Intraoperative floppy-iris syndrome (IFIS) deserves the attention of ophthalmologists and physicians as it occurs in about 50% of tamsulosin patients having cataract surgery and increases the risk for posterior capsule rupture and vitreous loss more than 10-fold.1 However, a recent article by Chang et al.2 shows that excellent surgical outcome was achieved when cataract surgeons were forewarned about tamsulosin use and precautionary measures were taken before and/or during surgery. The study highlighted the importance of communicating this drug history to ophthalmologists by the prescribing physicians.
In the United Kingdom, opticians increasingly refer patients for cataract surgery directly to ophthalmologists, although general practitioners (GPs) still do most referrals. To assess GPs' awareness of IRIS, we surveyed 85 GPs who regularly referred patients for cataract surgery at our local eye unit. The postal questionnaire was designed to assess the basic knowledge about the association between tamsulosin and IFIS of primary care physicians and the mean number of patients who were started on tamsulosin every month.
The response rate of 75.3% (64/85) was good, with 96.8% (62/64) admitting they were not aware of the association. Interestingly, 79.6% (51/64) were involved in prescribing tamsulosin monthly (more than 5 tamsulosin prescriptions per month).
Our survey has limitations as it examined a small cross-section of GPs. Furthermore, as the survey has a voluntary self-reporting nature, there may be elements of recall bias. Nonetheless, the survey demonstrated that the level of awareness of IFIS among GPs is very limited.
Educating primary care physicians about IFIS in cataract surgery is needed and will ensure that history of using tamsulosin is disclosed to the surgeon before cataract surgery, with a favorable visual outcome in this cohort of patients.
1. Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg. 2005;31:664-673.
2. Chang DF, Osher RH, Wang L, Koch DD. Prospective multicenter evaluation of cataract surgery in patients taking tamsulosin (Flomax). Ophthalmol. 2007;114:957-964.