Eyeworld

24 | EYEWORLD | SPRING 2025 ASCRS NEWS Contact Keyser: andrew.keyser@hotmail.com how much larger these packages were compared to their non-preloaded counterparts. A recent study, conducted in 2024 by myself, John Hovanesian, MD, David F. Chang, MD, and Cassandra Thiel, PhD, analyzed the packaging waste generated by a range of preloaded and non-preloaded IOLs available in the U.S. 2 Our work produced a first-of-its-kind snapshot of the current state of IOL packaging and found that waste varies significantly among brands and product types; the heaviest package across all models, the Rayner RayOne Spheric, weighed four times as much as the lightest, the Zeiss Lucia. We were able to highlight several areas where improvements could be made to lower the environmental impact of cataract surgery. Materials and components of boxes sourced from Alcon, Johnson & Johnson, Hoya, Rayner, RxSight, and Zeiss showed that the average preloaded IOL package weighs approx- imately 85 g, while the average non-preloaded package weighs 55 g. Beyond the added waste of the injector system itself, preloaded IOL box- es were larger and heavier than their non-pre- loaded counterparts to accommodate this extra material, further increasing the amount of waste produced by each preloaded model. If these injector systems were substituted for disposable, preloaded IOL cartridges that could be used with traditional autoclavable metal injectors, both packaging weight and size could be re- duced, minimizing waste. Additionally, many IOL packages included bulky IFU booklets, further increasing the waste associated with these products. These IFUs made up approximately 25% of each package and were not only much larger than the IOLs they were packaged with, but in the case of non-preloaded IOLs, were directly correlated with the size and weight of their boxes. This suggested that in the absence of these physical IFUs, packages could be much smaller, and a significant amount of waste could be eliminat- ed. This view was supported by the fact that of the four lightest packages, three utilized e-IFU, small inserts with QR codes linked to an online version of the complete information, in place of paper copies. Furthermore, in a striking direct comparison, we found that while Alcon's non-preloaded Clareon Vivity IOL utilized an e-IFU weighing only 4 g and accounting for just 11% of the total package weight, the similar but older AcrySof model, also non-preloaded, in- cluded a traditional IFU pamphlet that weighed 39 g and took up a full 50% of the total pack- age's weight. A recently published position paper from EyeSustain explains in greater detail the benefits of e-IFU and addresses many of the concerns associated with transitioning to them. 1 By shifting to e-IFUs and implementing preloaded cartridges in place of injectors, a substantial contribution to mitigating climate change can be made. It is our hope that this paper can serve as a benchmark against which ophthalmologists and ophthalmic manufactur- ers alike may inform themselves of the current landscape of IOL packaging and use these findings to drive further reductions to waste produced in the operating room. continued from page 22 It is our hope that this paper can serve as a benchmark against which ophthalmologists and ophthalmic manufacturers alike may inform themselves of the current landscape of IOL packaging and use these findings to drive further reductions to waste produced in the operating room.

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