After cataract surgery, tiny insert delivers steroids, eliminates need for eye drops

May 20th, 2020

 

The Dextenza eye insert helped Martha Eubanks after cataract surgery. Here she poses on a birding outing at sunrise on Mount Evans. Photos courtesy of Martha Eubanks.
The Dextenza eye insert proved critical to Martha Eubanks after cataract surgery. Here, she poses at sunrise on a birding outing on Mount Evans. Photos courtesy of Martha Eubanks.

Martha Eubanks noticed it first while driving at night. What should have been points of light blurred into a haloed mess. Eubanks, 74, of Denver, a retired State Farm insurance agent and an avid birder – she has 399 species on her list and counting – knew exactly what was happening.

Her wife Lucia Guzman had had cataract surgery in early 2019. Dr. Leo Seibold, a University of Colorado School of Medicine ophthalmologist at the UCHealth Sue Anschutz-Rodgers Eye Center – Anschutz Medical Campus, had performed that surgery, and it had gone well. By late 2019, Eubanks knew it was her turn.

“Everybody I know who’s over 70 is having this surgery done,” Eubanks said. “If you don’t have cataracts, it’s because you didn’t live long enough.”

Indeed, cataracts affect about half of those 75 and over in the United States, and cataract surgery is this country’s most common surgery, with about 3 million procedures performed a year. The surgery involves replacing the clouding lens of the eye with a clear replacement.

Seibold performed cataract surgery on Eubanks’s right eye on Jan. 7, and it went well. She kept the eye protected for the next 24 hours and slept with a patch for a week. The hardest part about the recovery was having to follow a regimen involving different eye drops she had to properly aim in the eye four times a day, then three times, then twice, and finally once a day over the following month.

“It’s about 150 drops over a month’s time. You have to be cognizant and you have to pay attention,” Eubanks said. “They give you a nice little chart, because when you’re 74, you can’t remember what you took and what you didn’t.”

Martha Eubanks is seeing clearly again after cataract surgery and her eyes are not drying out thanks to the Dextenza eye insert. Here, she poses at the Eubanks Woods Bird Sanctuary in Houston
Eubanks at a woods that may or may not be named after her. Photo courtesy of Martha Eubanks.

Two weeks later, Seibold replaced the lens in Eubanks’s left eye. As her second eye recovered, she would need neither the chart nor the eye drops. Seibold inserted what looked like a tiny plug into one of her left eyelid’s tear ducts. It wasn’t a plug, but a small, dissolving implant that would release a continuous dose of a corticosteroid of the sort she was still putting into her right eye, drop by drop.

Instead of eye drops, the ‘Dextenza’ eye insert made all the difference after surgery

The plug was a drug called Dextenza. Seibold had been introducing it to patients as an alternative to the many eye drops otherwise needed to reduce inflammation and ensure the eye’s proper healing after cataract surgery. Eubanks happened to have come along amid that transition and had the rare distinction of having done eye drops in one eye and the Dextenza insert in the other. Her preference was clear.

“I said to Dr. Seibold, ‘Was this not available before Jan. 7?’ It was pretty amazing,” Eubanks said.

The U.S. Food and Drug Administration had approved Dextenza in November 2018, so it was quite new (Dextenza’s active ingredient, dexamethasone, was initially approved in 1958). The drug didn’t so much fill a new medical niche as provide a new way to deliver an old medication.

The Dextenza eye insert made all the difference for Martha Eubanks after cataract surgery. Here she poses with her wife, Lucia Guzman, at Denali National Park in Alaska.
Eubanks and Lucia Guzman at Denali National Park in Alaska. Photo courtesy of Martha Eubanks.

Seibold had long recognized that eye drops were, for most patients, the hardest part of cataract surgery. All but the most skilled and experienced handlers of eyedroppers well know the feeling of blinking at the wrong time, or dribbling medicine down one’s cheek after an egregious misfire. Add arthritis and age- or disability-related dexterity issues and the challenge is multiplied. In addition, chart or otherwise, adding a four-times-a-day medication regimen to one’s daily routine is anything but routine. People forget. The occasional patient disliked eye drops so much they avoided the cataract surgery they really did need, Seibold said.

“With Dextenza, I don’t have to worry about any of those issues,” he said. “But what really sold me on it were the outcomes were good and patients loved it. Patients like Martha came back in and said, ‘This is amazing. I can’t tell you what a great thing it is not to have to put eye drops in my eye after surgery.’”

Assuming one’s health insurance covers it (most Medicare plans do, as do many private insurers), Dextenza also saves patients the out-of-pocket costs of eye drops, Seibold said. For a small minority of patients, there can be some initial irritation and tearing, but most patients never know the insert is there, he said, and it dissolves away after the medicine is gone.

Eubanks much preferred Dextenza to eye drops, but she was able to manage the eye drops too. The big deal was the cataract surgery itself, which got rid of the nighttime halos and has given her a better bead on those birds.

Her improved vision, she said, “gives me more control over my life and more independence,” she said. “My distance vision is just excellent. It has freed me in a way – it’s like I got younger, almost.”

About the author

Since 2008, Todd Neff has written hundreds of stories for University of Colorado Hospital and UCHealth. He covered science and the environment for the Daily Camera in Boulder, Colorado, and has taught narrative nonfiction at the University of Colorado. He was a 2007-2008 Ted Scripps Fellowship recipient in Environmental Journalism at CU.

His latest book, "The Laser That’s Changing the World," tells the story of the inventors and innovators who saw, and ultimately realized, the potential of lidar to help solve problems ranging from smokestack-pollution detection, ice-sheet mapping, disaster recovery, and, ultimately, autonomous-vehicle guidance, among many other uses. His first book, "From Jars to the Stars," recounts how Ball Aerospace evolved from an Indiana jar company - and a group of students in a University of Colorado basement - to an organization that managed to blast a sizable crater in the comet 9P/Tempel 1. "Jars" won the Colorado Book Award for History in 2012.

Todd graduated with a business degree from the University of Michigan, where he played soccer, and with a master’s degree from the Fletcher School of Law and Diplomacy at Tufts University. Before becoming a journalist at the turn of the millennium, he was an IT and strategy consultant. He once spoke fluent Japanese and still speaks fluent German.

When not writing, he spends time with teenage daughters and wife Carol, plays soccer, and allows himself to be bullied by a puggle he outweighs by a factor of seven.