Ophthalmic drug shortages are 'eroding' patient trust, with Ian Pitha, MD, PhD

Building on prior Ophthalmology Times coverage examining how 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, discussed what his team's findings mean for clinicians on the front lines — and for the patients who depend on them.

In an interview with Ophthalmology Times, Pitha pointed to the specialty's heavy reliance on generics as a double-edged sword. While generic medications have long kept treatment costs manageable for patients, they also reduce the financial incentive for manufacturers to maintain robust production pipelines — or to prioritize restoring supply once a shortage occurs.

“For a very long time, I felt very fortunate that we have a lot of really great generic options for our patients,” Pitha said. “But on the other side of that, if there's a shortage, other drugs might take precedence in getting back online before our generic glaucoma medications do.”

Compounding that vulnerability, Pitha noted, is the limited number of manufacturers producing ophthalmic drugs at scale. If one goes offline, the remaining companies face a steep ramp-up challenge. The nature of ophthalmic formulations — predominantly drops and injectables — adds another layer of susceptibility that isn't unique to the specialty but amplifies its exposure.

Beyond supply logistics, Pitha emphasized the downstream consequences that are harder to quantify but no less significant: the erosion of patient trust. Every prescription, he explained, asks patients to navigate an already complex web of healthcare, pharmacy, and insurance systems. When a drug simply isn't available, it doesn't just disrupt a treatment regimen — it chips away at the relationship between patient and provider.

“It can erode their trust in me as a physician, being able to provide those medications,” he said.

That trust problem intersects directly with adherence. Patients who've been counseled on the critical importance of staying consistent with their glaucoma therapy are left without recourse when shortages strike — and without clear guidance on what to do next.

“So many of our patients make such efforts to be adherent to their medications,” Pitha said. “And when they can't do that, it can be really frightening for them.”

As for the clinical stakes — whether prolonged shortages are measurably worsening vision outcomes — Pitha acknowledged that question remains largely unanswered. The team's study was designed as a foundation for that work, not a conclusion. What's clear, he said, is that the field needs to get there.