Waste Reduction in Practice

By John A. Hovanesian, MD

Sustainability is an increasingly urgent topic in ophthalmology. A few years ago, David F. Chang, MD, and colleagues conducted a survey that found 96% of surgical personnel—physicians and staff alike—believe that too much waste is generated in the OR.¹ These findings highlight the need for actionable strategies to reduce waste. Responding to this need, EyeSustain is bringing together industry, administrators, and ophthalmologists in a collaborative effort to implement sustainable practices that minimize waste and lessen our field’s environmental impact.

REDUCING PACKAGING WASTE

One of the most straightforward ways to make eye surgery more sustainable is by reducing packaging. For example, every cataract surgery—one of the most commonly performed procedures worldwide—uses a lens. A recent study showed that even slight modifications in IOL packaging—such as reducing cardboard or plastic components—could cut waste significantly.² In response, several manufacturers are simplifying their IOL packaging.

Another important area for improvement is instructions for use, the paper insert packaged with every IOL. Instead of printing these instructions in multiple languages and nearly doubling the size of an IOL box, a QR code on the package can link surgeons to up-to-date, web-based information. This digital approach both lowers the environmental footprint and ensures the latest data are easily accessible.

INDUSTRY-WIDE INITIATIVES

Alcon’s Green Innovations Surgical Team initiative places sustainability front and center in product development by rethinking product life cycles to reduce waste, plastic usage, and carbon emissions. Other leading manufacturers—Carl Zeiss Meditec, Bausch + Lomb, BVI Medical, Johnson & Johnson Vision, and Oertli, among others—are also making strides in sustainability. Their initiatives range from introducing reusable tubing for phaco systems to reducing and streamlining packaging. The goal is to minimize waste and lower the overall environmental footprint of ophthalmic surgery.

Adopting more sustainable solutions sometimes means returning to earlier practices, such as sterilizing and reusing certain instruments. Concerns over infection rates led to the widespread adoption of single-use items, but mounting evidence shows that reusing properly sterilized instruments does not increase infection risk. A balance can be struck between patient safety and environmental responsibility.

THE EYESUSTAIN PLEDGE

Perhaps the most meaningful step a surgical facility can make is to take the EyeSustain Pledge. By visiting www.eyesustain.org, doctors and their staff can learn about practical, evidence-based measures to reduce their carbon footprint. These often involve steps that any center can implement:

• Using a short instead of a full-body drape to cut down on plastic waste;
• Reusing eye drop bottles until they are empty or expired rather than discarding them after each patient; and
• Choosing alcohol-based surgical scrubs over those that require additional plastic packaging and water use.

These small changes, when adopted at scale, can make a substantial difference.

HOSPITALS, REGULATIONS, AND CHAMPIONS

At large hospital systems, internal champions—often young physicians—can drive significant change. Armed with evidence-based resources from EyeSustain, they can advocate for updated policies and practices. Kaiser Permanente, for example, has adopted more sustainable protocols thanks to the dedication of just a few committed ophthalmologists who have now reduced waste in surgery for hundreds of thousands of patients nationwide.

LOOKING AHEAD

The momentum behind sustainability in ophthalmology is growing. Surgeons, staff, and industry alike are paying closer attention to how their choices affect both patient care and the environment. Everyone has a role to play. Taking the EyeSustain Pledge, exploring more efficient packaging, and pushing for hospital-wide reforms can make ophthalmic surgery a model of responsible, high-quality care.

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. Keyser A, Chang DF, Thiel C, Hovanesian J. Analysis of intraocular lens packaging weight and waste. J Cataract Refract Surg. 2024;50(12):1270-1274.

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Small, Strategic Adjustments: Driving Environmental Impact Without Compromising Patient Care

By Oliver Findl, MD, MBA

Every day in the OR, I am reminded that the choices we make as surgeons extend beyond patient outcomes. From the number of drapes in a cataract pack to the specific instruments we use, our decisions reverberate throughout the entire health care ecosystem. Over the years, I have come to believe that with professional power comes the responsibility—and the unique opportunity—to drive sustainability in our field.

A CALL TO SUSTAINABLE ACTION

The conversation around sustainability has never been more urgent. In the wake of the COVID-19 pandemic, I have witnessed a seismic shift in how we view our practices. Discussions at ESCRS meetings and within industry committees have been particularly eye-opening. Sustainability is no longer just a buzzword—it is a foundational principle that must guide our daily operations.

I recall one meeting in which the focus was on identifying the low-hanging fruit—simple, immediate changes that can significantly reduce environmental impact without compromising quality of care. For example, by removing unnecessary drapes, syringes, and cannulas from our surgical packs, we can achieve an estimated 20% reduction in our carbon footprint per procedure. This is not about cutting corners; it is about optimizing what we already have to serve both our patients and our planet better.

ESCRS SUSTAINABILITY CALCULATOR

I designed the ESCRS Sustainability Index for Disposables in Cataract Surgery (Figure; www.escrs.org/sidics) to give my fellow surgeons the ability to quantify the carbon footprint of their surgical packs. My motivation for developing the calculator was my commitment to sustainable innovation in ophthalmology—the tool enables us to see directly how subtle adjustments in pack composition can lead to significant environmental benefits. These insights have been pivotal in driving change at my institution.

I envision a future when sustainability is a central criterion in supplier selection. I imagine a tender process where quality, cost, and environmental impact carry equal weight. By demanding transparency and leveraging data-driven comparisons, we can inspire suppliers to embrace practices that are not only responsible but transformative for our industry.

REFINING EXISTING PRACTICES

The most meaningful changes often begin with refining current practices. Manufacturers are now prioritizing sustainability from the ground up by selecting less toxic materials, optimizing supply chains to reduce long-distance transport, and redesigning products with environmental impact in mind. These incremental improvements, when multiplied across thousands of procedures each year, have the potential to reshape our environmental footprint dramatically.

THE POWER OF CHOICE IN OUR HANDS

What I want my colleagues to take away from this article is simple: every choice we make has the power to drive change. Our role extends beyond the technical aspects of surgery. As leaders in our field, we bear a responsibility to influence sustainable practices. See Practical Steps for Driving Sustainability for key steps I have found invaluable on this journey.

CONCLUSION

Sustainability in ophthalmology is not an abstract concept—it is an actionable commitment. Through our informed choices, advocacy, and collective effort, our profession can lead the charge toward a greener, more responsible future.