Reducing Topical Drug Waste in Ophthalmic Surgery (issued 2022)

Ophthalmic Organizations Release Position Statement on Multidose Topical Medications for Ophthalmic Surgery

The American Society of Cataract and Refractive Surgery (ASCRS), the American Academy of Ophthalmology (AAO), the American Glaucoma Society (AGS) and the Outpatient Ophthalmic Surgery Society (OOSS) jointly released a position statement in 2022 with recommendations for reducing topical drug waste with ophthalmic surgery:

Surgical facilities should be permitted to use topical drugs in multidose containers on multiple patients until the manufacturer’s labeled date of expiration if proper guidelines are followed. If applicable, surgical patients requiring a topical medication not used for other patients should be allowed to bring that partially used medication home for postoperative use.

These recommendations are based on published evidence and clarification of policies from regulatory and accreditation agencies with jurisdiction over surgical facilities. Read the complete position statement. The paper was published in JCRS in 2022. 

Background

Surgical drug waste significantly increases the cost and carbon footprint of ophthalmic surgery. In a 2020 survey, 93% of ophthalmologists said they believed that operating room waste is excessive. Nearly all (98%) said they preferred or were willing to consider using multidose bottles of topical medication at their surgical facility. However, less than half said they were using multidose bottles for topical anesthetic (43%), mydriatics (48%), NSAIDS (38%) and antibiotics (45%). These surgeons were much more likely to be operating in ambulatory surgery centers than hospital outpatient departments.

A new survey of OOSS member ASCs found that most said they were using multidose bottles on multiple patients, but only 12% said they continued utilizing them until the labeled expiration date; others said they were discarding the bottles at the end of the day (9%), the week (3%) or the month (72%).

The Ophthalmic Instrument Cleaning & Sterilization (OICS) Task Force is comprised of representatives from ASCRS, AAO, AGS, and OOSS, and previously developed ophthalmology-specific guidelines for surgical instrument processing and sterilization. Co-chaired by David F. Chang, MD, and Cathleen M. McCabe, MD, the task force is also focused on reducing unnecessary waste in ophthalmic surgery.

A sub-committee led by David J. Palmer, MD, and Alan L. Robin, MD, researched the regulations regarding multidose bottles by contacting multiple agencies, including The Joint Commission, the Accreditation Association for Ambulatory Health Care, the American Association for Accreditation of Ambulatory Surgery Facilities, the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration and the Centers for Medicaid & Medicare Services.

“Our surveys have shown that there is wide variation in whether multidose bottles are reused on multiple surgical patients, and, if so, for how long,” Dr. Chang said. “Documenting the policies of multiple national regulatory and accreditation agencies, this evidence-based position paper clarifies that multidose bottles can be used on multiple patients and need not be arbitrarily discarded at the end of the day, the week, or the month.”

Dr. Palmer has led efforts in Illinois to enable surgical patients to bring unused topical medication home for postoperative use, when appropriate. “Barriers to this common-sense practice vary at the state level,” he said. “This document reviews the legislative approach we followed in Illinois to create a new state law, which was adopted as policy by the American Medical Association, with the hope that it will support nationwide efforts to remove obstacles to this sensible practice.”

Additional background information can be read here.