The healthcare sector is a major contributor to greenhouse gas emissions, comprising 10% of emissions in the United States, and operating rooms produce most of the waste and emissions.^1,2 Because cataract surgery is the most performed surgery in the United States, ophthalmic ASCs are uniquely positioned to make meaningful change in the environmental impact resulting from current practices.³

In a recent editorial in the Journal of Cataract and Refractive Surgery, David Chang eloquently highlighted the importance of sustainability in ophthalmology. He noted that “because our specialty has the highest procedural volumes, ophthalmology has a compelling opportunity and obligation to lead efforts within medicine to make our essential services more sustainable.”⁴

One of the most significant ways ASCs can reduce waste is by implementing environmentally friendly practices in the operating room. This includes using reusable surgical supplies whenever possible, analyzing what is in custom packs to eliminate items rarely used and often thrown away, eliminating pharmaceutical waste by using multidose bottles on multiple patients and until the expiration date, allowing patients to take home unused and opened bottles that are part of the postoperative treatment plan, and looking for ways to recycle, repurpose, or re-sterilize disposables.

The April 2023 issue of the Journal of Cataract and Refractive Surgery also featured an article on the European Society of Cataract and Refractive Surgeons (ESCRS) survey of sustainability in ophthalmology.⁵ The survey aimed to assess the awareness and implementation of sustainable practices among ophthalmologists in Europe, and was compared with a similar survey of US surgeons previously reported in 2020.⁶

The two surveys were remarkably similar and found that 99 percent of surgeons in Europe and 93 percent in the US survey felt that operating room waste was excessive. Some of the factors driving operating room waste included safety concerns (71 percent), emphasis on profitability with single-use items by manufacturers (74 percent), excessive packaging of single-use items (70 percent), lack of environmental impact considerations (73 percent), and manufacturers’ liability concerns (67 percent). Both surveys reported 96 percent of respondents felt we should look for ways to reduce operating room waste.

We know we can do better without compromising safety. The Aravind Eye Care System of hospitals in India routinely reuses many routine cataract surgery items that are disposed of as single use in the United States. The reported endophthalmitis rate (0.04 percent in 2 million consecutive cases) was equal to the rate reported for 8.5 million cataract surgeries listed in AAO’s Intelligent Research in Sight Registry (IRIS) during the same time frame, all while producing 1/20th of the carbon emissions produced in the United Kingdom.^7-9

Partnering with industry to support efforts to reduce waste, and especially clearly communicating the level of interest by surgeons in reducing waste, is a first step. Already, industry leaders are finding ways to shift to more environmentally friendly practices, such as packaging with recycled and biodegradable materials, converting printed directions for use to QR codes and thereby allowing for a reduction in packaging size and materials, adding sustainability as a decision driver in new innovations, and participating in discussions and problem solving around sustainability in the operating room.

But sustainability isn’t just about reducing waste and decreasing greenhouse gas emissions. It’s also about ensuring that our ASCs are financially sustainable for the long term. By implementing environmentally friendly practices, we can save money on energy and supply costs, weather unpredictable disruptions in supply chains, decrease the cost of managing waste, decrease the need for additional supply storage, and devise processes that can help us remain financially viable in a rapidly changing healthcare landscape.

A collaborative effort to prioritize and organize information and ideas on sustainability was launched at the ASCRS meeting in April 2022 with the creation of the EyeSustain.org  website. This global effort comprised of ophthalmologists and associated societies was co-sponsored by ASCRS, AAO, and ESCRS and currently has over 20 member societies. The website is a continually updated source of information on sustainable practices globally, and a resource for calculating your carbon footprint, learning how to adopt more sustainable practices, and finding published data on global sustainability efforts.

Ultimately, sustainability is about more than just protecting the environment. It’s about ensuring that our ASCs can provide high-quality care for our patients for years to come. ■

References are available in the online version of this article.

Cathleen M. McCabe, MD is the immediate past president of OOSS as well as chief medical officer of Eye Health America and medical director of The Eye Associates in Bradenton, Florida.