Myriad vials of multi-dose eye drops and ointments in operating rooms and ambulatory surgery centers every day, resulting in unnecessary waste, environmental toxicity, drug shortages, and increased costs for patients. 

After consulting with the FDA, the CDC, the American Association for Accreditation of Ambulatory Surgery Facilities, and other organizations, it became clear to Dr. Alan Robin, M.D., executive vice president of the American Glaucoma Society (AGS), that the appalling drug waste has been due to a misunderstanding of a Centers for Medicaid and Medicare Services (CMS) rule concerning multi-dose vials, a rule that does not actually include eye drops. 

In a recent position statement, Dr. Robin announced that the AGS is joining with the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, and the Outpatient Ophthalmic Surgery Society in partnership with CMS to update and clarify CMS policies and to retrain surveyors. 

The position statement provides three recommendations:

• Topical drugs in multi-dose containers can be used on multiple patients in surgical facilities, if proper guidelines are followed.
• Topical drugs in multi-dose containers can be used until the manufacturer’s labeled date of expiration, if proper guidelines are followed.
• Post-op patients should be allowed to bring their partially used medications home with them for continued use, when appropriate.

According to the AGS, these recommendations will:

• Reduce drug waste and drug shortages
• Lower medication costs to patients
• Ensure patient safety 

The achievement of these goals could have far-reaching benefits. “There is consensus within ophthalmology,” Robin writes, “that excessive surgical drug waste unnecessarily increases the cost and carbon footprint of eye surgery, particularly given the high volume of procedures such as cataract surgery. With increases in surgical volume anticipated, waste is neither economically nor environmentally sustainable and could make periodic drug shortages more likely and the impact more severe.” It is our hope that AGS’s recommendations will be adopted, for the benefit of all concerned.

*Robin, A. (2022, April 6). A New Joint Position Statement on Multi-Dose Eye Drops and Drug Waste. American Glaucoma Society.