In 2022, an audit of waste produced from an outpatient surgery center in Indiana on a typical day showed that, among specialties operating that day (plastic surgery, otolaryngology, ophthalmology and urology), ophthalmology produced the least amount of surgical waste per case.
However, ophthalmology produced the greatest amount of waste overall: 15 out of 30 scheduled operations performed by ophthalmologists. All were from phacoemulsification. With the majority of surgery centers operating under minimal to nonexistent recycling or alternative disposal practices, ophthalmic waste literally piles up each day.
Within ophthalmology, protecting the environment requires minimizing waste produced in practice while optimizing resources used through changes in practice protocols.
These acts of conservation promise both resource and cost savings. A 2021 JAMA Ophthalmology study on pharmaceutical waste in cataract surgery reported that a cumulative 45.3% of pharmaceuticals a month went unused across four different practice settings, including private and federally run operations. Their practices contributed to an estimated $36,900 to $195,200 across each site in annual unused product costs; an annual average of $119,475 in unused pharmaceuticals at each site,, according to the study.
Data like this calls for broad change in ophthalmic and surgical practices. Three states have already signed into law legislation allowing patients to take home topical medications used in surgery if needed for post-operative care. The goal is to reduce waste and duplicate purchases.
Moreover, a multisociety policy paper “Reducing Topical Drug Waste in Ophthalmic Surgery” — co-authored by the American Society of Cataract and Refractive Surgery, the American Glaucoma Society and the Outpatient Ophthalmic Surgery Society — was endorsed by all 52 state ophthalmological societies.
In other areas of the world, ophthalmology is changing the practice of surgery as we know it. Southern India’s Aravind Eye Care System (AECS) demonstrates daily how quality care, case volume and low-waste practices can be optimized in surgery, and at little to no cost for many patients. Practices at AECS include drastically cutting emissions through in-house production of supplies, tailoring the sorting, cleaning, and disposal of surgical supplies to balance patient safety and product lifespan and adjusting operating room procedures to maximize productivity and surgical quality through significant collaboration among all staff.
In synergy, these efforts create a care system that produces carbon emissions at 5% of those produced in the United Kingdom per phacoemulsification while maintaining similar complication rates.
Recent efforts to address sustainability in ophthalmology have led to the creation of EyeSustain, an international organization dedicated to improving the sustainability of ophthalmic practice worldwide through collaboration, resource sharing and mutual empowerment from the individual to specialty society level.
So, where do you fit in? Whether you’ve acted upon or noticed or are just learning about issues related to sustainability in medicine and ophthalmology, your engagement is exceedingly valuable and necessary. Here are three ways you can contribute:
- Advocate for and discuss sustainability. From your practice to state level and beyond, calling for improved sustainability can lead to both practice and health system change and inspires others to take action.
- Research sustainable practices. Explore new ways to make sustainable best practices a reality.
- Cultivate sustainable action and build community. Share and discuss ways you’ve made sustainability a best practice through community engagement with academic institutions, ophthalmology societies and other community organizations.
This is only the beginning of addressing sustainability in ophthalmology. Whether you’re just beginning your career or a seasoned vet, today is a great day to get involved.
About the author: Margaret Tharp is an MS-3 at Indiana University School of Medicine in Indianapolis. Her sustainability efforts in medical school include co-establishing the IU School of Medicine chapter of Medical Students for a Sustainable Future, conducting a waste audit at an outpatient surgery center in her hometown Evansville, Ind., and involvement in climate advocacy efforts within her state medical association. She hopes to keep climate and sustainability work as key components of her career.
The Academy is a sponsoring society of EyeSustain.
The Academy also has a Task Force on Sustainability and has several sustainability activities, including My Green Doctor for Academy members, advocacy efforts, and an environmentally conscious Annual Meeting in SF.
Read about Meg Tharp’s article on medical waste produced during ophthalmic procedures. See p. 82.