Can changes be made regarding disposable ophthalmic surgery equipment?
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Medication, package inserts, drapes
There is so much waste in our offices and operating rooms, and we do not even think about it anymore. We have to start looking at what is happening and start being observant about where the waste is going.
We started to look at this waste and found out that eye drop bottles were being thrown away after every surgical patient. After talking with the FDA, the CMS and the Joint Commission, we were able to obtain guidance that says drop bottles are not injectables and should only be disposed of at the expiration date if handled properly.
When these bottles are thrown out, that means these medications, from antibiotics to dilating agents, may be going in our drinking water. That is on top of the greenhouse effect cost of all the plastic. It is criminal.
With the guidance to keep reusing eye drops, we should move to larger bottles of medication whenever there is a choice. That way, you are wasting less plastic, and the cost is less.
If we take a wider look at the operating room, we can see how much waste there is. Every IOL and device that we use comes with a package insert. I don’t think I have met anybody who reads those. They are created on the day that the package was made, and by the time we use them, they might be outdated and go right in the trash. What they should have is a QR code to cut back on some of that packaging.
Drapes are another issue. Most hospitals appear to be too lazy to sterilize everything correctly, so we use paper or plastic gowns and drapes. Those kinds of things start to get wasteful.
Alan L. Robin, MD, is an OSN Glaucoma Board Member.
Phaco tips, tubing
When we look at the state of medical waste and sustainability in our country, it is important to see what is being done elsewhere so that we can make changes.
Studies have looked at the amount of waste generated in a single cataract surgery in India vs. what is wasted here in the United States, and the difference is appalling. Then, when you look at the infection rates, you find that it is not any higher in India or, in fact, lower in terms of endophthalmitis with cataract surgery. That means that we are doing a lot of useless things and creating unnecessary waste.
One area in which I think we could make a reasonable change is with phaco tips. There are a number of companies that produce different kinds of tips, some multiuse and some single use. Making the switch to all multiuse tips would be an easy transition and help us cut down on some waste.
We could also look at using reusable phaco tubing. We would have to have good cleaning protocols, but that is another area with a lot of potential for a switch to more sustainable practices.
It could be beneficial to make the switch to more multiuse instruments through the use of proper sterilization. I understand that it makes sense to have a single-use option in cases of emergency or occasional use, but there are a lot of things that we could reuse safely.
In addition to waste in cataract surgery, there are other areas in ophthalmology where we can scrutinize sustainability more closely. One change we could make is in cornea. A lot of centers are still using foam containers for packaging and shipping corneas. Instead, we could use alternatives or at least recycle those containers.
Audrey R. Talley Rostov, MD, is an OSN Cataract Surgery Board Member.
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