Q&A: 72% of eye drop medication wasted due to ‘self-imposed use cessation dates’
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Multiuse eye drop bottles are often discarded at medical centers long before the FDA-regulated expiration date, leading to significant drug waste and increased costs, according to research published in Ophthalmology.
“A lot of larger institutions discard eye drop bottles based on ‘self-imposed use cessation dates,’ or SUCDs,” study author Gareth M.C. Lema, MD, PhD, vice chair of quality, safety and experience at the New York Eye and Ear Infirmary at Mount Sinai and associate professor of ophthalmology at Ichan School of Medicine, told Healio. “We found that we’re wasting most of the medication in the bottle — just under 72%, so almost three-quarters of the bottle we’re throwing away because of SUCDs.”
Lema and colleagues analyzed 297 discarded eye drop bottles from three clinics in the Mount Sinai Health System over 6 weeks to determine the amount of waste produced. They found that an average of 71.9% of the total volume of medication remained in each bottle when discarded and estimated that 91% of the bottles could have been fully depleted had FDA-regulated expiration dates — the date on the bottle — been followed.
The researchers also estimated that using the FDA dates would lower costs by $80,997 and reduce plastic waste by 72%.
Healio spoke with Lema about the study results and how they might affect eye care providers.
Healio: What do the results mean for eye care providers?
Lema: There has been this idea that eye drops have to be disposed of 28 days after they’re opened, but there’s really no guideline that says that. My sense is that in the absence of a rule, people have used a rule that’s not applicable to eye drops, but instead is applicable to compounded medications that are primarily used for injection.
When a medication is compounded — either concentrated, diluted or redistributed to other bottles — you have to use a new expiration date of 28 days, per the U.S. Pharmacopeia. But the drops we’re talking about are sourced directly from the manufacturer and are FDA-regulated. They have a preservative to prevent contamination or colonization of the solution in the bottle.
Although these study results mostly affect practices and larger institutions or groups that are overseen by the department of health and The Joint Commission, there are a few implications for both practices and drugs in general. First and foremost, drug shortages are very common and can be prevented by not discarding medications needlessly. Second, it could save a lot of money. These drops are expensive, and we determined that across three practices in a large metropolitan area it could amount to more than $80,000 a year that’s being wasted. Finally, on a national scale, there is a large amount of plastic waste.
These are problems that can be mitigated simply by using a bottle to its FDA-regulated expiration date.
Healio: Did anything about the results surprise you?
Lema: The most surprising to me was that we’re throwing out almost three-quarters of the volume. This was inspired by seeing our collection bin in the clinic. Every couple of weeks, the health system collects drops from us for proper disposal. I saw the bin one day and was stunned by how many bottles were in there. I assumed that there were tens of thousands of dollars’ worth of bottles in there over the year. I didn’t know that the volume wasted would be so high. I would have thought that maybe there would be 30% or 40% left, but to throw out 70% of the bottle seemed especially wasteful.
Healio: What was unique about this study?
Lema: There has been a growing interest in waste in ophthalmic surgery. It’s easy to see because every surgery results in the equivalent of a garbage bag of disposable waste.
Within medical clinics, it’s a little bit harder because you don’t always see the waste. I did because we have the collection bin, but this was the first study to quantify the volume of eye drop waste in clinics.
It expands the reach of sustainability from the OR to the eye clinic. Whereas most of our efforts have been in ophthalmic surgery, we’re now showing that there’s significant waste in the medical management of eye disease, and we can also try to improve and pursue sustainability.
Healio: Is there anything else you would like to add?
Lema: I think that sustainability is becoming a big thing. A couple of years ago I was at an American Academy of Ophthalmology meeting, and we had a special seminar session on sustainability. I recognized that in large cities, the hospitals always seem to be exempt. I asked about that, and one of the attitudes from the panel was that that’s going to change, and eventually hospitals are going to have to show they’re sustainable just like any other business.
If we can get ahead of this and be leaders in sustainability, it’s just one of the ways that eye care providers can be influencers in medicine.
For more information:
Gareth Lema, MD, PhD, is vice chair of quality, safety and experience at New York Eye and Ear Infirmary of Mount Sinai and associate professor of ophthalmology at Icahn School of Medicine. He can be reached at gareth.lema@mssm.edu.
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