Q&A: the Nanodropper

OT  hears how a device that lowers the volume of eye drops is helping to reduce side effects – and hefty medication bills – in the US

blue eye drop
An idea that started as a university project at the University of Washington is now a Food and Drug Administration-listed device for reducing the volume of eye drops.

OT speaks with Mackenzie Andrews, Nanodropper’s chief commercial officer, about the technology.

What inspired the development of the Nanodropper?

A ProPublica article came out in 2017 titled Drug companies make eye drops too big and we pay for the waste. This article focused on the financial barriers to care that these oversized eye droppers were creating for patients. Typical eye drops can be up to five times to large for the eye to absorb.

Mackenzie Andrews
Mackenzie Andrews
That was our original inspiration – to reduce this waste, and by doing that, make these medications more affordable and more accessible for our patient population. Through the process we learned that there were benefits not only for the patient’s wallet, but also for their eye health, and that there are benefits for optometrists in the clinic by reducing their waste.This started as a student project. After we won some academic competitions, the idea received press coverage and we were flooded with emails. Patients wrote in saying they were paying $300 to $400 (£250 to £333) every month for their eye drops. They were forced to make the decision between paying for their medication and paying for their rent. I think that shifted my mindset from this being an interesting way to apply my classroom experience to a real-world problem. It was those stories that inspired me to think ‘This is a real issue that we have to solve.’

Can you describe how the Nanodropper works?

We wanted to create an adaptor that would go on the top of the existing bottles. Once we had that idea, we started looking at the constraints for designing something like this. There are different bottle types and we wanted to make it fit as many bottles as possible.

We came up with a three-piece solution. The Nanodropper is made up of three different components. The base interfaces with the bottle. In US, about 90% of multi-use eye drop bottles have a similar thread size. We have a cap to keep the tip contaminant-free. The magic piece is this blue tip which is soft and flexible. It can stretch and form a fluid-tight seal over any original bottle nozzle shape.

How much does the Nanodropper reduce the volume of eye drops?

We designed the Nanodropper on the basis of decades of existing clinical research exploring micro volume dosing. Current standard eye drops are around 40–50 micro litres on average. The literature shows that the eye is able to absorb somewhere in the range of 7–10 micro litres. That is what we designed the Nanodropper to deliver. We are ensuring that we are delivering as much medication as the eye can absorb while minimising the excess waste.

What are the benefits of reducing eye drop volume?

The primary benefit is reducing the drop volume to a more appropriate volume for the human eye. We want to deliver as much medication as the eye can absorb but minimise waste. The eye drops are about three times as small so your bottle will last around three times as long.

Previous literature has shown that smaller drops reduce both local and systemic side effects of some of these medications. We have heard from our patients that the drops are more comfortable – they reduce things like skin irritation or a nasty taste in the back of their mouth when they take drops. Some patients have said that as a result they are more adherent with instilling their drops.

The Nanodropper is registered with the FDA as a disposable medical device. How does this influence considerations of cost and waste?

The Nanodropper is designed for a single bottle use. It should not be transferred between bottles because that does pose a contamination risk. How we describe the waste equation for this is that since the Nanodropper allows each bottle to last around three times as long, we are eliminating two full bottles of medication. It will be saving patients money as long as their bottles cost around $8–10 (£6.66–£8.33). We will also be minimising plastic waste because there is less plastic in the Nanodropper than a regular bottle. Even though it is single bottle use, we are still having a net negative impact on plastic waste.

Would Nanodropper consider expanding to other countries – for example, the UK?

There are a few barriers to expansion in places like the UK – there are different regulatory systems and we would need to go through the CE mark process. The other aspect is understanding the healthcare systems. In the US, patients are facing the brunt of the cost of their medications. It is not uncommon for patients to be spending hundreds of dollars each month on eye drops. In other countries, we are looking at options for partnering with national healthcare bodies as a way of reducing the overall national healthcare expenditure – instead of having this as something that the patient would pay for.