Cutting Waste Without Cutting Safety

Almost 10% of greenhouse gas emissions in developing countries come from medical waste, with surgery-related waste being a major contributor. Cataract surgery, in particular, is a significant source because it is the most common surgical procedure performed in the world.

“Because of our role in creating greenhouse gas emissions, we as ophthalmologists carry a great responsibility to care about this problem. At the same time, we have a great opportunity to impact it in a positive way,” said Cathleen McCabe MD, speaking about developing sustainable clinical guidelines and changing pathways at a symposium dedicated to sustainability.

“Fortunately, we know from large surveys conducted in the United States, Europe, and Asia that there is a strong commitment within the ophthalmology community to advocate for institutional sustainability and to partner with industry to develop ecologically responsible, clinically safe alternatives.”

Based on the results of multiple studies, there is no doubt that limiting cataract surgery-related greenhouse gas emissions can be achieved without sacrificing patient safety.

“Data show that, on average, the CO₂-equivalent produced by a single cataract surgery in the US is like that associated with driving about 300 miles. In contrast, at the Aravind Eye Care System in India—where there is reliance on optimised workflows, reusable instruments, and multi-dose medications—the CO₂-equivalent emission from a case is the same as driving 15 miles. Importantly, the difference is achieved without compromising safety as measured by rates of endophthalmitis and other complications,” said Dr McCabe, who is on the EyeSustain medical advisory board, holds a director position for sustainability on the Outpatient Ophthalmic Surgery Society board, and practices at The Eye Associates, Bradenton and Sarasota, Florida, US.

Outlining measures for addressing sustainability by reducing waste, Dr McCabe highlighted opportunities to modify the content of custom surgical packs, switch to electronic instructions for use for intraocular lenses, and increase the use of reusable instruments. She also discussed developing reusable one-day cassettes and tubing for phacoemulsification machines, creating pathways for removing the arbitrary 28-day expiration policy for multidose perioperative medications, allowing patients to take home opened bottles of medications needed for postoperative care, and establishing a new reimbursement model in the United States that would remove the existing financial disincentive to performing immediate sequential bilateral cataract surgery.

While there is a considerable amount of advocacy activity at the professional society level, Dr McCabe urged individuals to take action as well. She said a good place to start is by visiting the EyeSustain website, eyesustain.org, where there is a wealth of information on reducing surgical waste, becoming involved in advocacy efforts, and ways to improve their personal carbon footprint. She also highlighted online tools available on the ESCRS (SIDICS Calculator) and EyeSustain (Zasti Carbon Footprint Calculator) websites that allow surgeons to analyse their carbon footprint and the sustainability impact of introducing various modifications.

Providing take-home messages, Dr McCabe said, “There is robust scientific evidence from centres in India, Brazil, and elsewhere outside the United States establishing the safety and effectiveness of practices designed to decrease ophthalmology’s impact on greenhouse gas emissions and our carbon footprint. Equipped with this evidence, we should aim to reform current regulatory frameworks acting as barriers in the United States so we can integrate proven strategies for increasing sustainability.”