ASCRS News
June 2022
by David F. Chang, MD, and Aakriti Garg Shukla, MD
Amid growing interest and concern from ophthalmologists about the environmental impact of the healthcare sector, a new website to promote more sustainable ophthalmic care was launched and introduced at the 2022 ASCRS Annual Meeting. EyeSustain is a newly established global coalition of ophthalmologists and eye societies seeking to collaborate on making ophthalmic care and surgery more economically and environmentally sustainable. With seed funding from donations to an ASCRS Foundation EyeSustain fund, a committed team of editorial and advisory board members has been designing this new website for the past 5 months. For the first time, timely information and resources for reducing surgical waste and ophthalmology’s carbon footprint will be gathered and freely available in one central location, www.eyesustain.org, for the global ophthalmic community to access.
The environmental impact of surgical waste
Many are surprised to learn that healthcare accounts for nearly 5% of greenhouse gas emissions worldwide and approximately 10% in the U.S.1 In fact, the U.S. alone is responsible for about a quarter of the world’s total global healthcare carbon footprint. ORs are the single largest contributor to this disproportionately high environmental footprint, and the supply chain accounts for the largest percentage of carbon emissions from ophthalmic surgery. Globally, rigid OR regulations that are not evidence-based may substantially increase costs to the healthcare system and to eye patients.
In a survey with more than 1,000 ophthalmologist respondents, 93% thought that OR waste is excessive, 91% were concerned about global warming, and 87% wanted their medical societies to advocate for reducing ophthalmology’s carbon footprint.2 In addition to its environmental and financial impact, needless surgical waste may contribute to periodic supply shortages. Having the highest procedural volumes in medicine, ophthalmology has a unique opportunity to lead efforts to make healthcare more economically and environmentally sustainable. These efforts will ultimately impact global blindness because eyecare and surgery in low to middle income countries is so frequently constrained by limited resources.
Goals and resources
The primary mission of EyeSustain is to engage, network, and educate our global ophthalmic community about more sustainable practices. The website has several major sections with the largest being dedicated to sustainability in the OR. Led by Outpatient Ophthalmic Surgery Society (OOSS) President Cathleen McCabe, MD, and Executive Director Diane Blanck, OOSS has launched several initiatives for reducing surgical waste and will share its surveys along with steps that OOSS members are taking to mitigate wasteful practices. The Ophthalmic Instrument Cleaning and Sterilization (OICS) task force, comprised of members of ASCRS, the American Academy of Ophthalmology, the American Glaucoma Society, and OOSS, is also focused on reducing unnecessary surgical waste. Co-chaired by Dr. McCabe and David F. Chang, MD, the OICS task force’s guidelines, studies, and position papers are available here. Gitanjali Baveja, MD, Zasti chief medical officer and ophthalmologist, has provided a calculator tool that eye surgical facilities can use to measure and monitor their procedural carbon footprint over time. A huge financial and environmental cost is attributable to unused topical medication for cataract surgery. This includes partially used medication opened for individual patients, which they are not allowed to take home following surgery. A separate section of the website, organized by David Palmer, MD, and Alan Robin, MD, is devoted to the problem of excessive drug waste.
Other sections focus on sustainability in the clinic and global sustainability programs and best practices, as well as a focus on advocacy and education about the public health impact of climate change and collaborating with other medical specialties to decarbonize healthcare.
For the section on sustainability in the clinic, EyeSustain has partnered with My Green Doctor and its chief editor, Todd Sack, MD, to provide ophthalmology practices with a stepwise program to “go green” while saving water, energy, and money. EyeSustain also seeks to collaborate with industry on ways to reduce our surgical carbon footprint. John Hovanesian, MD, heads a dedicated section through which companies can report on and share their efforts to reduce carbon emissions and waste.
A section on global sustainability programs and best practices is led by Dutch ophthalmologist Sjoerd Elferink, MD. Within this section, Rengaraj Venkatesh, MD, has shared many of the innovative ideas that the Aravind Eye Care System has implemented to reduce their environmental impact. Finally, EyeSustain seeks to support advocacy and education about the public health impact of climate change and to collaborate with other medical specialties to decarbonize healthcare. A section dedicated to these issues is led by Barbara Erny, MD, who serves on the steering committee of the Medical Society Consortium on Climate and Health, and Cassandra Thiel, PhD, an expert on the environmental impact of healthcare.
Become involved
EyeSustain plans to engage and inform ophthalmologists through a mobile app and welcomes volunteers to support this global effort. Aakriti Garg Shukla, MD, will be chairing a Young Eye Surgeons subcommittee on sustainability. The European Society of Cataract & Refractive Surgeons has joined ASCRS as a co-sponsor of EyeSustain. This is an open global coalition, and we invite other ophthalmic organizations to join the Asia-Pacific Association of Cataract & Refractive Surgeons in becoming participating societies.
References
- Eckelman MJ, et al. Health care pollution and public health damage in the United States: an update. Health Aff (Millwood). 2020;39:2071–2079.
- 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;46:933–940.
