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  • How YOs Can Be Catalysts for Sustainability

    Our health care system accounts for nearly 10% of the nation’s greenhouse emissions, and ophthalmology is uniquely positioned to lead the charge in controlling health care-associated greenhouse gas emissions.

    Operating rooms account for over 30% of the carbon footprint the health care system creates. Given that cataract surgery and intravitreal injections are the most commonly performed procedures in the U.S., reducing waste and emissions during our operations has the potential to make a significant and lasting impact. 

    David F. Chang, MD, clinical professor at the University of California, San Francisco, has been a leader in the sustainability space for many years. He is the chair of the American Society of Cataract and Refractive Surgery (ASCRS) Foundation, a past ASCRS president and executive board member, current co-chair of the Ophthalmic Instrument Cleaning and Sterilization Task Force and a member of the Medical Society Consortium on Climate and Health steering committee. 

    More recently, he led the development of EyeSustain — a global coalition of ophthalmology societies charged with improving sustainability in ophthalmic practice. I recently sat down with Dr. Chang, to share his thoughts on how young ophthalmologists can be catalysts for change to adopt more sustainable practices in ophthalmology. Here are his views.

    How did you get involved in sustainability efforts? 

    Dr. Chang: I have co-chaired a multisociety task force that was initially established to develop specialty-specific, ophthalmic instrument cleaning and sterilization guidelines. This work was prompted in large part by the need to defend short cycle sterilization of ophthalmic instruments. Although this was widely accepted for cataract surgery worldwide, the Centers for Medicare & Medicaid Services (CMS) decided in 2014 that immediate use steam sterilization should not be used routinely. 

    Through this work, I came to understand how infection control guidelines are developed by organizations such as the Centers for Disease Control and Prevention (CDC) and Association of PeriOperative Registered Nurses (AORN), how device manufacturers write and validate their instructions for use with the Food and Drug Administration, and how licensing and accrediting bodies, such as CMS, then create and enforce the regulations governing operating rooms. 

    The result of the 2014 decision by CMS is a situation where: 1) surgeons lost any discretion to reuse appropriate products, and 2) broad infection control guidelines for general surgery are applied to ophthalmic cases by default, even though they may not be appropriate or necessary.

    The other factor was my longstanding collaboration with the Aravind Eye Hospitals in India on a variety of clinical research projects. In studying intracameral antibiotic prophylaxis, we found that Aravind’s routine reuse of gowns, gloves, and most surgical supplies did not increase their infection rate compared with the U.S., where each of these practices is disallowed. This means that so much of our surgical waste is unnecessary and is instead a product of the way that CMS has chosen to enforce infection control recommendations and manufacturers’ guidelines.

    What do you think is most important for YOs to understand when it comes to engaging in sustainability? 

    Dr. Chang: It starts with education and understanding that unnecessary OR waste loses money, aggravates supply chain shortages, and contributes significantly to landfills and greenhouse gas emissions from the health care sector. 

    Although we should all be alarmed, unsustainable spending and waste are unfortunately going to impact today’s early career ophthalmologists more than my generation. Changing embedded policies, biases and behaviors is difficult and requires leadership. Within every surgical facility and ophthalmology department, YOs can be the catalysts for change.

    What is EyeSustain?

    Dr. Chang: EyeSustain is a global coalition of eye societies and their members who are collaborating to make ophthalmic care and surgery more sustainable. It is co-sponsored by ASCRS, the American Academy of Ophthalmology and the European Society of Cataract and Refractive Surgeons. More than two dozen additional global organizations have joined us as member societies. Our website serves to centralize information and resources on sustainability for the entire global ophthalmic community.

    I hope that EyeSustain can educate, motivate, and empower YOs to take on this cause. Download the EyeSustain app and join this community of like-minded, concerned ophthalmologists around the world. Network and share what steps you have taken — how have you educated your nurses and administrators and instigated change? Share your thoughts on social media.

    What can we expect from EyeSustain in the future? 

    Dr. Chang: EyeSustain is developing a sustainability pledge that every individual surgical facility can take. This includes things like recycling; multidosing topical drops on multiple surgical patients; eliminating seldomly used items from custom packs; switching to waterless scrubbing; and eliminating patient hospital gowns and full-body drapes for ophthalmic surgery. 

    What YOs Can Do Now

    With a small investment of time, resources on the EyeSustain website will make you more knowledgeable about sustainability in ophthalmology than anyone else in your department or ambulatory surgery center. As a YO, knowledge can be empowering and can enable you to make a lasting impact when no one else is stepping forward.

    You can take immediate action to address carbon emissions and waste in the health care system: Ensure that our institutions are recycling and using best practices to reduce waste in both the clinic and operating room. They are important first steps to doing our part to combat climate change. We must support our leaders in both government and our institutions who are committed to taking action to help protect the health of our communities and patients. 

    Nathan L. Scott, MD, MPP About the author: Nathan L. Scott, MD, MPP, is an assistant professor of clinical ophthalmology and chief of the ocular oncology division at the Shiley Eye Institute at the University of California, San Diego. He was the Academy’s Robert A. Copeland Jr. Advocacy Education Fund recipient in 2019 and is a member of the Academy’s YO Advocacy Subcommittee.