Dear Colleagues,

The Affordable Care Act has challenged ophthalmologists to achieve the “triple aim” of good outcomes, happy patients, and reduced costs. This goal can only be achieved through innovation.

Happily, an exciting innovation in infection prophylaxis and the management of postoperative inflammation following cataract surgery can help us achieve this “triple aim.” That innovation is replacing drops with an injection into the vitreous after the completion of the surgery.

While drops are relatively effective and safe when patients take them properly, patients hate them. As a result, patients are rarely compliant. Moreover, the cost of drops is high.

I have found the Tri-Moxi (triamcinolone, moxifloxacin) injection available from Imprimis to be a highly effective and safe alternative to drops. My patients love it, and universally select it when given the option versus drops. I now use it routinely unless there is a contraindication, which is rare.

Compared to a branded drop alternative, this injection approach saves the patient or third party payer about $250 per eye. Multiply that times 3.6 million cataract surgeries each year, and the annual savings approach $1 billion. Moreover, as I read the literature, intraocular antibiotics are 5-10 times more effective in preventing endophthalmitis, and inflammation control is equivalent. That is a significant additional benefit.

Unfortunately, CMS has taken the position that payment for the injected drugs must come out of the Part B facility fee bundle. Since the facility fee remains unchanged, this means there is no source of reimbursement for the Tri-Moxi injection. The CMS policy also prevents the patient from paying for it. We need to get this policy changed not only for this injection but for other future innovations in development by industry.

CMS bases it approach on the mistaken premise that the injection is made “during [the] cataract extraction procedure” and is “part of the ocular surgery.” In fact, the intraocular antibiotic and steroid injection is not part of the standard cataract procedure. It occurs after the surgery is completed.

The injection is a replacement for drops, which are part of the postoperative care regimen. It should be reimbursed as such. In order to properly communicate this to CMS, we need your support for the following statement:

An intraocular injection of antibiotic and/or steroid after the completion of cataract surgery has the same purpose as postoperative topical drops. It is for postoperative infection prophylaxis and management of inflammation. It is not part of the standard cataract extraction procedure.

If you agree with this statement, please join me in subscribing to this petition of your peers. Simply CLICK HERE to enter your name on the list of ophthalmologists supporting this common-sense position.

Thank you for assisting us on this important initiative for improving patient care.

Warm regards,


Richard L. Lindstrom, M.D.
Founder and Attending Surgeon: Minnesota Eye Consultants
Adjunct Clinical Professor Emeritus: University of Minnesota Dept. of Ophthalmology
Medical Advisory Board and Board of Directors, Imprimis Pharmaceuticals
Associate Director: Minnesota Lions Eye Bank
Board Member: University of Minnesota Foundation
Visiting Professor: UC Irvine: Gavin Herbert Eye Institute



Richard L. Lindstrom, M.D.
Thomas W. Samuelson, M.D.
David R. Hardten, M.D., F.A.C.S.
Elizabeth A. Davis, M.D., F.A.C.S.
William J. Lipham, M.D., F.A.C.S.
Patrick J. Riedel, M.D.
Sherman W. Reeves, M.D.
Ted R. Pier, M.D.
Jill S. Melicher, M.D.
Christine Larsen, M.D.
Richard M. Launer, M.D.
Daniel S. Conrad, M.D.
Mark S. Hansen, M.D.
Ryan T. Barrett, M.D.

Alyson L. Blakstad, O.D.
Scott G. Hauswirth, O.D.
Neelu K. Hira, O.D., F.A.A.O.
Ahmad M. Fahmy, O.D.
Benjamin J. Fogal, O.D.
Mona M. Fahmy, O.D.
Noumia Cloutier-Gill, O.D.
Tara Barth, O.D.
Katherine Montealegre, O.D.
Sonja E. Iverson-Hill, O.D.
Johnna Hobbs, O.D.
Gina Doeden, O.D.
Mark R. Buboltz, O.D.
Kasie J. Mix, O.D.

Candace S. Simerson, COE, CMPE