Eye doctors reduce opioid prescriptions without compromising pain management

Eye doctors at the University of Michigan Kellogg Eye Center developed a plan to help curb the nation’s opioid epidemic – starting at their own clinic.

The approach: Doctors in the cornea clinic would give patients fewer pills after surgery – the time when many people are first introduced to opioid medications. They would also talk to patients about the proper use of opioids and the associated risks.

The interventions showed fewer opioids could be prescribed without compromising pain control after surgeries such as cornea transplants and vision-correcting surgeries.  

“Two recent policy changes – one by our institution, and one by our state – combined to create this new opportunity to learn about post-operative opioid consumption,” says Maria Woodward, M.D., M.S., cornea chief at Kellogg Eye Center and health services researcher at the U-M Institute for Healthcare Policy and Innovation. “First the cornea division at Kellogg changed policy, decreasing the number of opioid tablets we prescribe. Second, the state of Michigan instituted a mandatory prescription monitoring program.”

For a study published in JAMA Ophthalmology, a Kellogg team assessed the impact of limited opioid prescriptions for patients who had undergone corneal procedures such as penetrating keratoplasty, collagen cross-linking, superficial keratectomy and photorefractive keratectomy, a vision-correcting surgery to reshape cornea tissue that is a predecessor to the LASIK procedure.

Notably, the cornea is known for having more nerve endings than any other part of the body, making pain management a common part of post-operative recovery.

But exposure to opioids during procedural care can lead to long-term use. Physicians, led by study author Jennifer Waljee, M.D., M.P.H., co-director of Michigan-OPEN, are looking for a middle ground.

Prescribing patterns predictor of opioid use

The Kellogg study team identified 82 patients who underwent cornea surgery and surveyed them post-surgery about how many pills they actually used, what pain they experienced after surgery, and what they did with any leftover pills.

Before the clinic policy change, the average prescription for cornea surgery was 18.8 pills. When researchers interviewed patients, the amount of opioid medication they’d actually taken after the operation was eight. 

The rest was often still left at home, or carried around with them. 

After the policy change, the average prescription for cornea surgery dropped to 6.6 pills and patients reported using just four. 

Within the group receiving the lower pill count, 84% of patients reported that the prescription was adequate to control their moderate to severe pain and 22% reported receiving more pills than they needed. Only 7% felt they received less medication than needed for pain control.

The study findings suggest eye doctors may be prescribing more opioids than patients need after corneal surgical procedures. 

“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 lead study author who is also an assistant professor of Ophthalmology and Visual Sciences at the University of Michigan. 

The patient interviews reveal there’s more work to be done to keep leftover  opioid pills out of harm’s way. In the study, none of the patients discarded of pills as recommended by taking them to a health center or police station for disposal. 

“This study shows we’re making progress in the battle against opioid misuse,” Woodward says. “But we can do more to make sure that everyone knows how to prescribe them, use them and dispose of them safely.”

Paper cited: “Association of Limiting Opioid Prescriptions with Use of Opioids After Corneal Surgery,” JAMA Ophthalmology. DOI: 10.1001/jamaophthalmol.2019.4432