Eyeworld

68 | EYEWORLD | SUMMER 2025 G UCOMA by Ellen Stodola Editorial Co-Director YES CONNECT About the physicians Samantha Goldburg, MD PGY-4 Ophthalmology Resident Zucker School of Medicine at Hofstra/Northwell Hempstead, New York Lucy Li, MD PGY-4 Ophthalmology Resident New York Medical College Westchester Medical Center Valhalla, New York Mary Qiu, MD Glaucoma Specialist Department of Ophthalmology and Visual Science University of Chicago Chicago, Illinois Alan L. Robin, MD Emeritus Associate Professor of Ophthalmology and International Health Johns Hopkins University Baltimore, Maryland Emily Schehlein, MD Glaucoma Specialist Brighton Vision Center Brighton, Michigan Aakriti Garg Shukla, MD, MSc Glaucoma Specialist Leonard A. Lauder Associate Professor of Ophthalmology Columbia University Medical Center New York, New York An emphasis on sustainability in healthcare has gained momentum in recent years. Enhancing patient care through improving cost efficiency, reducing waste, and minimizing environmental impact have become growing priorities in glau- coma and other ophthalmic subspecialties. As the global burden of glaucoma continues to rise, it is essential to adopt practices that balance effective treatment with responsible resource utilization. Traditional glaucoma surgeries often involve disposable instruments and medical supplies that generate waste and environmental harm. By adopting more sustainable practices, we can reduce cost and ecological footprint while main- taining high-quality care. Economically, sustainability also plays a cru- cial role. With the rising costs of medical care and the need for ongoing treatments, utilizing durable equipment, reusable instrumentation, and stream- lining resource use can lower long-term healthcare expenses. Additionally, sustainable approaches to glaucoma surgery can make treatment more accessible to underserved populations, improving equity in healthcare delivery. We are fortunate to have a group of glaucoma specialists who are experts in sustainability offer us their perspective on how to make meaningful changes to your own clinical practice. Shivani Kamat, MD, YES Connect Guest Editor T he efficient use of resources and cutting down on waste have become popular topics across all of medi- cine. Many physicians are becoming conscious of the number of resources used and thinking about ways to be more sus- tainable, while still ensuring safe and success- ful procedures for patients. In this issue's YES Connect column, several physicians discussed sustainability in ophthalmology, particularly the glaucoma subspecialty. Concerns with sustainability in glaucoma One of physicians' main goals, said Alan L. Rob- in, MD, is we never want to do harm, but we also don't want to be wasteful, from a financial perspective and an environmental perspective, which can be equally harmful. Paying attention to sustainability might be a new mindset for some physicians, as it's not something that's taught in training but is something that's been gaining ground recently. Samantha Goldburg, MD, Lucy Li, MD, Aakriti Garg Shukla, MD, MSc, Mary Qiu, MD, and Emily Schehlein, MD, recently researched the topic of sustainability in glaucoma togeth- er. They noted that there are several concerns, and they broke these down into issues related to surgery, clinic, pharmaceutical waste, and transportation. In the operating room, Western surgical fa- cilities typically have single-use surgical equip- ment, excessive draping, large packaging of ma- terials, paper instructions for surgical devices, lack of recyclable material, and lack of recycling bins in the operating rooms, they said. Exam- ples of items that are only used once in cataract surgery in the U.S. and other Western nations include balanced salt solution bags, OVDs, I/A tips and sleeves, phaco tips and sleeves, cas- settes, tubing, cannulas, and syringes. Dr. Robin noted the package inserts includ- ed with IOLs, viscoelastics, MIGS devices, and many other products. They are rarely read and may be out of date by the time they are read. Although not too large, considering that more than 31 million cataract surgeries are done an- nually, the amount of paper wasted is astound- ing, he said. An electronic option or QR code would not only minimize waste but keep the information current when referenced. Disposable instruments, drapes, and gowns are a source for waste, and sterilizing these and reusing them could substantially minimize waste. Drs. Goldburg, Li, Shukla, Qiu, and Sche- hlein noted that the Aravind Eye Care System (AECS) in India reuses all these items for multi- ple patients without sterilization, except for the instruments that contact a patient's eye, which undergo IUSS without wrapping of surgical instruments. 1 "AECS was found to have a POE [postoperative endophthalmitis] rate of 0.04% in 2 million cases using their standard proto- cols, 2 which is identical to the AAO's reported rate of POE in the U.S. 3 The POE rate in the AECS dropped further to 0.01% with adoption Sustainability in glaucoma

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