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8 EW NEWS & OPINION Practitioners continued from page 3 April 2012 Original data from EyeWorld survey, January 2012 riod of inflammation," she said. "Should the FDA make one bottle size a mandate, patients will be required to incur the cost of an addi- tional prescription if they require therapy for a longer period of time." In addition, she observed practi- tioners routinely use NSAIDs off- label after other surgeries that may require the drops to be used for longer periods. Dr. Henderson stressed that the assertion that use of the same NSAID bottle will lead to infection is strictly theoretical. "I am not aware of any published studies that have reported an ocular infec- tion of the second eye from the use of the same bottle of NSAID," she said. Nick Mamalis, M.D., professor of ophthalmology, John A. Moran Eye Center, ophthalmology and vi- sual sciences department, University of Utah, Salt Lake City, agreed. "The risk of contracting bilateral endoph- thalmitis from the same drop of steroid or non-steroidal in both eyes is exceedingly remote," he said. He pointed out that for other types of drops this is commonplace. "There are people who use glaucoma drops in both eyes simultaneously," he said. "They don't use a separate bottle for each eye, and we have not seen a problem from an infection spread there." Dr. Mamalis and Uday Devgan, M.D., chief of ophthalmology, Olive View–University of California, Los Angeles Medical Center, said that they would like to have the option to use a single bottle for both eyes, but bottle size is a challenge. Dr. Mamalis said, "If I'm going to use a fourth-generation fluoroquinolone that comes in a smaller bottle, there's not enough in there to use one bottle for both eyes." Dr. Devgan agreed. "Part of the issue is I can't write for a bottle that is suffi- ciently large enough to cover both eyes," he said. "In my practice, be- cause the fill of the bottle is so little, I'm forced to have patients use a brand new bottle for each eye. These drops are certainly not inexpensive, and patients are often paying a good amount out-of-pocket," Dr. Devgan said. Louis D. "Skip" Nichamin, EyeWorld @EWNews Keep up on the latest in ophthalmology! Follow EyeWorld on Twitter at twitter.com/EWNews Are you a fan of EyeWorld? Like us on Facebook at Find us on social media facebook.com/EyeWorldMagazine M.D., medical director, Laurel Eye Clinic, Brookville, Pa., also sees the ruling as burdensome. "We're being overregulated to the point where common sense is assumed never to be used," he said. No one wants to contaminate eye drop bottles be- tween different eyes. "It all boils down to proper technique, to not allow the tip of the bottle to touch tissues and become contaminated," he said. This is something that he stressed ophthalmologists routinely instill in their patients. Richard A. Lewis, M.D., Sacra- mento, Calif., thinks that it is ridicu- lous to force consumers to buy a second bottle. "The worry about in- fection of these bottle tips is some- thing that we've never heard," he said. To this point he has urged pa- tients to save the bottles, which he said are well preserved. "It's very ex- pensive for these patients who are on fixed incomes, retired, with Medicare," he said. "They certainly can't afford the first bottle, now we're asking them to buy a second one." Overall, Dr. Lewis doesn't think that this was well thought out. "Un- less there is a body of literature that shows the risk of infection in using bottles in this fashion, there doesn't appear to be any good medical justi- fication for changing policy," he said. EW Editors' note: Dr. Devgan has financial interests with Alcon (Fort Worth, Texas), Bausch + Lomb (Rochester, N.Y.), and ISTA. Dr. Henderson has financial interests with Alcon, Bausch + Lomb, and ISTA. Dr. Lewis has finan- cial interests with Alcon, Allergan (Irvine, Calif.), and Santan (Osaka, Japan). Dr. Packer has financial interests with ISTA. Drs. Mamalis and Nichamin have no financial interests related to this article. Contact information Devgan: 800-337-1969, devgan@gmail.com Henderson: 781-487-2200, bahenderson@eyeboston.com Lewis: 916-649-1515, rlewiseyemd@yahoo.com Mamalis: 801-581-6586, nick.mamalis@hsc.utah.edu Nichamin: 814-849-8344, nichamin@laureleye.com Packer: 541-687-2110, mpacker@finemd.com