What is the deal with Flomax and may cataract surgeon?

 
So you are sitting with your family watching The Game of the Week and a commercial comes on for Flomax or another related medication for urinary retention.  The room goes uncomfortably quiet as the commercial narrator rattles off the drug's various and sundry side effects.  The seasoned 50-plus-year old plus male spectator can easily be spotted as he is the one who is leaving the room to fill the chip bow prior to his 9 year-old daughter asking, "What is that medicine for, Daddy?" (A similar dynamic has been observed during Viagra commercials - leaving 9 year old daughters with multiple questions, but virtually bottomless bowls of chips.)  These commercials often end with the disclaimer - "If considering cataract surgery, tell your eye surgeon you are taking Flomax."

Flomax is one of a number of medications prescribed for urinary retention related to benign prostatic hypertrophy.  The medication class is alpha 1a adrenergic antagonist (blockers) which improves urinary flow by reducing the tone of prostatic smooth muscle.  Unfortunately, the dilator muscle of the iris possesses the same class of receptors - so Flomax and is analogs effectively "block" the iris dilator muscle.  As many of you know, cataracts are located just behind the pupil, having a well-dilated pupil facilitates cataract removal.  In 2005, eye surgeons described a common occurrence during cataract surgery in patients taking Flomax, Intraoperative Floppy Iris Syndrome (IFIS).  As a direct result of IFIS, the risk of complications during cataract surgery increased - especially when the ophthalmologist did not know of the drug use.  Significantly, IFIS has been observed in eyes many months or even years after the patient discontinued this class of drugs!  Subsequently, surgical modifications have been developed to address the effect of adrenergic antagonist upon the iris.  These measures included preoperative use of atropine eye drops, intraoperative use of epinephrine (epi-Shugar-caine).  Additionally, there are mechanical pupil-supporting systems such as iris retractors, the Graether pupil expander and the Malyugin Ring, each used to hold the pupil in a dilated state to allow the surgeon optimum visualization and access to the cataract.

As I mentioned, Flomax (the generic name is tamsulosin) is just one of the medications used to treat benign prostatic hypertrophy (BPH).  Other medications used to treat BPH include Cardura (generic; doxazocin), Minipress (generic:prazosin) and Hytrin (generic: terazosin).

It should also be noted that alpha blocking agents have also been used for the treatment of urinary retention in women, as well as for systemic hypertension.

In summary, by notifying your ophthalmologist about your present or past used of alpha - 1a - antagonists, he/she can modify your cataract procedure to give you the best chance for an excellent outcome.