This ocular anesthetic, recently approved for the U.S. market, offers surgeons a new way to keep patients comfortable.
Keeping patients comfortable during eye surgery is vital to their overall satisfaction with surgical procedures. To meet patient expectations, many surgeons are looking for new ways to improve the experience. Harrow’s introduction of Iheezo (chloroprocaine hydrochloride ophthalmic gel) 3% for ocular surface anesthesia gives surgeons a new tool in their armamentarium to ensure successful procedures in the ambulatory surgical center (ASC).
Iheezo is a sterile, preservative-free, single-patient-use ophthalmic gel. According to Harrow, it represents the first approved use of chloroprocaine hydrochloride in the United States, as well as the first branded ocular anesthetic approved for the U.S. ophthalmic market in nearly 14 years.
Chris Bender, DNAP, CRNA, APRN, the anesthesia director at Vance Thompson Vision, says that after many years of innovation in the intraocular lens (IOL) space, he applauds Harrow for an advancement in anesthetics. “There has been a tremendous amount of movement in lens options but very little in anesthetics until now,” he continues. “I say bravo—and we are excited to be using something new.”
A COMFORTABLE OPTION
At press time, Dr. Bender had used Iheezo on approximately 20 cases with positive results. “I have been focused on ophthalmic anesthesia for a little over 10 years and my primary goal is keeping the patient comfortable,” Dr. Bender says. “My experience is limited with Iheezo given how new it is, but so far it has worked well for my patients. Patients remained very comfortable throughout their procedures.”
Only three drops of the topical anesthetic are applied to the ocular surface prior to the procedure, but additional drops can be applied as necessary to maintain the anesthetic effect. Dr. Bender says that there might be an advantage to using a gel anesthetic, compared to liquid drops. “I think everyone that works in ophthalmologic surgery can relate to the fact that the local anesthetic drops sting—and we’ve just accepted that there is a certain amount of sting and burn the patient has to deal with,” he says. “But I would say that, so far, this product seems a lot more tolerable. I think that may be due to the viscous nature of it being a gel. It coats the eye nicely.”
William F. Wiley, MD, medical director of the Cleveland Eye Clinic, agrees that the level of comfort seems to be elevated with Iheezo. He was involved with a trial of Iheezo that included around 40 patients and was impressed by the level of comfort these patients experienced.
“We had options that were doing a great job at numbing but sometimes included some toxicity of the cornea that may have slightly delayed visual recovery because it dried the cornea out,” Dr. Wiley says. “Iheezo appears to do a great job of numbing the eye without the epithelial toxicity. It could be the formulation or the fact that it is a gel material which coats the ocular surface. It may be able to prevent some of the evaporative damage that can occur from a traditional drop.”
Dr. Wiley adds that some patients may fear the administration of eyedrops and could potentially find the gel more pleasant. Ultimately, however, the administration of the gel is essentially the same as a topical drop. But whereas a drop can run out of the eye like a tear, Dr. Wiley says the gel stays in place.
Priya Mathews, MD, MPH, director of cornea and ocular surface disease at Center for Sight in Florida, agrees that patients were kept comfortable using Iheezo. At press time, she had used it during one surgery day for 20 patients. She had the unique situation of using Iheezo in several patients who had undergone surgery the previous day with traditional anesthetic drops. That means her patients had anesthetic drops for one eye, and Iheezo for the second.
“About half the patients said they were more comfortable with Iheezo for the second eye, and the other half did not feel a difference. No patients reported a worse experience with Iheezo,” Dr. Mathews shares.
Iheezo might help provide a “better balance of anesthesia” when it comes to cataract surgery, Dr. Mathews says. “It is such a quick surgery, but it is also so important that the patient is comfortable the entire time,” she explains. “We need medications strong enough to prevent pain, but at the same time, we don’t want to give them more than they need for a simple surgery. If we can avoid intravenous, that helps, particularly in the elderly population. I like the idea that we might be able to move toward doing only topical anesthetic treatment in the future.”
FITTING INTO THE FLOW
Anytime that the ASC adds a new product, there can be a learning curve if it changes the flow of surgery. Those who have used Iheezo say the application is similar to current anesthetic drops. “It’s not so different from administering other products, and I would say the learning curve is minimal to none,” says Dr. Mathews.
Dr. Bender says he is pleased to see Iheezo in a single-use application format. It’s not only convenient and easy to use, it also eliminates concerns over cross contamination and handling.
“Typically, you will find that many local anesthetic drops come in a bottle for multipatient use, so this is inherently different,” he says. “I think it’s the direction that many products are moving from a regulatory perspective.”
But single use also requires the need for greater attention to detail. Because there is a finite amount of volume available in each package, Dr. Bender says it is important to be mindful of the exact amount applied during a procedure.
Dr. Mathews adds that integrating Iheezo into the surgical flow might require some forethought. “When I trialed it, we made a plan about how and when to administer the drops for patients who were undergoing femtosecond laser procedures,” she explains. “We did one drop before the femtosecond laser, a second drop when the patient returned to the preop holding area, and a third drop before going into the OR. That flow worked for our ASC. It’s helpful to get together with the anesthesia team and preop nurses beforehand to decide the most effective and efficient way in your ASC.”
IHEEZO REIMBURSEMENT
In March, the Centers for Medicare and Medicaid Services (CMS) approved transitional pass-through reimbursement status for Harrow’s Iheezo anesthetic gel. This means for the next three years, Iheezo will be eligible for separate reimbursement outside of the surgical bundled payment in both the Ambulatory Surgery Center (ASC) and Hospital Outpatient Department (HOPD) settings of care. Under the Healthcare Common Procedure Coding System (HCPCS), the permanent, product-specific J-code for Iheezo, J2403, became effective on April 1.
For the next three years, Medicare will separately reimburse for Iheezo based on the average sales price (ASP) plus 6 percent. The ASP will not be established until the beginning of 2024; until then, Iheezo will be reimbursed at the wholesale acquisition cost ($544) plus 3 percent.
THE EVER-IMPROVING PATIENT EXPERIENCE
It seems that the introduction of Iheezo is another step in the direction of an improved patient experience. Dr. Wiley says that anesthetics can sometimes be overlooked, even though they can have a significant impact on patient satisfaction.
“Patient comfort is a critical component of the overall surgery,” he says. “We are always looking at safety, efficacy, and improved results—but you can have a safe procedure with a great outcome and still have a displeased patient if they were uncomfortable. And they’re going to tell their friends.”
Dr. Wiley observes that with expectations at an all-time high, the smallest details count. “The patient base is only getting more challenging as their expectations are rising,” he sums up. “Anesthetics are just one piece of the puzzle—but an important one. Any improvement to the patient experience is a step in the right direction.” ■
