Eyeworld

10 | EYEWORLD | WINTER 2025 ASCRS NEWS EYESUSTAIN UPDATE References 1. Multiuse Phaco Cassettes. Position paper. www.eyesustain. org/resource-library/position-pa- pers/multiuse-phaco-cassettes. 2. Chang DF, Thiel CL. Survey of cataract surgeons' and nurses' attitudes toward operating room waste. J Cataract Refract Surg. 2020;46:933–940. 3. Chang DF, Elferink S, Nuijts RMMA. Survey of ESCRS mem- bers' attitudes toward operating room waste. J Cataract Refract Surg. 2023;49:341–347. 4. Chang DF, See W. APAO survey of cataract surgeons' attitudes toward operating room waste. Asia Pac J Ophthalmol (Phila). 2025 Sep 5:100243. Online ahead of print. 5. Chang DF, Haripriya A. Post- operative endophthalmitis rate associated with routine off-label reuse of single use phacoemul- sification cassettes in more than 1,000,000 consecutive surgeries. Asia Pac J Ophthalmol. 2025 Sep 27: 100247. Online ahead of print. 6. Ghoraba HH, Haque ME, et al. Incidence of endophthalmitis after cataract surgery in the setting of uveitis and immuno- suppressive therapy within the IRIS ® Registry. Ophthalmology. 2025;132:1253–1259. by David F. Chang, MD Chair of the EyeSustain Advisory Board lens material and irrigation fluid are sterile, there is no evidence that single-use phacoemul- sification cassettes are safer compared to reus- able cassettes, and many facilities worldwide have been reusing single-use cassettes off-label for years. Surveys of cataract surgeons' practice pat- terns and attitudes toward operating room (OR) waste have been conducted in North America, Europe, and most recently, Asia Pacific. 2-4 In each survey, more than 90% of ophthalmolo- gists thought that surgical waste is excessive, wanted more reusable supply options from manufacturers, and wanted more discretion from manufacturers and policymakers to reuse certain products. In each survey, approximate- ly 75% of respondents were willing to reuse phacoemulsification tubing/cassettes and un- used irrigation solutions. However, there were large regional differences in the percentage of surgeons that were currently reusing these products. Phacoemulsification tubing/cassettes were being reused by 41% of respondents in Asia Pacific, compared to 21% in Europe and 7% in North America. 4 This presumably reflects geographic differences in regulations governing off-label reuse of single-use supplies. As an example, the Aravind Eye Care System's (AECS) 15 eye hospitals in southern India routinely reuse a single-use phacoemulsi- fication tubing/cassette for the entire surgical day's caseload of 20–30 procedures. We recently reported that their postoperative endophthal- mitis (POE) rate with this protocol was 0.01% in 1,133,959 consecutive phacoemulsification procedures performed during the 9-year period between 2016 and 2024. 5 This was lower than the 0.06% POE rate in 9,587,018 cata- ract surgeries from the American Academy of Ophthalmology (AAO) Intelligent Research in Sight (IRIS) Registry during an overlapping 10-year period from January 2013 to March 2023. 6 Intracameral moxifloxacin prophylaxis was used in every procedure at AECS during this period, which would not have been true of the IRIS Registry population. However, be- cause of U.S. regulations, virtually all the IRIS Four regional multinational societies release a joint position paper on multiuse phacoemulsification supplies continued on page 12 The "reduce, reuse, and recycle" slogan became popular in the 1970s with the passage of the Re- source Conservation and Recovery Act. In medicine, it is critical that we are able to safely transition to the reuse and multiuse of items in the most frequency performed procedures. In this EyeSustain Update, we feature David F. Chang, MD, co-found- er and chair of the EyeSustain Advisory Board, discussing the new position paper advocating for multiuse phacoemulsification cassettes. —Emily Schehlein, MD EyeSustain Update Guest Editor T he four regional multinational soci- eties of cataract and refractive sur- geons have jointly endorsed a position paper 1 on the importance of multiuse phacoemulsification cassettes to safely reduce unnecessary surgical waste and carbon emissions. Identifying this as a major unmet need in cataract surgery, the position paper calls on industry to prioritize development of multi- use supply options for every phacoemulsification machine platform and for regulatory agencies to facilitate review and approval of these products. This is the first time that the American Society of Cataract and Refractive Surgery (ASCRS), the European Society of Cataract and Refractive Surgeons (ESCRS), the Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS), and the Latin American Society of Cataract and Refractive Surgery (LATAMSCRS) have collaborated on a joint position paper—in this case speaking to industry and policy makers with a unified voice on behalf of cataract sur- geons worldwide. The paper was developed in conjunction with EyeSustain, a global coalition of 55 ophthalmology societies collaborating to advance sustainability in eyecare through edu- cation, research, innovation, and advocacy. This position paper is an evidence-based re- view of the global phacoemulsification cassette market, global survey data on surgeon practices and opinions, and published evidence support- ing cassette reuse safety and the impact of this practice on unnecessary carbon emissions and non-recyclable plastic waste. Considering that

• Cover