Health·Second Opinion

Drug companies won't fix wasteful eye drops — so some students did

It's the time of year when people with allergies reach for their antihistamine eye drops to get some relief from itchiness and irritation. But much of that medicine ends up running down the cheeks in a waste of resources some students are working to change.

U.S. creators of 'Nanodropper' eye Canada as their next market

A typical eyedrop is three to four times the size of the liquid capacity of the average human eye. Most of the drop is often wasted. (Craig Chivers/CBC)

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It's the time of year when people with allergies reach for their antihistamine eye drops to get some relief from itchiness and irritation.

But much of the medicine ends up running down the cheeks. And that's intentional.

There are actually videos demonstrating how to reduce this waste by making a "pocket" with the lower eyelid in which you're supposed to carefully release the drop. But chances are some of it will still dribble down your face. It's a bit like throwing a handful of pills at your open mouth, hoping that one gets in.

It's even difficult for eye experts like ophthalmologist Dr. Nir Shoham-Hazon. "If you press the bottle too firmly, you'll get more than one drop," he said.

Shoham-Hazon is New Brunswick's only glaucoma specialist and regularly instills prescription drops in patients' eyes, especially after surgery. "And patients of course, either not seeing well or being not as careful … if they press any bottle a little firmer they're going to get more than one drop coming out," he said. "Then for sure it's wastage, and it's a big problem because these drops cost money."

Drops are simply too big to be fully absorbed by the eye which, for an adult, can hold only about seven to nine microliters (μl). Commercial and prescription eye drops dispense up to 40 μl.

It's not news to pharmaceutical companies — including Allergan, Merck, Pfizer and Canada's Valeant —  that have been the subject of multiple class-action lawsuits in the U.S. by patients who alleged they were "compelled to purchase an unusable or wasted portion of each eye drop in multi-use containers, in violation of state consumer legislation."

In their defence, the companies argued their eye drop bottles comply with U.S. Food and Drug Administration standards and it's not as though they're withholding a smaller, more efficient bottle.

However a 2017 story by U.S. media outlets ProPublica and NPR revealed how Allergan scientists, for example, experimented with glaucoma microdrops as small as 5 μl that were as effective as regular-sized drops, but the company allegedly shelved those plans for financial reasons.

That story sparked enough outrage that within weeks U.S. senators from both parties jointly introduced legislation to force companies to reduce the waste. The bill was subsequently watered down and has yet to pass.

Mackenzie Andrews, Jennifer Steger, Allisa Song (left to right) at the University of Washington's Holloman Health Innovation Challenge where they won first prize for their Nanodropper. (Matt Hagen/UW Buerk Center )

Allisa Song, 26, a medical student from Seattle, wanted a more immediate solution "I was thinking, how do we circumvent these drug companies who won't budge?"

So she and three friends, all with biomedical or engineering backgrounds, came up with a plastic adapter that screws onto the tip of any bottle and turns those wasteful blobs of eye medicine into a precise, little 9.4-μl drop.

Song said the adapter, they've named the Nanodropper, extends the life of a one-month supply of drops to three or four months. Their invention has won more than a dozen student awards since 2018, including a recent $15,000 US prize from the University of Washington.

N.B. opthalmologist calls eyedropper hack 'brilliant'

The FDA has licensed the Nanodropper, and Song is eyeing Canada as the company's next market once they begin production.

In the U.S., where prescription drug prices are high, people with glaucoma often pay more than $300 US a month for drops intended to preserve their vision.

Song said they've been contacted by more than 100 patients who are eager to start using a Nanodropper. "We also have eye care professionals, optometrists and ophthalmologists who have reached out to us. So we're working to get them Nanodroppers in bulk and they can reach their patient population."

Shoham-Hazon was one of the doctors who contacted Song. "I think it is brilliant," the Miramichi-based ophthalmologist said. Not only because of the smaller drop delivery but also, he pointed out, the adapter tip is soft so it's less likely to cause injuries if it accidentally comes in contact with eyeballs.

The Nanodropper isn't the only innovation that solves the big drop problem. A high-tech spray device that delivers tiny droplets precisely onto the eye has also entered the U.S. market. But it can't be used universally with all eye drop bottles, just medicines packaged specifically for the device.

A small glitch in the rollout of the Nanodropper is the price. Song and her colleagues aimed for $14 US, but recent manufacturing estimates put the price as high as $25 US, which is a concern.

"We just want to make sure that our cost isn't going to be another barrier to care," she said. "So we're going to try to work with our manufacturer and package sterilizers to reduce that down as much as we can."

The company is aiming to begin production of the Nanodropper by the end of the year.

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