Eyeworld

20 | EYEWORLD | AUGUST 2020 ASCRS NEWS continued from page 19 • 93% of surgeons want more freedom to reuse disposable products at their discretion. • At least 72% would consider reusing irri- gation solutions and tubing, capsulotomy needles, cannulas, metal blades, and nonmetal devices such as iris retractors. • 87% would like their medical societies to advocate for the reduction of surgical carbon footprint. Respondents cited regulatory agencies and facility regulations as having the greatest impact on limiting their reuse of supplies, along with other factors like manufacturers' efforts to reduce liability and driving the market toward more profitable single-use products. Dr. Chang, who is co-chair of the OICS Task Force, said this survey showed overwhelm- ing support for having more reusable options and for manufacturers' instructions for use (IFUs) that allow surgeons to decide when it is safe and appropriate to reprocess and reuse a product. "I was impressed that the majority of re- spondents are open to reusing most intraocular drugs and many supplies, such as phaco tubing and irrigation solution. I also expected more divergence in opinions between surgeons and nurses. Instead, they were quite closely aligned for most questions, including reuse of many supplies and devices," Dr. Chang said. Dr. Thiel said she was surprised by the number of surgeons and nurses who reported already using multidose or reusing specific phar- maceuticals and supplies. "Infection control is one of the things most often cited (anecdotally) for why we don't reuse or multidose medical items, and our sur- vey found that a lot of surgeons and nurses are already successfully doing this," Dr. Thiel said. With studies that show the potential to reduce waste from cataract surgery without negatively impacting patient safety, what's next? One might think the next step is to go straight to regulatory agencies, but Drs. Chang, McCabe, and Jeffrey Whitman, MD, agreed that surgical supply manufacturers might be able to have a greater, faster impact. "The simplest way of changing this is we don't have to go to lawmakers if [industry] makes changes on their own, and that is to change their IFUs," Dr. Whitman said. "I think if we get to industry, that's the easiest way. If we can't then we do need to talk to politicians to see, governmentally, how we can move this forward." Dr. Chang said the survey "sends a clear message to the surgical manufacturing indus- try that ophthalmologists are concerned about excessive surgical waste and want more reusable products." Dr. McCabe also said that manufac- turers changing their instructions for use would be "one of the most straightforward and rapid changes" to reduce waste. "Unless there is data to support a risk of reuse—and there has been an enormous volume of surgeries in health systems like the Aravind hospital system that demonstrate safety—there is no reason to write IFUs in a way that limits reuse," she said, adding that she thinks the survey shows "potential competitive advantage" for manufacturers who address concerns about OR waste and its concomitant environmental impact. Going forward research-wise, Dr. Thiel said more evidence is needed to show some reuse practices are safe, as well as implementation research to establish guidelines that enable ev- eryone the ability to reuse/reduce waste safely. Dr. Thiel also sees the opportunity for reg- ulatory change to facilitate reuse/reduced waste practices, and she thinks manufacturers could be developing products with a smaller environ- mental footprint. Finally, she said education is still important. "I think it is incumbent on medical schools to teach their students about climate change and sustainability," Dr. Thiel said. "The COVID pandemic taught us how vulnerable our medical supply chains are, and climate change will only cause more supply shortages. In addition, cli- mate is affecting our patients' health, and med- ical trainees should be aware of these issues. In addition, we should start training students and practicing physicians how their own practice causes climate change and other environmental pollutants that negatively affect health." Ultimately, Dr. Thiel said the survey offers hope that interest is at least moving in the direc- tion of making medicine more sustainable. "It's not going to be easy, but this suggests it's very possible," she said. References 1. Chang DF, et al. Survey of cataract surgeons' and nurses' attitudes toward operating room waste. J Cataract Refract Surg. 2020;46:933–940. 2. Morris DS, et al. The carbon footprint of cataract surgery. Eye. 2013;27:495–501. 3. Tauber J, et al. Quantifica- tion of the cost and potential environmental effects of unused pharmaceutical products in cat- aract surgery. JAMA Ophthalmol. 2019;137:1156–1163. 4. 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. Relevant disclosures Chang: None McCabe: None Thiel: None Whitman: None Contact Chang: dceye@earthlink.net McCabe: cmccabe13@hotmail.com Thiel: Cassandra.Thiel@nyulangone.org Whitman: whitman@keywhitman.com

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