Mydriasert pupillary dilation for cataract surgery: A clinical and economic study

Purpose Mydriasert® is an ophthalmic insert containing phenylephrine and tropicamide. A prospective clinical evaluation of Mydriasert for pupillary dilatation prior to cataract surgery was conducted. The impact on nurse time of using Mydriasert compared to eye drops was also evaluated. Methods The following data were collected prospectively: amount of time spent inserting Mydriasert, patient satisfaction score (on a scale of 1‐10), pupil size (on a pre‐defined categorical scale of 1 (small pupil) to 4 (very large pupil) and any adverse events related to the insert. An economic model of mydriasis was also developed. Results Mean nursing time spent inserting Mydriasert was 1.52 minutes(SD=0.6,n=85), mean patient satisfaction score was 8.97(SD=2.32,n=97) and mean pupil size was 3.32(SD=0.66,n=114) corresponding to a large to very large pupil size. The insert had extruded unnoticed in 3 cases. For a national population (England), the estimated nurse time saved was 1,159 hours per week when using the single application Mydriasert compared to repeated instillation of eye drops to achieve mydriasis. Conclusion Mydriasert is a safe and efficacious alternative to topical drops for pupillary dilatation. The rate of insert extrusion was low compared to that published in a smaller study reporting on a much smaller sample. This may reflect a learning curve for Mydriasert insertion. The economic analysis demonstrated that using Mydriasert could potentially free up nursing time to spend on other responsibilities.Commercial interest