Biosimilars

COVID-19

Cataract Surgery

Cataract

Cataract Therapeutics

Clinical Diagnosis

Cornea

Dry Eye Awareness

Dry Eye

Gene Therapy

Geographic Atrophy

IOL Advances

Imaging

Glaucoma Awareness

Glaucoma Insights

Therapeutic Glaucoma

Interventional Glaucoma

Ocular Allergy

Ocular Surface Disease

Optic Relief

Optometry

Pediatrics

Pharmacy

Indispensable

Practice Management

Presbyopia

Ptosis

Refractive Surgery

Refractive

Retina

Surgery

Technology

Therapeutics

Understanding Antibiotic Resistance

Workplace

News

All News

Contributors

Money Matters

Media

Expert Interviews

Medical World News

Podcasts

Case Based Roundtable Series

Case of the Quarter

EyeView

Grand Rounds

Insights

Rapid Readout

Viewpoints

What’s Your WhEYE?

Conferences

Conference Coverage

Conference Listing

Events

Publications

Digital Edition

Europe Ophthalmology Times

Modern Retina

Supplements and Featured Publications

Partners

Subscribe

Resources

Job Board

About

Advertise

Privacy

Editorial

Terms and Conditions

Contact Us

Do Not Sell My Personal Information

Ophthalmology Times - Ophthalmology news, articles, and events

Facebook

Instagram

LinkedIn

Spotlight

Clinical

Glaucoma

1rem

Authors

Cystoid macular edema can permanently alter vision, so it is highly crucial to utilize best practices for treating the cataract surgery complication.

Key strategies for treating postsurgical CME

A recurring feature at the 2024 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting in Boston, Massachusetts, was the call for environmentally friendly practices worldwide, with the goal of decreasing the impact of ophthalmic surgeries on the planet.

A driving force in this movement is EyeSustain

 an organization dedicated to the development of such friendly environmental practices, that exists as a global coalition of eye societies providing education and resources to support sustainable practices in ophthalmology.

Here is a sampling of the ASCRS discussions on the topic.

Greening eye care: reducing ophthalmology’s environmental footprint

The presenters, led by first author Sarishka Desai, BA, described the EyeSustain platform and its 5-pronged mission: educate the global ophthalmic community about more sustainable practices, collaborate with industry to reduce our carbon footprint and surgical waste, support research and innovative solutions that reduce ophthalmology’s environmental impact, support advocacy and education about the public health impact of climate change, and collaborate with industry to reduce our carbon footprint and surgical waste.

Desai, of the University of Connecticut School of Medicine in Farmington, and colleagues presented EyeSustain’s approach to reducing the ophthalmic carbon footprint. She was joined in the study by Nitya Devireddy, BS, MPH, of Penn State College of Medicine in Hershey, Pennsylvania; Sofia Miguez, BA, of Yale School of Medicine in New Haven, Connecticut; and Barbara Erny, MD, of the Department of Ophthalmology at Stanford University in California.

The greenhouse gas data associated with health care are startling. Health care is responsible for 4.4% of all global greenhouse gas emissions, 71% of which arise from the manufacturing, use, and disposal of medical supplies. Ophthalmology has the highest procedural volume of any surgical specialty, with 50 million cataract surgeries expected to be performed globally each year by 2050, Desai reported.

In light of the procedural data, the authors highlighted 6 areas that are currently undergoing research and quality improvement initiatives through the EyeSustain system.

 of cataract surgeons and nurses by David Chang and Cassandra Thiel found that 93% of respondents believe that the trash associated with OR procedures is excessive, and that methods to reduce waste should be identified and implemented.

 encouraged regulatory agencies to allow electronic instructions for use be disseminated in lieu of the traditional paper instructions included with each cataract pack.

Ongoing projects spearheaded by EyeSustain members, including medical students and ophthalmology residents, are taking a look at educating surgeons and surgical staff about sustainability and the impact of OR waste, OR water consumption, and evaluation of flash sterilization associated with cataract surgery.

In recognition of the fact that medications in the OR represent an estimated $560 million in waste annually, a multisociety position paper

 recently formulated 3 key recommendations: topical drugs in multidose containers can be used for multiple patients in surgical facilities if proper guidelines are followed; topical drugs in multidose containers can be used until the manufacturer’s labeled date of expiration if proper guidelines are followed; and, when applicable, patients should be able to take their partially used medication home for postoperative use.

The Aravind Eye Care system’s low-carbon model from Madurai, India, uses alternate energy sources, transport, infrastructure, and equipment maintenance.

 Studying global systems of eye care and waste produced can provide a deeper understanding of the impact of hospitals and providers on climate change, as well as ideas on how western eye care systems can proactively reduce carbon emissions.

The EyeSustain platform includes ophthalmology-specific action steps for greening offices and clinics in collaboration with the 

Partnerships can be established with large manufacturers to reduce packaging, make instruments reusable, and streamline the manufacturing and distribution processes.

In addition to the impact of practice waste on the environment, EyeSustain also recommends studying the effects of climate change on the incidence rates of ophthalmologic conditions, including cataracts, allergic disease, and glaucoma, among others.

Desai and her colleagues recommended that institutions take the following steps:

Conduct a waste audit to quantify the carbon footprint of an institution’s OR emissions. This includes using the EyeSustain-Zasti Carbon Footprint Calculator, using the Sustainability Index for Disposables in Cataract Surgery calculator for cataract packs to evaluate the item-by-item potential for carbon dioxide savings, and surveying clinical staff to identify areas of perceived excess waste.

Identify key stakeholders at an institution and an enthusiastic, multidisciplinary team and completing the OR Sustainability Pledge (

), which has been completed by ambulatory surgery centers/hospital outpatient departments from 9 countries thus far.

Implement best practices; multisociety recommendations for sustainability are easily accessible at eyesustain.org and My Green Doctor for outpatient/clinic resources and local legislation using the American Academy of Ophthalmology Topical Medical Waste Reduction Act legislative template.

Using phacoemulsification waste to guide changes in surgical sustainability

Adjustments to improve the sustainability of ophthalmic surgical practice can have a large impact when scaled to case volume, according to author Margaret Tharp, BSc, who described this study at the ASCRS meeting. She and her coauthors Stella Protopapas, BA, MPH, and Minka Gill, BSc, are from the Indiana University School of Medicine in Bloomington, whereas David J. Palmer, MD, ABO, is from the Northwestern University Feinberg School of Medicine in Chicago, Illinois.

In their study, they sought to draw connections between results from a 24-hour waste audit at an outpatient surgical center and current resources available from EyeSustain to improve the sustainability of ophthalmic surgical practice.

The authors documented the extensive waste generated from 1 day of surgeries in an institution that included 13 phacoemulsification procedures, 5 plastic surgeries, 3 urologic surgeries, and 5 otolaryngologic cases. The waste products were sorted as medications (eg, propofol, eye drop containers), textiles (eg, surgical gowns, drapes), metals (eg, metal wiring, disposable instruments), and plastics (eg, hard, soft, wrappings).

When the amounts of the waste products were tallied, the authors found that “ophthalmology produced the greatest amount of waste in a single day relative to other operating specialties, despite producing the least amount of waste per case. Most ophthalmic waste was from textiles, hard plastics, and medications,” the authors reported.

The specific 13 phacoemulsification procedures resulted in 95.4 lb of waste broken down as follows: 18.5 lb of hard plastic, 5.5 lb of soft plastic, 8.3 lb of wrapping, 13.5 lb of medications, 41.2 lb of textiles, 6.7 lb of miscellaneous waste, and no metals. Compared with other operating specialties, ophthalmology produced the least amount of waste per case but the greatest amount of waste in total due to the relatively high case volume.

It has been reported that “discarded/unused pharmaceuticals from US cataract surgeries demonstrated waste of [approximately] $150 per case while generating carbon dioxide–equivalent emissions that approximated 25,000 to 100,000 flights from San Francisco, California, to Boston annually.

Small changes can have dramatic results. Tharp and colleagues suggested that the following would have positive consequences.

Revising the use of tetracaine bottles intraoperatively; for example, reusing the bottles between cases or sending the bottles home with patients

Optimizing packaging of surgical supplies and electronic instructions

Utilizing intravenous sedation to limit anesthesia gas carbon dioxide–equivalent emissions

Focusing on cutting waste also creates an opportunity to explore the practices of global leaders in sustainable eye care, such as the efforts of the Aravind Eye Hospitals, which provide similar surgical success rates at a fraction of the waste produced by US practices.

 A downside may be that such practices require significant reuse of materials, central sterilization, and stakeholder diligence, which can require complex interventions, according to Tharp. 

EyeSustain’s Surgical Facility Sustainability Pledge can serve as a guide for ophthalmologists to improve the sustainability of their practice in an approachable and lasting manner.

Factors contributing to the carbon footprint of cataract surgery

Omar Taboun, MSc, a medical student at Western University’s Schulich School of Medicine & Dentistry in London, Ontario, Canada, working under the direction of Netan Choudhry, MD, FRCSC, also described the negative impact of cataract surgery on the environment at the ASCRS meeting.

He commented, “We know that climate change can affect human health through various means, such as adverse weather events causing injury and exposure to pollutants [exacerbating] underlying health conditions. As health care providers, it is our responsibility to treat patients for their conditions that may ultimately be influenced by environmental factors. Counterintuitively, the health care sector is itself a greenhouse gas emitter,” Taboun said.

Surgery contributes significant emissions to the environment through the necessary materials and tools used during procedures. In addition, the need to maintain sterility increases waste.

The term footprint indicates the sum of all emissions direct and indirect resulting from this procedure, Taboun explained, the resultant value of which is typically reported in carbon dioxide equivalents

And although cataract surgery requires only a few minutes to complete, the procedural volume has increased exponentially over the past 2 decades,

Taboun and colleagues developed a 2-fold goal: they wanted to increase their understanding of the carbon footprint and waste accumulation to identify the primary contributors and pinpoint areas for improvement to enhance the sustainability of cataract surgery.

They conducted a literature search of PubMed, Google Scholar, and Medline to identify studies related to the carbon footprint and the elements of cataract surgery. The results yielded 6 studies, with 2 being the basis for this discussion,

He highlighted 3 main points extracted from the published data: the lowest footprint published was just under 6 kg of carbon dioxide equivalents; the highest published footprint was just over 180 kg of carbon dioxide; and the major factors contributing to the footprint include procurement of pharmaceuticals and materials, building and energy use, such as heating/cooling, lighting, electricity-powered tools, and travel by patients and staff to the location where the procedure is performed.

Taboun directed attention to centers that already have sustainable practices in place, such as the Aravind Eye Hospital, which reports the lowest footprint. These sustainable practices include the use of multiple operating tables in a single room; reusing gloves, gowns, and various medical equipment;

and using highly efficient autoclave settings.

Importantly, when these changes were implemented in the Aravind Eye Hospital,

 the rates of endophthalmitis remained comparable to other centers: 0.02% vs from 0.04% to 0.07% reported.

Taboun offered 3 ways that surgeons can offset the negative effects of cataract surgery on the environment—by focusing on procurement, energy use, and travel emissions.

Reduce emissions associated with procurement by collaborating with manufacturers to reduce packaging as much as possible and encouraging recycling in every OR.

Reduce building and energy use by incorporating renewable energy, such as solar panels, and more strategic lighting protocols and optimizing energy use within surgical centers.

Establish outreach clinics closer to more populous regions, whereby mostly staff members must travel, and patients less so, which will reduce travel emissions, along with performing bilateral procedures.

“Implementing sustainable practices, although challenging, will allow us to continuously provide this procedure and restore vision for millions of people at less of a cost to the environment,” Taboun said.

1. Chang DF, Thiel CL; Ophthalmic Instrument Cleaning and Sterilization Task Force. Survey of cataract surgeons’ and nurses’ attitudes toward operating room waste

. 2020;46(7):933-940.doi:10.1097/j.jcrs.0000000000000267

2. Schehlein EM, Hovasesian J, Shukla AG, Talley Rostov A, Findl O, Change DF. Reducing ophthalmic surgical waste through electronic instructions for use: a multi-society position paper. 

. 2024;50(3):197-200. doi:10.1097/j.jcrs.0000000000001381

3. Cleaning and Sterilization Task Force. Reducing topical drug waste in ophthalmic surgery: multisociety position paper

. 2022;48(9):1073-1077; doi:10.1097/j.jcrs.0000000000000975

4. Goel H, Wemyss TA, Harris T, et al. Improving productivity, costs and environmental impact in International Eye Health Services: using the ‘Eyeficiency’ cataract surgical services auditing tool to assess the value of cataract surgical services. 

. 2021 ;6(1):e000642. doi:10.1136/bmjophth-2020-000642. 2021

5. US EPA O. Greenhouse gas equivalencies calculator. United States Environmental Protection Agency. Updated January 2024. https://www.epa.gov/energy/greenhouse-gas-equivalencies-calculator

6. Gadani H, Vyas A. Anesthetic gases and global warming: [otentials, prevention and future of anesthesia. 

. 2011;5(1):5-10. doi:10.4103/0259-1162.84171

7. Thiel CL, Schehlein E, Ravilla T, et al. Cataract surgery and environmental sustainability: waste and lifecycle assessment of phacoemulsification at a private healthcare facility. 

. 2017;43(11):1391-1398. doi:10.1016/j.jcrs.2017.08.017

8. Pandey D, Agrawal M, Pandey JS. Carbon footprint: current methods of estimation. 

. 2011 ;178(1-4):135-160. doi:10.1007/s10661-010-1678-y

9. Pandey D, Agrawal M, Pandey JS. (2011). Carbon footprint: current methods of estimation. 

. 2011;178(1-4):135-160. doi:10.1007/s10661-010-1678-y

10 Rachmiel R, Trope GE, Chipman ML, Buys YM. Cataract surgery rates in Ontario, Canada, from 1992 to 2004: more surgeries with fewer ophthalmologists. 

11. Morris DS, Wright T, Somner JEA, Connor A. The carbon footprint of cataract surgery. 

. 2013;27(4):495-501. doi:10.1038/eye.2013.

12. Latta M, Shaw C, Gale J. The carbon footprint of cataract surgery in Wellington. 

13. Ravindran RD, Venkatesh R, Chang DF, Sengupta S, Gyatsho J, Talwar B. Incidence of post-cataract endophthalmitis at Aravind Eye Hospital: outcomes of more than 42,000 consecutive cases using standardized sterilization and prophylaxis protocols. 

. 2009;35(4):629-636. doi:10.1016/j.jcrs.2009.01.002

14, Pershing S, Lum F, Hsu S, et al. Endophthalmitis after cataract surgery in the United States: a report from the Intelligent Research in Sight registry, 2013-2017. 

. 2020;127(2):151-158. doi:10.1016/j.ophtha.2019.08.026

Organization eyes green practices, shifting ophthalmology landscape.

Minimizing the carbon footprint of ophthalmic surgeries

Prevent Blindness, the nation's leading nonprofit organization dedicated to eye health, is proud to announce December 2 to 8, 2024, as its fourth annual Geographic Atrophy (GA) Awareness Week.

GA is an advanced form of dry age-related macular degeneration (AMD), and it is estimated that approximately 1 million people in the United States are affected by the condition.

To raise awareness and provide support, Prevent Blindness offers free educational resources on GA, including a comprehensive fact sheet, a series of social media graphics in both English and Spanish, a dedicated web page, and expert-led videos. This year’s GA Awareness Week is made possible with funding from Apellis Pharmaceuticals, Inc.

For individuals living with GA or AMD, as well as their caregivers, Prevent Blindness offers the free 

 program. This initiative provides access to a variety of resources, including directories, self-help guides, downloadable apps like 

, information on clinical trials, and the latest research news on AMD.

“This is an exciting time for research and treatment options for those with geographic atrophy,” said Jeff Todd, president and CEO of Prevent Blindness. “We encourage patients to check out our various GA resources and work directly with their eye doctor to put together the best treatment plan to help save sight.”

The cause of GA is unknown, but the following can increase a patient’s risk for GA:

Race – Caucasians have a higher rate of AMD

Women not using menopausal hormone replacement therapy

High sun exposure throughout the life span

Poor diet with a low intake of fruits and vegetables (specifically dark green leafy vegetables)

To inform patients with Geographic Atrophy (GA) and their care partners, Prevent Blindness offers an episode of the 

 titled “Advancements in Treatments for Geographic Atrophy.” The episode features Rajeev S. Ramchandran, MD, MBA, Associate Professor of Ophthalmology at the Flaum Eye Institute, University of Rochester Medical Center.

Additional Focus on Eye Health Expert Series episodes include:

 Past President and CEO, Sherry Williams, sharing her story as a care partner for her mother diagnosed with GA.

” episode, features Janet S. Sunness, MD, medical director of the Richard E. Hoover Low Vision Rehabilitation Services at the Greater Baltimore Medical Center.

 EyeCon 2024 event at the Hilton Fort Lauderdale Marina, David Chin Yee, MD, presented “GA: What Every OD Should Know.” In a conversation with 

es, he noted there are some critical signs and symptoms that ophthalmologists and optometrists alike should look for detecting the early stages of GA.

“What we look for, usually, is that the patient will note loss of central vision, specifically identified on the Snellen visual acuity,” he said.

Yee noted that patients may notice their reading speed can be diminished. Another issue is difficulty in low-light settings.

“So, if they go to a nice restaurant, it is a candlelight dining, they will have the need to want to take out their flashlight or their phone to make it brighter for them to be able to read or see what they could have seen years prior before having this problem,” Yee said.

Prevent Blindness offers GA patients and others the 

 resource from its Living Well With Low Vision program. As loss of vision can lead to feelings of depression, anxiety, and loss of independence, some individuals may notice a change in their desire to socialize with others, or increased frustration with the additional time it may take to accomplish tasks of daily living.

Prevent Blindness encourages patients experiencing these types of issues to seek support groups of others who are living with GA.

1. Fourth Annual Geographic Atrophy Awareness Week - Prevent Blindness. Prevent Blindness. Published November 26, 2024. Accessed November 29, 2024. https://preventblindness.org/geographic-atrophy-week-2024/

2. Hutton D. Eyecon 2024: What every OD and MD should know about geographic atrophy. 

 Published September 28, 2024. Accessed November 29, 2024. https://www.ophthalmologytimes.com/view/eyecon-2024-what-every-od-and-md-should-know-about-geographic-atrophy

Prevent Blindness has announced its fourth annual Geographic Atrophy (GA) Awareness Week from December 2 to 8, 2024, to raise awareness about GA, an advanced form of dry age-related macular degeneration affecting around 1 million Americans. The organization provides free educational resources, including fact sheets, social media graphics, and expert-led videos. The Living Well With Low Vision program offers additional support for GA patients and caregivers. Risk factors for GA include age, genetics, and lifestyle factors. Prevent Blindness also highlights the importance of early detection and mental wellness support.

Prevent Blindness announces its fourth annual Geographic Atrophy Awareness Week, December 2 to 8, 2024. The organization offers free educational resources, including videos and guides, and supports GA patients through programs like Living Well With Low Vision.

Prevent Blindness providing free educational resources on geographic atrophy

Harrow has announced an initiative to expand access and affordability for its ophthalmic pharmaceutical products. This includes a program of targeted price reductions for several Harrow products and a strategic partnership with GoodRx.

A component of Harrow’s Access and Affordability Program is reducing the prices of several widely used eyecare products as a method of addressing cost barriers that limit patient access. The program began with price reductions for 2 of the company’s products, VIGAMOX and MAXIDEX, with the analysis of additional products underway.

Harrow’s new partnership with GoodRx will provide a cash-pay alternative for the purchase of select Harrow products, including FLAREX, ILEVRO, MAXIDEX, TOBRADEXST, VEVYE, VIGAMOX, and ZERVIATE. The GoodRx platform offers an alternative to traditional insurance allowing patients discounted pricing. This partnership may address the financial needs of those patients who may not have adequate insurance coverage for the eyecare medications they need.

Harrow has initiated a program to enhance access and affordability for its ophthalmic pharmaceuticals, including price reductions for products like VIGAMOX and MAXIDEX. The initiative also involves a strategic partnership with GoodRx, offering a cash-pay alternative for select products, providing discounted pricing outside traditional insurance. This approach aims to alleviate cost barriers for patients lacking adequate insurance coverage. Harrow's CEO emphasizes the mission to make sight-saving treatments more accessible while delivering value to shareholders. Patients can access discounts through the GoodRx platform, enhancing affordability and accessibility.

The program aims to expand access and affordability for Harrow's ophthalmic pharmaceutical products through targeted price reductions and a strategic partnership with GoodRx.

Keith Warren, MD

Articles

Latest Updated Articles