Eyeworld

SUMMER 2025 | EYEWORLD | 69 G References 1. Ravindran RD, et al. Incidence of post-cataract endophthal- mitis at Aravind Eye Hospital: outcomes of more than 42,000 consecutive cases using standardized sterilization and prophylaxis protocols. J Cataract Refract Surg. 2009;35:629–636. 2. Shukla AG, et al. Reusing surgical materials for cataract surgery: an assessment of po- tential contamination. J Cataract Refract Surg. 2024;50:993–999. 3. Pershing S, et al. Endophthal- mitis after cataract surgery in the United States: a report from the Intelligent Research in Sight Registry, 2013–2017. Ophthalmol- ogy. 2020;127:151–158. 4. Haripriya A, et al. Endophthal- mitis reduction with intracam- eral moxifloxacin prophylaxis: analysis of 600,000 surgeries. Ophthalmology. 2017;124:768– 775. 5. Schehlein EM, Robin AL. Should we use disposable to- nometers and gonioprisms in the office? Ophthalmol Glaucoma. 2025;8:109–111. 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. Foo K, et al. The carbon footprint of glaucoma care with drops or laser first. Clin Exp Oph- thalmol. 2025;53:435–437. 8. Tham YC, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Oph- thalmology. 2014;121:2081–2090. 9. Miller KM, et al. Cataract in the Adult Eye Preferred Practice Pattern. Ophthalmology. 2022;129:P1–P126. 10. Lozano AC, et al. Telemedicine for screening and follow-up of glaucoma: a descriptive study. Telemed J E Health. 2024;30:1901– 1908. In a 2019 study of four surgical centers, al- most 50% of all drugs and two-thirds of topical drugs were discarded after a single use during phacoemulsification surgery, Drs. Goldburg, Li, Shukla, Qiu, and Schehlein noted, adding that the authors estimated that this drug waste generated 23,000 to 105,000 metric tons of un- necessary CO2eq emissions annually in the U.S. 6 Additionally, transportation to and from the ophthalmology clinic and OR has been shown to be the greatest source of carbon emissions re- lated to ophthalmic care. 7 Most emissions come from transportation in cars. This is particularly concerning for glaucoma patients who require frequent follow-up, they said. "The number of people affected by glau- coma worldwide continues to increase and is estimated to be nearly 112 million by 2040. 8 As glaucoma prevalence rises, there will be a growing number of people who require timely diagnosis and management of this potentially blinding condition. Resources essential to pro- viding this care will further challenge already stretched healthcare systems and will contribute to the impending climate crisis," they said. Different procedures and practices con- tribute waste in different ways. In Western operating rooms, almost every piece of equip- ment is single use and gets thrown away at the end of the case, Drs. Goldburg, Li, Shukla, Qiu, and Schehlein said. In a British study, one phacoemulsification procedure in the U.K. was found to generate about 130 kg carbon dioxide equivalent, which is the same as driving a car 310 miles. For reference, an estimated 5.2 mil- lion cataract surgeries were performed in 2017 of routine intracameral moxifloxacin while maintaining their prior protocols." 4 Dr. Robin said that he began to question ways to be more sustainable, and he used the Aravind Eye Hospital as an example of being conscious about sustainability. They have lower complication rates in cataract surgery than we do in the U.S., he said. "We've learned that they recycle everything that they can, and they even divide plastics into those that can be sold to others versus plastics that they can recycle." In the clinic, single-use equipment has become the mainstay given the theoretical risk of disease transmission, Drs. Goldburg, Li, Shukla, Qiu, and Schehlein said. However, there are clear AAO and CDC guidelines stating that reusable tonometry tips can be sufficiently disinfected with 5,000 parts per million sodium hypochlorite. 5 Dr. Robin noted glaucoma drops as an area where physicians can seek to become more sustainable. We often use drops for one day or one patient, then they are thrown away, he said. This is an issue in both glaucoma and cataract surgeries in the preop and postop periods. He mentioned that some patients have trouble put- ting drops in their own eyes and often contam- inate the drops. In operating rooms, however, it's a nurse or a technician putting drops in the eyes, so the products are not contaminated, and Dr. Robin said it doesn't make sense to be wasteful with these. The worst part is they're thrown in a trash can, which is put into our landfill, and there is a large chance that the pharmaceuticals even- tually land in our drinking water. "I'm really concerned about that," Dr. Robin said. continued on page 70 Bottles of eye drops that were disposed of following a single cataract and minimally invasive glaucoma surgery Source: Aakriti Garg Shukla, MD, MSc Waste produced following five eye surgeries in a typical Western operating room Source: Aakriti Garg Shukla, MD, MSc

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