How to better understand ophthalmic drug shortage impacts, with Ian Pitha, MD, PhD

Building on his team's finding that ophthalmic drug shortages are both more frequent and longer-lasting than the national average, Ian Pitha, MD, PhD, an ophthalmologist at the John A. Moran Eye Center, returned to Ophthalmology Times to discuss what the field can — and must — do differently going forward.

The path to meaningful prevention, Pitha argued, runs through data. While researchers at the University of Utah and elsewhere are actively investigating the root causes of drug shortages, Pitha was candid about the limits of what that inquiry can yield. "The reasons are very complex," he said. "You can't point to one cause for the shortage." Even when shortages are attributed in broad terms to business decisions, Pitha noted, that framing obscures a wide range of contributing variables that suppliers don't always disclose.

What that opacity demands, in his view, is a smarter targeting strategy — one focused less on cataloguing causes after the fact and more on identifying, in advance, which medications carry the greatest risk of shortage and the greatest consequences if they go offline. "I think an important thing to investigate would be being able to identify drugs that are in particular risk of shortages, that are going to have an impact on our patients," Pitha said, "and find ways to prevent those shortages, or at least to mitigate them."

Central to that effort is improving the methodology behind how the field defines a clinically essential ophthalmic medication. In the current study, that list was assembled through expert consensus — a process Pitha acknowledged has room to grow. "I think there are better ways to do that," he said. "I think we can use big data and come up with a weighted list of medications that are important to ophthalmology." Such a ranking, grounded in large-scale prescribing and utilization patterns rather than panel opinion alone, would give researchers and policymakers a clearer signal about which shortages demand the most urgent attention.

Pitha was equally clear that drug shortages are not merely a logistical inconvenience — they are a public health issue that requires balancing resilience against the real-world pressures of cost and efficiency. "We can build in a lot of redundancies into our drug pipelines," he said, "but I think that comes at additional costs." The goal, then, is not to harden the entire supply chain indiscriminately, but to protect the medications where disruption would have an outsized effect on patients — many of whom, as Pitha noted previously, are already working hard to stay adherent to their therapy.

Pitha closed by crediting his key collaborator, Dr. Erin Fox of the University of Utah Drug Information Service, whose expertise in drug shortage research made the study possible.