Results from a recent study published in Eye on popular over-the-counter (OTC) name-brand vs store-brand ocular products offer new insight into discrepancies between product information, safety, and descriptive data with consumer reviews and ratings.
Give me some background first.
Ocular product recalls became the apparent norm in 2023, starting in January with the recall of artificial tears, extending to artificial eye ointments in February, more eye drops in March, and the eventual reports of death tolls, enucleations, and vision loss cases connected with these products.
See here for our coverage on these, including product recalls from the second half of 2023.
And what did this study investigate?
Researchers conducted a cross-sectional study to analyze the potential connection between the following product characteristics for 100 of the top-selling OTC name-brand products (NBPs) in eye care across the United States:
- Pricing
- Consumer satisfaction ratings
- Marketing claims
- Allergenic contents
- Consumer safety metrics
Note: These products included eye drops, gels, and ointments.
What wholesalers were these sold through?
From January to April 2023, the investigators used Amazon to search for the top-selling NBPs and identified store brand alternatives (SBAs) from the following retailers:
- Walmart
- CVS
- Walgreens
- Target
- Amazon
- Kroger
- Rite Aid
- Albertsons-Safeway
- Costco
How was this product information obtained?
Via Amazon and the store websites using the NBPs’ and SBAs’ descriptive data, respectively.
That data included:
- Price-per-ounce
- Number of reviews
- Average consumer ratings
- Ingredients
- Marketing claims
Go on …
Investigators cross-referenced the American Contact Dermatitis Society and North American Contact Dermatitis Group allergen databases to identify products’ allergen info.
They also extracted recalls (reported by healthcare professionals [HCPs] only) from the FDA website and adverse events (AE) associated with the products from the FDA Adverse Event Reporting System (FAERS).
Plus: Consumer ratings (adjusted for fake reviews) were accessed using Fakespot.
Note: Fakespot is a free website that uses artificial intelligence (AI) to inspect product/business reviews and identify fake or unreliable reviews on Amazon, Best Buy, eBay, Walmart, and other websites.
Now these findings.
A total of 100 NBPs and 110 SBAs were identified, with most among both product groups containing allergens (62%), including:
- Benzalkonium chloride (23%)
- Propylene glycol (15%)
- Polysorbate 80 (11%)
However: AEs were not quite as frequently noted, with 83% lacking any reports.
So what were the top products across the board?
The five top-selling NBPs (with no HCP-reported AEs) included:
- Bausch + Lomb ReNu MultiPlus Lubricating & Rewetting Drops
- Consumer rating: 4.7 (5,372 reviews)
- Systane Long Lasting Lubricant Eye Drops Vials Eye Drops
- Consumer rating: 4.7 (1,781 reviews)
- Genteal Tears Gel Drops
- Consumer rating: 4.6 (1,292 reviews)
- Refresh Optive Lubricant Eye Drops
- Consumer rating: 4.7 (11,992 reviews)
- Oasis Tears Plus
- Consumer rating: 4.7 (2,994 reviews)
And what were the top SBAs?
The top five SBAs, also with no AEs reported, were:
- Equate Contact Lens Rewetting Drops
- Consumer rating: 4.6 (194 reviews)
- CVS Health Lubricant Gel Drops
- Consumer rating: 5 (10 reviews)
- Up & Up Lubricant Eye Drops
- Consumer rating: 3.3 (130 reviews)
- Rite Aid Artificial Tears Lubricant Eye Drops
- Consumer rating: 4.8 (73 reviews)
- Signature Care Lubricant Eye Drops
- Consumer rating: Not available (reviews also not available)
*Note: Retailers for Equate, Up & Up, and Signature Care eye drops were not specified.
How else did they compare?
NBPs had notably higher prices and more reported AEs (overall), they also had fewer allergens vs SBAs.
The study authors also reported that NBPs were more likely to be heavily marketed as #1 or “doctor-approved” over SBAs, with more reviews and higher consumer ratings.
I’m sensing a “but” …
The authors reasoned that SBAs receiving fewer reviews and lower ratings than NBPs could be due to NBP metrics often being “manipulated by Amazon sellers, suggesting a potential marketing push from NBP manufacturers.”
I’m listening …
They stated that the number of discrepancies among Amazon products—including fake-adjusted ratings—indicate the need for “more robust and transparent review systems.”
According to the authors: “As the OTC eye care product industry continues to grow, a combined effort from regulatory bodies, manufacturers and healthcare professionals is imperative to ensure product safety and maintain consumer trust.”
Any insight on why more AEs were reported for NBPs?
Likely due to name recognition. The authors stated that the more than $10 average price-per-ounce difference between NPBs and SBAs could “save patients hundreds of millions of dollars per year if SBAs are selected.”
The crux, though: SBAs are often more likely to contain allergens (as this study found) and should be avoided among patients with preservative allergies or eye drop sensitivity.
Limitations to this research?
A lack of sales data was noted among these products.
However, based on prior research findings, the authors suggested that the market share of generic medications may exceed that of name-brand medications—”supporting the lower prevalence of SBA AEs,” they stated.
Translation: Fewer generic medications (ie: SBAs) means fewer chances for AEs to be reported. Conversely, more name-brand medications (NPBs) means more chances for HCPs to reported AEs.
And lastly … final takeaways from this.
Although consumer metrics like pricing, reviews, marketing claims, and ratings are widely and commonly relied on for product purchases, “these factors do not consistently align with the safety metrics of OTC eye care products,” the investigators wrote in an abstract.
They also advised patients and practitioners to be aware that NBPs may, in fact, actually have more AEs than SBAs, despite higher ratings, marketing claims, and more reviews.
This abstract was presented during the Association for Research in Vision and Ophthalmology (ARVO) meeting in Seattle Washington, May 5-9, 2024.