AAO 2024: Ophthalmic drop wastage due to artificial expiration date

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Key Takeaways

Clinics discard 72% of eye drop medication volume, resulting in significant financial losses annually.
FDA expiration dates, based on preservatives and contamination rates, are more suitable for multi-use eye drops.
The 28-day expiration guideline is outdated and not applicable to multi-use eye drops, yet many clinics still follow it.
The study seeks to raise awareness and promote adherence to FDA guidelines to reduce ophthalmic wastage.

In a paper presented at the American Academy of Ophthalmology annual meeting in Chicago, Jonathan Tan, a third year medical student at the Icahn School of Medicine at Mount Sinai detailed the study on ophthalmic eye drop waste in clinics, revealing 72% medication loss due to outdated 28-day expiration guidelines, resulting in significant financial waste. The study advocates following FDA expiration dates.

This transcript has been lightly edited for clarity.

Jonathan Tan: Hello, my name is John Tan. I'm a third year medical student at the Icahn School of Medicine at Mount Sinai. Our paper looked at ophthalmic wastage, specifically from eye drops that were used in the clinic setting. We looked at this because we were noticing that a lot of our clinics follow these expiration dates of 14 or 28 days, where they throw out a bottle of medication, regardless of how much medication is left in the bottle after those 28 days. We were noticing that a lot of this was accumulating. We wanted to see how much wastage there was. We did a study. We found that over the course of these 6 weeks that we looked at, we were discarding around 72% of medication volume from our clinics. And when we extrapolated this out to a year, we found that this resulted in about an $80,000 loss to our health systems. We wanted to do this because societies like the AAO EyeSustain have advocated for helping wastage, improving wastage by following the FDA regulated expiration dates instead.

These FDA regulated expiration dates are based off of guidelines that are based off the preservatives in the drugs, decontamination rates, and should be effective enough to prevent any infection or contamination of the dropper tip. We wanted to just emphasize the amount of waste that is occurring in these clinics, as well as promote the efforts to follow the FDA expiration date to sustain and maintain our eye drops and prevent wastage.

Every clinic has slightly different guidelines of how they follow their jobs. Most clinics will follow the 28-day guideline. We wanted to put this paper out just to give more wide recognition of this problem, to encourage people to kind of put these measures into place, to follow the FDA regulated expiration date. We received good feedback from different clinicians at different sites who have used this paper to kind of motivate their administration to follow these guidelines. There's been nothing official that has come out, but we hope that in the future, that things like these will start to pick up and allow people to really see the waste that's occurring and have a numerical number that can actually quantify how much waste is occurring to encourage the implementation of new measures.

There hasn't been any communication directly with the manufacturers. The expiration date that's actually printed on the bottle is the date that they received from the FDA, so they're on board with it. The 28-day expiration date is something that clinics put in by themselves. It's based off of this guideline that was published back in 2015, also by the US Pharmacopeia, that stated that drugs need to be discarded within 28 days. That has since been clarified that it doesn't involve the multi-use eye drops that most clinics use in their system. It's moreso meant for injections or one-time use drops. And that's been clarified, but hasn't really been far outreaching, and clinics are still using the clinics are still using the 28-day guideline as of now.