Opioids and Ophthalmology

 

TAKE-HOME MESSAGE

  • Although ophthalmologists write only a small portion of opioid prescriptions, all physicians need to be aware of the ongoing opioid epidemic and strategies to reduce unnecessary opioid prescriptions. Retrobulbar anesthesia, along with peri-operative intravenous or oral nonopioid analgesics, may lead to reduced opioid use postoperatively after eye surgery. With use of opioid prescription guidelines, the number of unnecessary opioid prescriptions has fallen over the past few years.

  • The opioid epidemic affects everyone, and this is a helpful review for ophthalmologists who manage postoperative pain.
–  Raza M. Shah, MD

 Eye Care

This is a literature review of the implications of the current opioid epidemic for ophthalmology and of the need to decrease prescribing these medications. A very surprising finding was that, "Overall, opioid prescriptions represented approximately 8% of all prescriptions ophthalmologists wrote per year, and when prescribed, had a mean supply of opioids for 5 days." They also note that 15% of oculoplastic surgeons wrote >100 opioid prescriptions per year. In referring to retinal specialists, 21% wrote >10 per year and 6% wrote >50 per year. Numerous other rather surprising statistics are given. Of particular note is the following statement, "Despite cataract surgery having the lowest rate of opioid prescriptions, they contributed the highest volume of opioid prescriptions within their dataset due to the higher overall volume." This last statistic flies in the face of the often quoted rubric that is routinely given to residents in training, "If the patient needs strong pain medication following cataract surgery, he/she probably is having a significant complication such as high pressure or infection and needs to be seen immediately." Means to address perceived over-prescribing of opioids even by ophthalmologists, such as guidelines, are discussed. Overall, this is a very informative and disturbing paper.

PURPOSE OF REVIEW

The number of opioid-related overdose deaths has rapidly increased since 2000, increasing more than five-fold from 1999 to 2016. Although surgeons only write 10% of opioid prescriptions annually, with ophthalmologists writing only a fraction of this amount, all physicians need to be cognizant of the current opioid epidemic and ways to decrease unnecessary opioid prescriptions.

RECENT FINDINGS

Previous work within ophthalmology has shown that retrobulbar anesthesia along with peri-operative intravenous or oral nonopioid analgesics can lead to decreased postoperative opioid use following ophthalmic surgery. Recent literature has shifted focus towards the use of opioid prescription guidelines in managing postoperative pain and decreasing the number of unnecessary opioids being prescribed by ophthalmologists. Overall, the frequency of opioid prescriptions may have gradually declined the past few years with such efforts, increased awareness, and new healthcare policies to monitor opioid prescriptions. However, ophthalmologists still continue to prescribe a substantial number of opioid medications, much of which may not be necessary.

SUMMARY

This review serves as a tool to aid all ophthalmologists in managing postoperative pain. There is a recent trend in addressing the opioid epidemic and efforts are being made to limit the overprescribing of opioids. Continued efforts are still required by all ophthalmologists to address the current opioid epidemic.

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