Ophthalmologists reduce opioid prescriptions without compromising pain management

ByMartha R. Camara

Oct 31, 2019

For a study published in JAMA Ophthalmology, a Kellogg team assessed the impact on limiting opioid prescriptions after corneal procedures, such as penetrating keratoplasty, collagen cross-linkingsuperficial keratectomy and photorefractive keratectomy, which is vision correction surgery to reshape the corneal tissue it is a predecessor of LASIK procedure.

SEE ALSO: Corneal Reticulation Helps Maintain Vision in Corneal Disease

Notably, the cornea is known to have more nerve endings than any other part of the body, making pain management a common part of postoperative recovery.

But exposure to opioids during procedural care can lead to long-term use. Doctors, led by the author of the study Jennifer Waljee, MD, MPHco-director of Michigan-OPENseek common ground.

Prescribing patterns predictive of opioid use

The Kellogg study team identified 82 patients who had corneal surgery and asked them after the surgery about how many pills they actually used, how much pain they felt after the surgery and what they did with the remaining pills.

Before the clinic’s policy change, the average prescription for corneal surgery was 18.8 tablets. When researchers interviewed patients, the amount of opioid medication they actually took post-surgery was eight.

The rest was often left at home or taken with them.

After the policy change, the average prescription for corneal surgery fell to 6.6 pills, and patients reported using only four.

SEE ALSO: Patients use only a fraction of opioids given after surgery

In the group receiving the lowest number of pills, 84% of patients said the prescription was enough to control their moderate to severe pain and 22% said they received more pills than needed. Only 7% felt they received less medication than needed to control pain.

The study results suggest that ophthalmologists may be prescribing more opioids than patients need after corneal surgery.

“We were very encouraged to see that even a dramatic reduction in the number of opioid pills prescribed had no negative impact on pain control,” says Woodward, the study’s lead author who is also an assistant professor of ophthalmology and visual sciences at the University of Michigan.

Patient interviews reveal that there is still work to be done to keep leftover opioid pills safe. In the study, none of the patients discard pills as recommended taking them to a health center or police station for disposal.

“This study shows that we are making progress in addressing opioid abuse,” says Woodward. “But we can do more to make sure everyone knows how to prescribe, use and dispose of them safely.”

Article cited: “Association of limiting opioid prescriptions with opioid use after corneal surgery”, JAMA Ophthalmology. DO I: 10.1001/jamaophthalmol.2019.4432