AAO 2024: One simple change to boost sustainability in eye clinics: Stop discarding eye drops before they expire

(Image credit: AdobeStock/Iuliia Alekseeva)

Ophthalmologists at the New York Eye and Ear Infirmary of Mount Sinai were well aware that multi-use eye drop bottles were often discarded long before reaching their FDA-regulated expiration dates. However, the results of their study measuring the extent of this waste left them astonished: on average, 72 percent of the medication was still in the bottles when they were thrown away.

The findings, presented this week at the 128th annual meeting of the American Academy of Ophthalmology in Chicago, suggest that by following the FDA-regulated expiration dates could not only reduce medication and plastic waste, but also save millions of dollars annually, and potentially prevent nationwide eye drop shortages.

“We were really surprised by just how much medication was being wasted,” researcher John Tan of the New York Eye and Ear Infirmary of Mount Sinai said in an news release. “We hope that clinics and providers use the FDA-regulated expiration date printed on each bottle. Considering the frequent medication shortages we have to contend with, this is one simple way to reduce the strain on our supply of ophthalmic medications.”

Academic medical centers and healthcare systems often discard multi-use eye drop bottles well before their FDA-regulated expiration dates out of an abundance of caution. However, these self-imposed early discard dates are not evidence-based and do little to prevent contamination. In fact, when proper storage and drop administration precautions are followed, no infections from FDA-regulated dropper bottles used in clinical settings have been reported. The FDA determines expiration dates through rigorous testing of the eye drops in their marketed containers, including the effectiveness of preservatives.

To conduct their study, Tan and his colleagues collected 297 discarded eye drop bottles from three surgical sites within the Mount Sinai Health System over a 6-week period. They measured the remaining volume in each bottle, estimated the number of unused drops, and assessed the resulting plastic waste and financial cost.

Many times, the bottles were discarded within 14 to 28 days of first use. That’s almost a year and a half before the expiration dates listed on the bottles. On average, 72 percent of the medication remained in the discarded bottles. Had the manufacturer expiration dates been followed, they estimate that 91 percent of bottles would have been completely used before being tossed and their health system could have saved $80,997 per year at three clinic sites.