• Background

    Current U.S. practice during ophthalmic surgery often leads to significant waste of topical drugs and ointments, such as eyedrops and injectables. Although many surgical eyedrops and ointments are labeled as "multidose," it has become common practice in many surgical settings to discard after use on a single patient. This practice increases costs for patients, practices and payers. It has also been recognized as a contributing factor in drug shortages impacting ophthalmology, as well as detrimental to the environment due to landfill accumulation and carbon emissions.  

    Academy Position

    Safe and responsible use of perioperative topical medications needs to prioritize patient safety alongside fiscal and environmental responsibility. With appropriate guidelines and safety practices, ophthalmic surgeons can significantly reduce drug waste. Using these drugs more efficiently makes ophthalmic surgery better for patients, ophthalmic practices, payers and our planet.

    The multi-society position paper "Reducing Topical Drug Waste in Ophthalmic Surgery" recommends:

    • Topical drugs in multidose containers can be used on multiple patients in surgical facilities if proper guidelines are followed.
    • Topical drugs in multidose containers can be used until the manufacturer’s labelled date of expiration if proper guidelines are followed,
    • When applicable, patients should be able to bring partially used medication home for post-operative use.

    What We’re Doing

    The Academy is part of a multisociety effort to clarify existing guidance on use of multidose drugs with key federal agencies that have oversight. This engagement has informed the consensus recommendations outlined in the multi-society position paper written in collaboration with the American Society of Cataract and Refractive Surgery, the American Glaucoma Society and the Outpatient Ophthalmic Surgery Society. Together, we’re advancing an initiative to educate ophthalmic practices on how to use these drugs more responsibly and efficiently.

    What You Can Do

    Review our recommendations and work with your surgical teams to update drug-use practices accordingly.

    State Action

    In July 2021, a new Illinois law was enacted that seeks to limit waste and patient out-of-pocket costs. The law provides that any unused topical antibiotic, anti-inflammatory, dilation or glaucoma drop or ointment must be offered to the patient upon discharge if the medication is administered at a hospital, emergency room or ambulatory surgical center when required for continuing treatment. The Academy has developed model legislation based on this bill that other states can consider. 

    In November 2021, the American Medical Association (AMA) enacted new medical waste policy via its House of Delegates. The policy calls on the AMA to work with national specialty societies, state medical societies and other stakeholders to advocate for legislative and regulatory language that would allow for the practice of offering patients any partially used, stock-item medication upon discharge when required for continuing treatment. Co-sponsored by the Academy, the new policy was widely recognized by the AMA House of Delegates as a commonsense step to lower the cost of care, reduce medical waste and improve patient outcomes. 

    Resources