Eyeworld

N EWS 26 | EYEWORLD | JUNE 2019 by Vanessa Caceres EyeWorld Contributing Writer Results from a third study were presented at the 2018 American Academy of Ophthalmolo- gy Annual Meeting by Jenna Tauber. The study included four surgical sites and focused on rou- tine phaco cases. They found that many drugs used in cataract surgery were not fully used, leading to an annual waste of $36,900 to up to $195,000 at one center. Eye drops in particular were wasted when compared with ocular injec- tions, such as balanced salt solution and system- ic medications. "In many parts of the country, after only a few drops, regulations require that the entire bottle be discarded," Ms. Tauber said. These results should be published soon. Causes Contributors to surgical waste in developed countries include single-use products, medi- cations that cannot be reused after opening, packs of equipment that contain materials, and equipment not actually used during surgery, Dr. Schuman said. Another source is plastic, particularly the draping, gloves, gowns, bowls, and syringes used with every case, Dr. Thiel said. Waste disposal is also an added cost, Dr. Thiel said. "We don't have a lot of details on what's being thrown away and why. Hospitals and surgical centers have to pay not only for purchasing supplies but also for the treatment of various waste streams. This spending on supply procurement and disposal can make up nearly 40% of a hospital's expenses," she said. Reducing resource consumption is crucial both for the environment and for the cost of provid- ing care, she explained. It's too early to say if there is one particular type of ophthalmic surgery that leads to more waste than others, Dr. Thiel said. For the most part, a reduction in waste must come from policy changes versus chang- es by individual surgeons, Dr. Schuman said. "The issue mostly has to do with our systems at administrative levels and highly risk-averse countries," he said. For instance, at Aravind two beds can be placed in a single OR, but HIPAA and infection control guidelines prevent this in D o you know how much waste your clinic generates during ophthalmic surgery? A group of researchers at New York University are examining surgical waste within ophthalmology. Even with today's focus on sustain- ability and waste reduction, ophthalmic surgery has room for improvement. Delving into the research The researchers published two studies related to ophthalmic surgical waste and have a third in progress. Cassandra Thiel, PhD, has examined waste in other specialties, including OB/GYN, orthopedics, and radiology. In one study, researchers compared waste generated during glaucoma surgery at two facilities, one in the U.S. and another at Ara- vind Eye Hospital, Madurai, India. 1 The waste produced in the glaucoma operating room was weighed and compared. The average waste per trabeculectomy in India was 0.5 kg, com- pared to an average of 1.4 kg at the U.S. facility (P<0.05). When comparing device surgeries and trabeculectomy with phacoemulsification, the average waste was 0.4 kg in India versus 0.7 kg in the U.S. Dr. Thiel was the lead author in a second study that focused on waste and lifecycle as- sessment of phacoemulsification at two tertiary care centers of the Aravind Eye Care System in southern India. 2 The observational case series used manual waste audits, purchasing data, and interviews with staff to quantify environmental emissions. They found that Aravind generates 250 grams of waste per phaco and almost 6 kg of carbon dioxide equivalents in greenhouse gases, which is an estimated 5% of the phaco carbon footprint generated in the U.K. but with comparable surgical outcomes. "Surgical systems in most developed countries and in par- ticular their use of materials are unsustainable," the researchers concluded. "We produce 20 times the waste they do, yet our outcomes are no better," said Joel Schuman, MD. A closer look at eye surgery waste About the sources Joel Schuman, MD Director New York University Langone Eye Center New York Jenna Tauber, MD candidate New York University School of Medicine New York Cassandra Thiel, PhD Assistant professor Department of Population Health New York University School of Medicine New York Contact information Schuman: joel.schuman@nyulangone.org Tauber: jenna.tauber@nyulangone.org Thiel: Cassandra.thiel@nyulangone.org

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