Eyeworld

N JUNE 2019 | EYEWORLD | 27 the U.S., Dr. Thiel said. Another example: Many areas in the U.S. have policies against allowing patients to take home antibiotics used in the cataract surgery OR. Dr. Thiel also discussed the trend toward single-use disposables, which she said add to the environmental burdens by producing more waste and creating more emissions from production. However, "it's difficult to step back from this, as reusables require the right handling and infrastructure locally," she said. Yet there's one other barrier that currently works against surgical waste reduction. "I think the biggest limitation is lack of awareness of the issue and a lack of a com- prehensive approach to deal with the issue," Dr. Thiel said. "It requires innovation, and it requires the right range of people around the table." Another consideration is the potential harm adopting "greener" policies in the U.S., simi- lar to those used at Aravind, could create, Dr. Schuman said. Solutions There are some steps that ophthalmic surgeons can potentially follow to lower waste. 1. Think minimalist. "Surgeons can limit their requested equipment and medications to only what they truly need and ensure that only what they need gets opened," Dr. Schuman said. "If you don't bring it in to the OR, you don't have to throw it out—so start there," Dr. Thiel advised. 2. Recheck policies. "If the institution permits surgeons to send patients home with drops from the OR, they should take advantage of this policy and do so," Ms. Tauber suggest- ed. If not, surgeons could bring up the issue at departmental meetings. 3. Update policies. Once you've exam- ined where to cut down on waste within your own surgery, see if it's possible to expand that among your peers. This could include the development of an "always needed" surgical list versus an "as needed" list, Dr. Thiel said. She also advised eye surgeons to consider better scheduling, task shifting, and the flow of supplies through the physical space. "Can you get creative while still maintaining safety and effectiveness?" she said. Dr. Thiel thinks ophthalmic surgery—cat- aract surgery in particular—has the potential to lead the sustainable surgery movement. "Cataract surgeries are incredibly successful and generally have a lower infectious risk than ab- dominal or joint surgeries. This gives ophthal- mologists more space to explore which policies truly protect patient and staff health and which only give the appearance of protecting patient and staff health," she said. References 1. Namburar S, et al. Waste gen- erated during glaucoma surgery: A comparison of two global facilities. Am J Ophthalmol Case Rep. 2018;12:87–90. 2. Thiel CL, et al. Cataract surgery and environmental sustainability: Waste and lifecycle assessment of phacoemulsification at a pri- vate healthcare facility. J Cataract Refract Surg. 2017;43:1391– 1398. Financial interests Schuman: None Tauber: None Thiel: None Getting ready for surgery; single-use disposable custom packs and reusable instrument trays being opened and arranged on the back tables Leftover bottles of tetracaine will be thrown out after surgery. Source (all): Cassandra Thiel, PhD

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