How does prostate health affect cataract surgery? One of the most common medications used to treat benign prostate hypertrophy is Flomax, also known as tamsulosin. If you look carefully at the labeling on Flomax, there is a warning for patients undergoing cataract surgery of which many may be unaware.
Flomax works by blocking the alpha receptors in the smooth muscle of the neck of the bladder and urethra to relax and allow for improved urine flow. However, these same alpha receptors are also located in the smooth muscle of the iris. People who use Flomax have higher risks of complications during cataract surgery due to the effects of the medication on the iris causing small pupil size (miosis) and relaxed iris muscle tone.
Flomax is not the only medication that can cause iris problems during cataract surgery. Other medicines that work on alpha receptors used for hypertension, such as Cardura and Hytrin, can have similar effects.
During cataract surgery, the cloudy lens, which is located behind the iris, is removed from the eye. For people with a history of Flomax use, there is a high association with floppy iris during surgery. The syndrome is aptly named, “intraoperative floppy iris syndrome.”
Due to the lack of muscle tone, the iris can prolapse completely out of the eye through the incision during surgery causing permanent damage to the delicate iris structure. For patients who suffer from iris prolapse, the iris damage leads to long-term negative visual consequences of debilitating glare and light sensitivity.
One common question patients ask is if they stop taking Flomax, will it lower their risks? The answer is unfortunately, no. Even a history of Flomax use years in the past can increase the risk of floppy iris and complications during surgery. Stopping the medication, one week or even one year prior to surgery, does not seem to alter or reduce the risk of iris complications.
For patients with a history of Flomax use, cataract surgeons often take special precautions in preparation and planning for surgery to lower the risk of iris damage. For instance, one common technique is the use of iris retraction devices, such as iris hooks or iris rings, that help maintain the shape of the pupil during surgery.
Fortunately, for those who have suffered iris damage from floppy iris after having cataract surgery performed, some cases can be repaired. But the key is to never have the problem in the first place. Let your surgeon know if you have a history of prostate problems or have used medications like Flomax, even if it was 10 years ago. That way your surgeon can take the extra steps and precautions necessary to avoid damaging your iris during surgery.
Dr. Tokuhara is a cataract surgeon with Desert Vision Center in Rancho Mirage and a member of Desert Doctors. He can be reached at (760) 340.4700. For more information visit www.desertvisioncenter.com or www.desertdoctors.org.