I have been advocating a change in practice patterns concerning Flomax patients who have cataracts.  I received an e-mail from the American Academy of Ophthalmology (AAO) containing an Advisory on this subject, which I will share with everyone: 

Academy, ASCRS Update Previous Advisory Following New Findings About Link Between Flomax and Post-Cataract Surgery Complications

The Academy and the American Society of Cataract and Refractive Surgery (ASCRS) have issued an update to their previous joint patient advisory regarding eye surgery and patients’ past, current or planned use of alpha-blockers, particularly Flomax® (tamsulosin). Recently, the lead article in the Journal of the American Medical Association reported that during a five-year study period, tamsulosin doubled the risk of serious postoperative complications following cataract surgery. No increased risk with non-selective alpha-blockers was seen. The findings of this study were widely reported in the press. The Academy and ASCRS believe this is an opportunity to reinforce and update their advice to the public about alpha-blockers and Intraoperative Floppy Iris Syndrome (IFIS).

The advisory recommends the following:

1) A patient should advise his or her ophthalmologist if he or she currently uses, or previously took, an alpha-blocker such as Flomax.

2) A patient should not decide to discontinue these drugs without first consulting his or her prescribing physician.

3) If he or she already has cataracts, the patient may wish to consult with his or her ophthalmologist before starting an alpha blocker for the first time.

The patient advisory emphasizes that if the ophthalmologist is made aware of the drug history, the success rate is still excellent and there is no need to delay or avoid cataract surgery that has been recommended.

View the Information statement.

This advisory recommendation is certainly a step in the right direction.  However, I still feel the policy has not gone far enough!  I repeat my recommendation: 

any patient being placed on Flomax or another alpha blocker should have an exam with their ophthalmologist prior to starting the medication.  If a cataract is found during this examination, the cataract should be removed before starting the medication!

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