to you for free.
Many patients assume that their medications don't affect their eyes because they're prescribed for something else. However, this is a common myth, and many medications have ocular side effects or are directly related to ocular health.
By letting your optometrist know about all your meds, they can inform the cataract surgeon before your initial surgical consultation. This knowledge allows the cataract surgeon to better determine your surgical risks and the surgical technique required for a safe operation. If your medications induce dry eye, we can also treat your eyes more aggressively, allowing for better visual outcomes post-surgically.
Because Flomax is so commonly prescribed, we make it a habit of asking every man about prostate and urinary tract medications before referring them to a cataract surgeon. Unfortunately, this often catches patients off guard because they find it funny that an eye doctor is talking to them about prostate meds.
Can I still have cataract surgery if I'm taking Flomax?
Yes. As long as your cataract surgeon knows that you've taken an alpha agonist medication like Flomax, they can plan for it during the operation and take the necessary precautions to reduce—but not completely eliminate—the risk of complication.
If you are already taking these drugs, you do not need to stop them. Alpha-blockers do not harm your eyes, but you must inform your eye doctor that you are taking them (or have taken them in the past) before having eye surgery.
Should I stop taking Flomax before cataract surgery?
Stopping a medication like Flomax before cataract surgery is a conversation you must have with your cataract surgeon and primary care provider. Some cataract surgeons recommend temporarily stopping certain medications like Flomax before surgery, but this is not universal.
Conclusion:
It's important to talk to your optometrist about your complete medical history, including current and prior medications you may have taken. Then, when referring you for cataract surgery, they can pass this information on to the cataract surgeon.
Suppose you've been delaying cataract surgery but are now considering treatment for BHP with a medication like Flomax. It would be best to talk to your eye doctors about whether it might be better to proceed with the surgery as soon as possible to reduce intra-operative risk.
As always, the team of optometrists at Helio Optometry would be happy to help you with your cataract concerns. From the initial diagnosis, surgical referral and post-operative care, we want to help you through the process. So book a cataract consultation or a routine eye exam with us at our 149th Street clinic in Edmonton, Alberta.
