By Rebecca Salowe
Scheie Vision Summer 2020
A recent study published in JAMA Ophthalmology showed that rates of opioid prescriptions filled after eye surgeries have doubled in the United States between 2000 and 2014, despite the reduced invasiveness of these procedures. This study was led by Brian VanderBeek, MD, MPH, MSCE, as well as Anton Kolomeyer, MD, PhD.
There has been a considerable increase in deaths in the United States due to opioid abuse over the past few decades. In Americans under age 50, drug overdose is currently the number one cause of mortality. It is estimated that more than 200,000 individuals in the United States died from an opioid-associated overdose between 1999 and 2016. In 2017, opioid abuse was declared a public health emergency in the United States.
No specific guidelines exist for prescribing opioids within ophthalmology, and little research has examined trends in this specialty. In light of the current opioid epidemic and the resultant rise in mortality, Dr. VanderBeek sought to characterize opioid use within an ophthalmic setting. “We wanted to see what was happening in the real world,” he explained. “How was ophthalmology responding to the opioid epidemic?”
To answer this question, Dr. VanderBeek analyzed data from a large national U.S. insurer’s medical claims database. This database contains information on more than 2.4 million incisional ocular surgeries on patients from all 50 states. Surgeries across six different ocular subspecialties were included in the study.
The odds of having opioid medication filled after any incisional surgery tripled from 2000-04 to 2014-16, even after controlling for differences among types of surgery. The highest rates of filled prescriptions were seen after trauma, strabismus, and retina surgeries. However, even procedures that are not typically painful, such as cataract surgery, saw an increase in filled opioid prescriptions during this time period.
The researchers also found that geographic location was associated with the odds of filling a prescription. Individuals in the Mountain States were most likely to fill an opioid prescription following eye surgery, while those in the Northeast were least likely.
These results run counter to recent trends in eye surgery. There has been a shift towards smaller incisions and topical anesthesia, the latter which is associated with shorter recovery periods and higher patient satisfaction. However, topical anesthesia has also been linked with increased perception of surgical pain, possibly contributing to increased desire for stronger postoperative pain control.
The causes of the increase in filled opioid prescriptions after eye surgery remain mostly unknown, though Dr. VanderBeek believes them to be multifactorial. “We believe several factors contributed to the rise in use of opioids,” he said. “This includes the introduction of pain scales, the relatively recent ability for patients to rate their doctors online, and widespread advertising by the pharmaceutical industry.”
There are certainly instances where opioid prescriptions following eye surgery are warranted and necessary. However, given the current national opioid crisis, now is the time to examine the role of opioids in pain management within this specialty and to consider alternative strategies. Dr. VanderBeek hopes that this study provides a basis for this discussion among ophthalmologists.