Reducing Ophthalmic Surgical Waste Through Electronic Instructons For Use (eIFU)

Three major societies have jointly released a position paper that urges surgical manufacturers to move to electronic instructions for use (e-IFU) wherever possible. The American Society of Cataract and Refractive Surgery (ASCRS), the European Society of Cataract and Refractive Surgeons (ESCRS), and the American Academy of Ophthalmology (AAO) are the co-sponsors of EyeSustain, a consortium of 47 global eye societies dedicated to advancing sustainability in ophthalmology through education, advocacy, and research. 

Every surgical supply, including IOLs, IOL cartridges, and viscoelastic syringes, is packaged with paper instructions for use (also known as IFU). These pamphlets are printed in multiple languages and, in the case of an IOL, significantly increase the size and weight of the box. “When you consider that no one reads these pamphlets and yet they accompany products used for every case, this generates an enormous amount of needless waste,” said Emily Schehlein, MD, co-chair of the EyeSustain Task Force that developed the paper.

To eliminate this unnecessary source of waste, the position paper calls for moving to QR codes that link to online e-IFU as a commonsense alternative. In addition to reducing paper waste and manufacturing costs, electronic instructions can be updated more easily and could be accessed by surgeons in the clinic, which is where IOL models and powers are selected. “Although this option is permitted by the U.S. Food and Drug Administration and the EU Medical Device Regulation, we learned from manufacturers that a major problem is that many countries require a printed IFU,” said John Hovanesian, MD, the other task force co-chair.

The task force collaborated with the Medical Device Manufacturers Association to survey American instrument and supply manufactures across multiple specialties about electronic instructions. Although 95% thought they were an acceptable alternative to printed instructions, only 30% were using electronic instructions for most of their products. Inconsistent instructions for use requirements between different countries was unanimously listed as a barrier. However, lack of customer demand and lower company prioritization were also cited as factors, according to David F. Chang, MD, chair of the EyeSustain Advisory Board. “To my knowledge, we are the first specialty to issue a multi-society position statement on electronic instructions for use for surgical products,” he said. “We hope this elevates the issue in manufacturers’ agendas and spurs collaborative efforts to align regulatory standards that encourage electronic instructions across all surgical specialties worldwide.”  

ESCRS members are encouraged to visit www.EyeSustain.org to download the app and to access resources on how to reduce waste and carbon emissions from our services. In addition, please encourage your surgery center, hospital, or department to take the EyeSustain surgical facility pledge online. This is a symbolic commitment to seek ways over time to reduce costs and emissions associated with unnecessary O.R. waste from eye surgery.

Read the position paper