Melbourne ophthalmologist Dr Elvis Ojaimi outlines his pre- and post-operative treatment regime for surgical patients, and why he reaches for preservative-free products whenever he can.
Throughout an ophthalmologist’s career, there are many moments when one might look back at the way things were done with a mixture of curiosity, admiration, and sometimes disbelief.
For Dr Elvis Ojaimi, a Melbourne surgeon with expertise in complex cataract surgery and vitreoretinal surgical procedures, one thing that perplexes him – knowing what he knows today – was the lack of emphasis placed on the tear film in ophthalmic surgical patients.
But beyond that, there is the impact of preservatives, despite the good intentions of eyecare professionals prescribing eye drops to relieve discomfort.
“Compared to 10 years ago, there’s a much higher priority put on the tear film, especially before surgery, so we can obtain accurate biometry measurements, such as A scans and keratometry.
“Today, I go as far as prescribing patients eye drops before they see me for their first visit (two to four weeks). Many I see are older with meibomian gland dysfunction (MGD), some have aqueous insufficiency or rosacea. I’m more attuned to picking up these ocular surface issues early because in the past we didn’t, and it came back to bite you. Patients would get fantastic refractive outcomes but would be unhappy with pain and intermittent blurriness.”
Thankfully for Dr Ojaimi today, such occurrences are a rarity, after making lubricating eye drops a key part of his pre- and post-operative regime in the face of overwhelming evidence, especially in cataract cases.
But he has gone a step further, ensuring his patients only use preservative-free products, after multiple studies highlighted the benefits in terms of dry eye symptoms, inflammation and, in Dr Ojaimi’s own experience, recovery time.
“If you’ve got preservatives in your drops, I think it disrupts and slows down the healing of the incisions and the ocular surface.”
It all began a few years ago at a conference when Dr Ojaimi was talking to corneal surgeons lauding Hylo Forte (sodium hyaluronate 2 mg/mL), a preservative- and phosphate-free product available in Australia through AFT Pharmaceuticals.
The company is one of the country’s best known sellers of preservative-free ophthalmic products, including lubricants, eye wipes and heat masks.
Upon further investigation, he discovered the company also supplied NovaTears (perfluorohexyloctane) and NovaTears+ Omega-3, a unique preservative-free eye lubricant and tear film stabiliser specifically designed for the relief of evaporative dry eye disease.
With many of his patients suffering from MGD, which comes under the evaporative dry eye umbrella, NovaTears has now become a pre-operative go-to in his clinic. He’s also talking to them about warm compresses and eye lid hygiene – to ensure the tear film is optimal ahead of the crucial work-up phase.
With increasing demand for premium multifocal and extended depth of focus intraocular lenses, he argues highly accurate biometry readings have never been more important.
He prescribes Hylo-Forte standalone often in slightly younger patients with aqueous deficiency.
And about 20% of patients are recommended a combination of the two therapies – those who may be struggling with issues like Sjögren’s syndrome and poor aqueous volume along with MGD and/or blepharitis.
Post-operatively, Dr Ojaimi encourages patients to continue with their preservative-free drops for two months until they stabilise. This even includes his surgical and medical macular patients too.
“When we perform vitrectomy, we put three trocars into the conjunctiva, there’s Betadine, and so much disruption to the ocular surface,” he says.
“And even with intravitreal injections, and patients with sensitivity and bad dry eye beforehand, they’re the ones that can really suffer after treatment, and it takes them a few days to recover.”
While these products tick many important boxes for Dr Ojaimi, they also have some added benefits.
This includes availability in specially designed multidose containers, making them easier to handle for patients with arthritis and dexterity issues.
Hylo-Fresh, Hylo-Forte and Novatears are available over the counter, can last up to six months after opening, and for some, they’re also available via the Pharmaceutical Benefits Scheme.
That makes them an affordable and accessible option for many.
What’s more, the company recently released a preservative-free glaucoma medication, Vizo-PF (dorzolamide hydrochloride; timolol maleate). It’s encouraging news with a 2024 study showing that prolonged pre-operative use of topical glaucoma medications with preservatives may negatively affect long-term trabeculectomy outcomes.
Three years since switching his regime to preservative-free eye drops from AFT Pharmaceuticals, Dr Ojaimi says the difference in patient outcomes has been palpable.
“Acuity recovery is pretty fast with cataract surgery, but it’s the irritation and intermittent blurring, having to blink to get their vision right, that causes the most concern.
“It used to take months longer for patients to recover after surgery, but we now know, with pre-operative moderate or severe dry eye, preservative free drops such as NovaTears in the perioperative period allows for a smoother recovery.”
And 10 years from now, it’s a decision he can look back on, knowing he did right by his patients.
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Dry eye, glaucoma and beyond for AFT Pharmaceuticals
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Finding a niche with preservative-free eye drops
