Thoughts From Your Colleagues

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Social Media Group Raises Money to Support the Surgical Scope Fund

Shortly after COVID-19 hit, patients overfilled our hospitals in New York, and the donning and doffing of PPE became the new routine. I quickly realized that my attire in the hospital would need a change. I purchased numerous pairs of scrubs and a pair of “hospital-only” sneakers. I also wanted to wear a scrub cap to cover my hair, primarily because of my frequent use of the indirect ophthalmoscope.

After an unsuccessful online search for ophthal­mology themed caps, I asked my talented mother-in-law (who had already been sewing masks for family and friends) whether she could find a pattern to make them. I purchased the fabric, she came up with a design, and the next thing I knew I had six custom scrub caps adorned with evil eyes, colorful eyeglasses, and eye charts.

I shared a picture with my colleagues on a social media forum for women ophthalmologists. Within minutes, mem­bers were requesting to buy them. I had not expected these responses, but after some thought and discussion, and with the agreement of my mother-in-law, we decided to create a scrub cap drive to support the Surgical Scope Fund.

After many hours of sewing and purchases from 120 oph­thalmologists, we raised over $1,200 to donate to a vital fund for our profession. We hope this initiative will inspire others to take on similar fundraising and community-building proj­ects to help support important ophthalmologic causes.

Maggie B. Hymowitz, MD
Ophthalmic Hospitalist
Northwell Health Eye Institute
Great Neck, N.Y.

Editors’ note: Looking to support ophthalmology programs? Email scrubcapsmd@gmail.com to order a scrub cap. You can also donate directly to the Surgical Scope Fund at aao.org/advocacy/surgical-scope-fund/overview.

Reducing Confusion in Eyedrop Packaging

I have encountered a problem in clinical practice that I am sure many ophthalmologists have experienced: inconsistency in the eyedrop bottle cap colors for drugs within the same drug class, despite recommendations from the Academy on consistent color coding (e.g., pink for steroids, turquoise for prostaglandins, and yellow for beta-blockers).¹ Clinicians often use these cap colors along with the drug names when giving patients instructions about using eyedrops. While at first glance, it seems like any inconsistencies should be easy to remedy, my discussion with Dr. Wiley Chambers at the FDA helped me to better understand the nuances of the task.

I asked why the FDA could not require each drug class to adhere to a color convention. The answer was interesting. First, we are running out of colors, and there are relatively few options left. Second, the drug companies do not make the bot­tles but purchase them from manufacturers that provide bottles for a variety of products, not just drugs—and these companies are not regulated by the FDA. The pharmaceutical industry represents a minority of their business, so these packaging companies are not likely to embrace the extra costs to make special color caps for eyedrops.

A further problem is that patients taking two or more eyedrops sometimes inadvertently swap the caps, so that now the beta-blocker is pink and the steroid is yellow. Thus, even when patients are trying to follow the instructions, they might overdose on beta-blockers and receive an insufficient dosage of antiinflammatory medi­cation. I inquired if the bottle manufacturers could select different screw thread pitches or clockwise versus counter­clockwise thread patterns, and the answer was the same: The bottle manufacturers are not willing to incur the extra costs to accommodate this solution, as it is not required by any regulatory agency.

There is another possible solution to the problem of mistakenly swapping caps. The cap can have a colored ring (actually part of the cap’s tamper-proof closure) the same color as the cap, and this ring stays on the bottle. This solu­tion has been used on a number of products. Unfortunately, some generic products did not follow design specifications properly, and some rings fell off into patients’ eyes. However, the issue has now been fixed.²

So, since it appears that we are running out of discrim­inable wavelengths, and bottle manufacturers are not reg­ulated or inclined to modify the bottle caps and threading, this is likely as good as we are going to get.

Michael S. Korenfeld, MD, ACOS
Wildwood, Mo.

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1 aao.org/about/policies/color-codes-topical-ocular-medications. Accessed Oct. 6, 2020.

2 www.fda.gov/drugs/drug-safety-and-availability/fda-warns-consumers-about-potential-risks-using-eye-drops-packaged-bottles-loose-safety-seals. Accessed Oct. 6, 2020.