Multidose Preservative-Free Eyedrop Bottles: A Boost for Patient Compliance, a Challenge for Designers
By Marguerite McDonald, MD, FACS
Patients want them, physicians want them. And for years, designers have worked to develop a working multidose, preservative-free (MDPF) bottle for administering prescription ocular medications and artificial tears.
There have been numerous compelling reasons for pursuing such a bottle.
Patients would benefit because some preservatives in eye drops can be toxic, causing pain and blurred vision – which can drive patients to stop using their medications. In addition, a calibrated MDPF could deliver one drop at a time, eliminating the unpleasantness of liquid streaming down the face.
Many patients who have arthritis in the hands or fingers also report difficulty twisting off the top of tiny preservative-free vials and effectively squeezing the medicine out of them.
Finally, patients who have to transport medications find a single bottle easier to carry than multiple small plastic vials – which is just one of many reasons that a single bottle is more convenient than plastic vials.
Environmental considerations, too, have driven the effort to perfect a MDPF bottle. A single bottle requires roughly eight times less plastic to manufacture, nine times less energy to transport, and creates far less waste.
For those working to meet the demand for a MDPF bottle, one huge hurdle has been to design a bottle that is both contamination-proof but also cost-effective to mass produce. In order to win Food and Drug Administration approval, any MDPF bottle would have to prove the absence of tip contamination and "suck back" of airborne contaminants. The product would also have to demonstrate biocompatibility between the drug and the materials.
Despite those challenges, progress is being made:
In 2016, an Allergan product, the Aptar Squeeze multidose, preservative-free bottle for Restasis won FDA approval. The bottle’s one-direction valve and air filter prevent contaminants from entering the bottle.
A design by Novelia is used in producing OASIS Medical MDPF tears and Fresh Kote PF tears.
Retaine HPMC Lubricant Eye Drops from OCuSOFT is a multi-dose, preservative-free artificial tear sold in a 10 mL bottle that features an original airless pump design.
A novel design by the TearClear company utilizes a chemical filter that fits inside the bottle that strains benzalkonium chloride out of the drop as it leaves the bottle tip, while permitting the active ingredients to pass into the eye.
An MDPF delivery system created by NDC includes a preservative-free main chamber, a one-way valve and an antimicrobial tip. This system has been tested at New York Medical College, where researchers determined the reservoir and tip remained sterile during use. With this unique design, the medication is delivered when the patient pushes a button.
Perfecting an easy-to-produce, reasonably priced and contamination-proof MDPF bottle marks an important advancement in ophthalmology practice. These MDPF bottles improve patient comfort, reduce plastic waste and likely result in greater patient treatment compliance.
Marguerite McDonald, MD, FACS, with OCLI on Long Island, NY, is clinical professor of Ophthalmology at NYU Langone Medical Center, NY, and clinical professor of Ophthalmology at Tulane University Health Sciences Center, New Orleans, Louisiana.