Published: May 15, 2020

The medicine with a curious name – Shugarcaine -- was the first anesthesia developed for use inside the eye. Invented in 1997 by Dr. Joel Shugar, the buffered lidocaine solution “is widely used in cataract surgery,” according to the medical journal Ophthalmology Management. Shugar was a pioneering ophthalmologist who trained as an electrical engineer before earning his MD and then pursuing ophthalmology as a resident at the University of Florida.


A phenomenon an ophthalmologist began noticing 20 years ago led to Shugar’s subsequent invention, Epi-Shugarcaine. In the early 2000s, ophthalmologist John R. Campbell noted that a number of patients in his practice were experiencing iris billowing, pupil constriction, and iris prolapse during cataract surgery. “It would make for a very difficult case,” Campbell remembered. 


He was first concerned that the problem was caused by a medication not being mixed properly at the practice, but determined all of the protocols were being followed. He remembers also suspecting a new cardiac medicine could be the culprit. To add to the puzzle, the “floppy iris” problem, while significant, was still affecting only a small percentage of patients.


Campbell asked a nurse, Pat Tomasello, and the practice’s surgical tech, Karen Whorton, to pore through the patient charts. After months of work, Tomasello reported that all of the patients identified were men, and all were on the medication tamsulosin. Tamsulosin (Flomax®) is a medicine often prescribed for Benign Prostatic Hyperplasia (BPH). “That is how we connected the dots,” Campbell said. He collaborated with another ophthalmologist, David Chang, and they published a study, “Intraoperative Floppy Iris Syndrome Associated with Tamsulosin,” in 2005. 


BPH is very common. The American Urological Association reports it affects about half of all men between the ages of 51 and 60, and up to 90 percent of men over the age of 80. As cataracts are also a factor of aging, there is overlap of patients taking Flomax® who also require cataract surgery.


In response to this problem, Shugar invented Epi-Shugarcaine, which combines Shugarcaine with epinephrine. It is one method doctors use to help with dilation in patients with floppy iris syndrome.


Shugar was also well known for a charitable cause he championed at his Florida practice called “The Gift of Sight Day.” Just before Thanksgiving, he performed cataract surgery free of charge to patients who could not afford it. Over a period of eight years, he performed 300 surgeries, according to the Tallahassee Democrat. He was a frequent contributor to scientific journals and also reviewed articles for publications related to ophthalmology.


Sadly, Shugar died in a skydiving accident in 2008, at the age of 49. His obituary stated that his lifelong dream was to invent a fully functional artificial eye.


Based on the work pioneered by Dr. Shugar, Edge Pharma produces unit-dose syringes of Epi-Shugarcaine, which make it easy for hospitals and surgery centers to utilize this medication without needing to compound the doses at their facilities.