How Ophthalmology Waste Is Impacting the Environment

Ophthalmology’s high procedural volume and reliance on disposable materials, eye drops, and excessive packaging contributes significantly to the healthcare industry's environmental footprint. Cataract surgery, for example, is the most demanding procedure among medical specialties and can generate up to 181.9 kg of carbon dioxide equivalents per procedure. More than 50 percent of greenhouse gas emissions in ophthalmology, too, come from supply procurement for materials used for surgery, according to the BPOS. There exists notable international disparities in sustainability practices in the eyecare space, and, as healthcare providers, it will be crucial to mitigate the industry’s environmental impact to protect global health for the future.

The transition to sustainable practices poses several challenges – including legislative barriers that can hinder the adoption of greener technologies or materials. Maura Di Nicola, Assistant Professor of Clinical Ophthalmology at the Bascom Palmer Eye Institute, Miami, told The Ophthalmologist that “On a local level, institutional policies sometimes lag behind the latest evidence-based practices, leading to unnecessary waste for a prolonged period of time.” She says that “an additional barrier comes from a lack of financial incentives for manufacturers to invest in sustainable practices, such as gaining approval for multi-use surgical instruments.”

Di Nicola also explains that when it comes to recycling, the higher cost compared to producing new materials, particularly plastics, can make it difficult to justify recycling efforts, especially in the short term. Moreover, training staff on recycling methods can be time-consuming, and the adoption of electronic pamphlets – and other digital alternatives – can be met with resistance due to cultural factors and concerns about safety and efficacy. While it is understandable that there would be some concerns regarding various green initiatives, it is a hurdle that will require concerted effort to be overcome.

Recent advancements in this industry actively seek to reduce the environmental footprint of the operating room, the clinic, and beyond. This includes the use of disposable vials and eyedrops, as well as excessive packaging and pamphlets. “It has been demonstrated that the risk of cross-contamination for multi-use eyedrops decreases significantly with proper staff training,” adds Di Nicola. “Both the American Academy of Ophthalmology (AAO) and American Society of Cataract and Refractive Surgeons (ASCRS) have supported the use of multi-dose eyedrops on multiple patients, as long as proper protocols are routinely followed.”

Small changes, like replacing physical instruction pamphlets with QR codes for many of the disposable items, can reduce packaging waste by up to 50 percent while simultaneously lowering transportation costs. The European Society of Cataract and Refractive Surgeons (ESCRS) conducted a cataract pack analysis across 44 surgical centers, creating a “lowest common denominator” pack and developing an online tool so facilities can identify how they can change their cataract packs to reduce costs and emissions. Waterless scrub techniques and reusable face drapes have also proven to be effective alternatives to traditional disposable items. Some facilities are even reusing surgical tips and blades, and sterilizing them on-site to minimize waste.

Achieving a global buy-in for a sustainability mindset will ultimately decide whether or not we can address the pressing environmental issues our planet faces. Di Nicola states that, beyond the benefit to the environment, the economic benefits of more sustainable practices can help achieve this. “It has been shown that reducing the number of instruments in vitrectomy trays can result in significant cost savings. In resource-limited settings, sustainable practices have become the norm, demonstrating that it is possible to maintain high standards of care while minimizing waste.”

While legislative changes – such as the Topical Medical Waste Reduction Act – are paving the way for more sustainable practices, there is still much to be done. Indeed, the so-called future of this space will depend on implementing institutional and national legislation that promotes environmental sustainability practices; policies that offer economic incentives for manufacturers to adopt sustainable practices; and the implementation of small, actionable changes that can help build a more sustainable future. “By working together towards these goals, we can create a more environmentally responsible and sustainable future for our profession,” Di Nicola concludes.