If you’re like me, and use eyedrops every day — in my case for dry eyes — you probably don’t think twice about the excess that spills down your cheeks every time you instill the one or two drops vouchsafed in the directions on the bottle’s label.
Well here’s an eye-opener for you (pun intended). The “medicine you wiped off your face is wasted by design — and it’s well-known to the drug companies that make the drops.”
Eyedrops overflow our eyes because drug companies make the typical drop — from pricey glaucoma drugs to a cheap bottle of Visine — larger than a human eye can hold. Some are so large that if they were pills, every time you swallowed one, you’d toss another in the garbage.
ProPublica has been documenting the many ways health care dollars are being wasted. We’ve shown how hospitals throw out brand new supplies, nursing homes flush tons of unexpired medication and drug companies concoct costly combinations of cheap medication. Recently we described how arbitrary drug expiration dates cause us to toss safe and potent medicine.
Often, large swaths of the medical and pharmaceutical communities know about this waste — even about solutions to it — but do nothing. Those who end up paying the bill, in one way or another, are consumers.
Liquid medication is squandered every day. Beyond eyedrops, liquid cancer drugs are frequently packaged in oversized single-use vials that contain more of the drug than most patients need. This guarantees that a quantity of life-saving medication is tossed — and its cost tacked onto patients’ bills.
Both eyedrops and cancer drugs are sold by volume, and we spend billions of dollars every year on them. Chemotherapy drugs can run thousands of dollars per infusion. Crucial eye medications to treat conditions like glaucoma may cost hundreds of dollars for a small bottle that only lasts a month, making the waste of even a drop a problem for low-income patients.
Last year, drug companies brought in about $3.4 billion in the U.S. alone on drops for dry eyes and glaucoma drops, according to the research firm Market Scope.
With both eyedrops and cancer drugs, pharmaceutical companies have done research showing that it’s possible to waste less — and save consumers money. Some of that research has been around for decades.
“If it spills out, it’s just wasted,” said York, who has a doctorate in pharmaceutical chemistry and is now retired. “It’s not doing any good.”
So his team created a 16-microliter drop — a microdrop — that was about a half to a third of the size of most drops on the market today, he said. They used a standard bottle with a latex dropper tip that wouldn’t cause injury if it touched the eye. Then they recruited 29 glaucoma patients to test the tiny drops. Glaucoma, a leading cause of blindness in the United States, is characterized by increased pressure in the eye, which can damage the optic nerve. Daily use of medicated eyedrops preserves sight by reducing the pressure.
The patients tried different formulations of the same medication in both micro- and regular drops, which were about twice as large, for a week at a time. The researchers tracked the patients’ eye pressure and side effects, such as burning, stinging, itching and dryness.
Their results were conclusive: Microdrops worked as well as larger drops to lower eye pressure. They also reduced some of the uncomfortable side effects of larger drops. And all the patients preferred using them.
York and two of his Alcon colleagues published their results in 1992 in the American Journal of Ophthalmology. Robin, who consulted on the research, was the principal investigator.
“The microdrop delivery system worked,” York said recently. The drop “was manufacturable. It reduced stinging and the amount of drug needed to produce the same biologic effect. Excess drug draining out of the eye would be significantly reduced.”
But his innovative solution ground to a halt when it came to getting it on the market.
The bottom line was that the innovation reduced profits, and therefore anathema to the pharmaceutical companies.