Topical Drug Waste

Safe and responsible use of perioperative topical medications must prioritize patient safety alongside fiscal and environmental responsibility. With appropriate guidelines and safety practices, ophthalmic surgeons can significantly reduce drug waste — making surgery better for patients, practices, payers, and our planet.

The Academy, together with partner societies, has outlined recommendations in the multi-society position paper Reducing Topical Drug Waste in Ophthalmic Surgery:

• 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 labeled expiration date if proper guidelines are followed.
• When applicable, patients should be able to bring partially used medication home for post-operative use.

The Academy is part of a multi-society effort to clarify existing federal guidance on the use of multidose drugs with key agencies that have oversight authority. This engagement has informed the consensus recommendations in the multi-society position paper, developed in collaboration with the American Society of Cataract and Refractive Surgery (ASCRS), the American Glaucoma Society (AGS), and the Outpatient Ophthalmic Surgery Society (OOSS).

Together, we are advancing an initiative to educate ophthalmic practices on how to use these drugs more responsibly and efficiently. 

Current U.S. practice during ophthalmic surgery often leads to significant waste of topical drugs and ointments, including eyedrops and injectables. Although many surgical eyedrops and ointments are labeled as "multidose," it has become common in many surgical settings to discard them after a single patient use.

This practice increases costs for patients, practices, and payers. It has also been identified as a contributing factor in drug shortages affecting ophthalmology, and is harmful to the environment through landfill accumulation and carbon emissions.

In July 2021, Illinois enacted a law to limit waste and reduce patient out-of-pocket costs. The law requires that any unused topical antibiotic, anti-inflammatory, dilation, or glaucoma drop or ointment must be offered to the patient upon discharge if administered at a hospital, emergency room, or ambulatory surgery center when required for continuing treatment. The Academy has developed model legislation (PDF) based on the Illinois law that other states can consider adopting.

In November 2021, the American Medical Association enacted new medical waste policy through its House of Delegates. Co-sponsored by the Academy, 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 allowing practices to offer patients any partially used, stock-item medication upon discharge when required for continuing treatment. The policy was widely recognized as a commonsense step to lower the cost of care, reduce medical waste, and improve patient outcomes.