Reusing Some Supplies May Trim Costs

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This month, News in Review highlights selected papers from the original papers sessions at AAO 2023. Each was chosen by an Annual Meeting Program Committee subspecialty chair because it presents important news or illustrates a trend in the field. Only four subspecialties are included here; papers sessions will also be held in five other fields. For more information, see the Mobile Meeting Guide (aao.org/mobile).

Reusing gonioscopy and tonom­etry supplies can lead to substantial cost savings, according to new research by scientists at Columbia University Irving Medical Center. The total savings for the average ophthalmology practice associated with reusing these supplies tallied nearly $122,000 over one year and $1,225,000 over 10 years.

“This study highlights significant excess cost and waste generation in ophthalmology that is insidiously becoming common practice,” said lead investigator Alexis Kassotis, MD, at Columbia University Medical Center. The savings associated with reusable ophthalmology equipment could be redirected to support patient care and other aspects of practice, she said.

PRISMS. Semicircles of the Goldmann-type applanation tonometer.

Study approach. The researchers wanted to evaluate and compare costs associated with disposable and reusable ophthalmological devices, and they chose to focus on gonioscopy lenses and tonometry tips because both reus­able and disposable versions of these are used in the United States, making a cost analysis and comparison possible.¹ The team used scenario analysis to estimate the cost of using disposable and reusable gonioscopy lenses and tonometry tips over one, five, and 10 years at a single medical center.

The brands used included iCare IC100 rebound tonometer and tips, Haag-Streit Goldmann applanation to­nometry prisms, Tono Safe disposable tips, Volk reusable gonioscopy lenses, and Katena disposable gonioscopy lens­es. Assuming all of these brands were available, Dr. Kassotis said, “The mean cost of all commonly used devices was calculated.” For reusable tonometry tips and gonioscopy lenses, the cost of sanitation after each use and the need for replacement every few years—due to device dysfunction or loss and waste—was taken into account, said Dr. Kassotis.

Findings. Over the course of one year, reusing tonometry tips saved $97,037 compared to disposables, yielding an 89.9% cost savings. Adop­tion of reusable gonioscopy lenses saved $24,907 over one year, a 66.0% cost savings compared to disposable lenses. Over 10 years, using reusable tonometry tips saved $908,368 and using reusable gonioscopy lenses saved $316,275—a 96.5% and 91.6% cost savings, respectively.

Cost savings for reusable applanation tonometry prism tips and gonioscopy lenses combined led to an estimated total savings of $121,944 over a year’s time. After a decade, the savings ballooned to more than $1.2 million. “A single disposable tonometry tip or gonioscopy lens is cheap. However, the cumulative cost of disposable devices is far greater than that of reusable ver­sions because reusable options can be sanitized and reused many times,” Dr. Kassotis said.

A potential drawback to reusable equipment is the theoretical risk of con­tact with mucous membranes and the spread of infection, said Dr. Kassotis. She added, however, that there is no high-quality evidence that reusable de­vices, when properly sanitized, increase infection transmission.

Additional considerations. Although this study focused solely on cost, both infection control and ease of use should be factors when choosing between disposable and reusable equipment, she said, adding, “The environmental impact of disposable devices should also be considered.”

—Christos Evangelou, PhD

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1 Junk AK et al. J Glaucoma. 2020;29(7):507-512.

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Relevant financial disclosures: Dr. Kassotis—None.

For full disclosures and the disclosure key, see below.

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