In 2020, we published the results of the first large survey of ophthalmologists on OR waste.1 The survey was conducted by the Ophthalmic Instrument Cleaning and Sterilization (OICS) Task Force, which has representatives from the ASCRS, AAO, Outpatient Ophthalmic Surgery Society (OOSS), and Canadian Ophthalmological Society. Of the more than 1,000 ophthalmologists who responded, 98% believed that OR waste is excessive, 78% believed that more surgical supplies should be reused, 91% were concerned about climate change, and 87% wanted their medical societies to advocate for reducing the carbon footprint of ophthalmic surgery.

The strong consensus of opinions captured by the survey inspired EyeSustain.org, a web- and app-based resource center for sustainability in ophthalmology. Its development addressed the need to centralize information and resources related to sustainability in ophthalmology. The website was launched on Earth Day during the 2022 ASCRS Annual Meeting.

FIVE OBJECTIVES

The mission of EyeSustain includes five objectives:

  • No. 1: Engage, network with, and educate the global ophthalmic community about more sustainable practices;
  • No. 2: Collaborate with industry to reduce ophthalmology’s carbon footprint and surgical waste;
  • No. 3: Support research and innovative solutions for reducing ophthalmology’s environmental impact;
  • No. 4: Collaborate with other medical specialties on reducing the carbon footprint of the health care system; and
  • No. 5: Support advocacy and education about the effects of climate change on public health.

THE WEBSITE

Funded initially by the ASCRS Foundation and developed by an advisory board with expertise on sustainability in health care, the EyeSustain.org website has several major sections. One focuses on reducing OR waste and has an online carbon footprint calculator. Relevant studies and position papers from the OICS task force are archived here. Other sections focus on reducing ophthalmic drug waste, making clinics more sustainable, and sharing global best practices in ophthalmology. Each section has a resource library with references to the peer-reviewed literature that can be used to advocate for change within institutions and facilities.

Surgical manufacturers have been invited to share their waste-reducing initiatives in a section dedicated to industry collaboration on making surgery more sustainable. Another section provides pertinent information on the effects of climate change on public health.

COLLABORATION

The European Society of Cataract and Refractive Surgery (ESCRS) and AAO joined ASCRS as cosponsors of EyeSustain.org after its launch. The goal of this partnership is to develop a global coalition of ophthalmic organizations, societies, and their members who are committed to promoting the sustainability of eye care through advocacy, collaboration, and education. Each member society will incorporate sustainability into its educational programs, designate representatives to a global EyeSustain council, and establish a committee on sustainability to engage interested members. For instance, these efforts were on display at the 40th Congress of the ESCRS in September 2022 (congress.2022.escrs.org/sustainability).

An example of the power of collaboration is the OICS task force position paper on topical drug waste in ophthalmic surgery.2 Endorsed by the ASCRS, AAO, OOSS, and American Glaucoma Society, the document was released and posted on EyeSustain.org in April 2022. The evidence-based paper documents the policies of multiple regulatory and accreditation agencies and clarifies that multidose bottles may be used on multiple patients and until the labeled date of expiration.

In our OICS survey, 98% of respondents expressed a willingness to use multidose bottles on multiple patients, but less than half of them were currently doing so.1 The respondents who were practicing in hospitals were far less likely to reuse the bottles than those operating in ambulatory surgery centers.3 A separate unpublished OOSS survey, however, found that 88% of ambulatory surgery centers discarded multidose topical drug bottles at the end of the day, week, or month.

After meeting with the OICS task force, the CMS issued a clarification to its surveyors that topical drops are not subject to the 28-day expiration policy that applies to injectable medications. The OICS position paper also recommends that surgical patients requiring a topical medication not used for other patients be allowed to bring that partially used medication home for postoperative use.2

CONCLUSION

EyeSustain.org makes it easy to locate and share resources such as multisociety position papers with the global community. The aim is to help ophthalmologists around the world effect policy change within their own institutions.

1. Chang DF, Thiel CL; Ophthalmic Instrument Cleaning and Sterilization Task Force. Survey of cataract surgeons’ and nurses’ attitudes toward operating room waste. J Cataract Refract Surg. 2020;46(7):933-940.

2. Palmer DJ, Robin AL, McCabe CM, Chang DF; Ophthalmic Instrument Cleaning and Sterilization Task Force. Reducing topical drug waste in ophthalmic surgery: multisociety position paper. J Cataract Refract Surg. 2022;48(9):1073-1077.

3. Thiel CL, Zhang J, Chang DF. Differences in reuse of cataract surgical supplies and pharmaceuticals based on type of surgical facility. J Cataract Refract Surg. 2022;48(9):1092-1094.