Eyeworld

SEPTEMBER 2023 | EYEWORLD | 17 References 1. Chang DF, Thiel CL. Survey of cataract surgeons' and nurses' attitudes toward operating room waste. J Cataract Refract Surg. 2020;46:933–940. 2. Chang DF, et al. Survey of ESCRS members' attitudes toward operating room waste. J Cataract Refract Surg. 2023;49:341–347. 3. Steenmeijer MA, et al. The environmental impact of the Dutch health-care sector beyond climate change: an input-output analysis. Lancet Planet Health. 2022;6:e949–e957. 4. Kwakye G, et al. Green surgical practices for health care. Arch Surg. 2011;146:131–136. 5. Eckelman MJ, Sherman J. Environmental impacts of the U.S. health care system and effects on public health. PLoS One. 2016;11:e0157014. 6. 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. 7. Thiel CL, et al. Cataract surgery and environmental sustain- ability: Waste and lifecycle assessment of phacoemulsifi- cation at a private healthcare facility. J Cataract Refract Surg. 2017;43:1391–1398. 8. Haripriya A, et al. Changing operating room practices: the effect on postoperative endophthalmitis rates following cataract surgery. Br J Ophthal- mol. 2023;107:780–785. difference in opinion between the OICS and ESCRS cohorts was that ESCRS respondents ascribed less impact on surgical waste to hos- pital/facility policies and regulatory agencies to reuse supplies. Despite this, both OICS and ESCRS respondents advocated for similar global strategies for reducing surgical waste, including regulatory bodies allowing more surgeon discre- tion in reusing products and that manufacturers consider environmental impact, such as using recycled materials and offering more reusable instruments/supplies. Single-use instruments are a major cause of surgical waste, and most respondents to both surveys either reuse or are willing to reuse surgical products, pharmaceuticals, and in- struments. A minority of respondents thought that patient preference was a major driver of single-use instruments. More ESCRS members were currently reusing intraocular pharmaceuti- cals like lidocaine, antibiotics, and capsular dye. Of note, more than 20% of ESCRS respondents reused phacoemulsification and I/A tubing and irrigating solution compared to less than 8% of their OICS counterparts. Both OICS and ESCRS participants were interested in eliminating the full-body drape and making use of short cycle autoclave sterilization processes for reusable instruments. The results of the OICS and ESCRS surveys highlight a global paradigm shift among oph- thalmologists toward OR practices promoting sustainability in the context of climate change. The concordant responses from surgeons in these studies call into question the convention- ally held premise that surgeons prefer single-use products and historical OR standards and proto- cols. In fact, many respondents thought we should develop ways to reduce waste and were currently reusing or willing to reuse phar- maceuticals and other OR supplies. Among the OICS group, those working in ASCs were more likely to reuse products, demonstrating that institutional policy may be limiting reuse. Most ESCRS respondents work in hospital settings and still were more likely to reuse items com- pared to their OICS counterparts. Instead of relying on OR protocols intend- ed for general surgery cases, ophthalmologists around the globe are redefining OR standards of care to promote environmental sustainability, efficiency, and high-quality patient outcomes. The Aravind Eye Hospitals in India have adopt- ed sustainable practices and achieved postop- erative endophthalmitis rates lower than the U.S. while significantly decreasing the carbon footprint of phacoemulsification. 7,8 In 2022, a multi-society position paper was released by the OICS Task Force demonstrating the safety of: 1) using multidose topical eye drop bottles on multiple patients until expiration date and 2) patients using partially used medication at home for postoperative use. These examples of scientific research and guideline position papers endorsed by multiple ophthalmological societ- ies hint at the outdated nature of current OR protocols and highlight that surgeons can have more discretion over reuse of medications and supplies. Given these strong and globally held beliefs, ESCRS, ASCRS, AAO, and many other professional ophthalmological societies have collaborated in the global EyeSustain initiative to spearhead initiatives promoting environmen- tal waste reduction in ophthalmic ORs. A new era of sustainable surgery to confront global cli- mate change is beginning, and ophthalmologists around the world are front and center.

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