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Compounded drops save time, money

by Gary Wörtz, MD, Commonwealth Eye Surgery

In my opinion, compounded drops are the closest thing we have seen to the holy grail of postop pharmaceuticals in my career. Not only do compounded drops save patients money, the quality and convenience compared with both brand-name and generic formulations have piqued the interest of both providers and patients.

Previously, we had an unmet need in eye care, in which medicines continued to become more expensive with only incremental improvements. Among new formulations of steroids, antibiotics and NSAIDs, the only advantage seen was reduced dosage from four times a day down to once or twice a day.

With the increasing prices, however, one of the biggest challenges in preparing a patient for cataract surgery was trying to get them their eye drops. I have patients who were spending hundreds and hundreds of dollars, almost as much as they were spending on the surgery. It became a full-time job for a staff member to try to get these eye drops prescribed, dispensed and filled.

On top of that was the complexity of schedule: multiple drops taken daily with a tapering schedule over weeks among patients who are often elderly and may have more difficulty with compliance. Understanding the nuances of shaking a bottle and matching the bottle with the instruction schedule were often too cumbersome. Despite efforts to provide printout sheets that a patient could mark and lots of education, phone calls and staff time, we still routinely saw patients who could not manage their schedule and would be inadvertently noncompliant with their drop regimen.

Then, about 5 years ago, I was introduced to the intriguing concept of compounded drops by my friend and colleague Bill Wiley, MD. I started using them shortly thereafter and have had great success ever since. I currently use the combination prednisolone acetate, gatifloxacin and bromfenac (Ocular Science). In more than 5,000 consecutive cases, I have had no increase in macular edema, no noticeable increase in inflammation rates and zero endophthalmitis.

Additionally, there are various companies with multiple formulations. There are compounded drops that combine steroid, antibiotic and NSAID along with some for patients who only need a steroid and antibiotic. Some companies are also developing formulations for glaucoma and myopia prevention.

Switching to compound drops has probably been the single most beneficial change I have had to my ophthalmic practice in the 11 years since I finished training. It has improved the quality of my life, my staff’s quality of life and my patients’ quality of life. The price for compounded drops is always lower than any branded drug and almost always less than paying three copays. It is a rare situation that we can save time and cost while simplifying the process for our patients and staff.

By taking medications that are complicated to acquire with a complex schedule and reducing that complexity down to a drop that we can dispense in our office, we can make sure that the patient has exactly what they need before they go home after surgery. It takes this three-headed monster that has been expensive to both patients and our practice in time and staff hours and turns it into a simple process with one bottle.

For more information:

Gary Wörtz, MD, can be reached at Commonwealth Eye Surgery, 2353 Alexandria Drive, Lexington, KY 40504; email:

Disclosure: Wörtz is a member of the medical advisory board for Ocular Science.

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