The Environmental Impact of the OR A

He suggested learning more efficient and sustainable practices from lower resource settings that don’t have the luxury of wasting money or resources. For example, the Aravind Eye Hospitals in India have been able to provide 60% of their care and cataract surgery for free to patients who cannot afford it.

“To do this, they maximise safe but efficient and cost-effective practices. They routinely reuse many surgical products, devices, and pharmaceuticals rather than discarding them after a single use, as we do in the West.”

For example, surgeons don’t change surgical gowns after each case. Despite these routine practices that classify as infection control violations in the West, Dr Chang said their registry study from Aravind reported a 0.04% rate of endophthalmitis in more than 2 million consecutive cataract surgeries—identical to the US rate in an overlapping period from the American Academy of Ophthalmology’s (AAO) Intelligent Research in Sight (IRIS) Registry.

“Through this comparison, you reach the infuriating conclusion that discarding all of our surgical supplies and devices after a single use did not make cataract surgery safer but instead generated an enormous amount of unnecessary waste.”

Yet, there is growing acknowledgement in Western practices to act now to reduce surgical waste. Dr Chang introduced EyeSustain (eyesustain.org), a web-based coalition of ophthalmology societies and their members collaborating to advance more sustainable practices in the industry, as such an example. Co-sponsored by ASCRS, ESCRS, and AAO, the website centralizes resources and information about sustainability in ophthalmology. It outlines immediate waste-reducing steps surgical facilities can take, such as using multidose topicals and reusable instruments and eliminating unnecessary items from surgical packs.

Dr Chang emphasised the importance of ophthalmologists educating themselves and their staff to promote a team approach to sustainability in the OR.

“Because we have the highest surgical volumes, ophthalmology has a unique opportunity and an obligation to make our procedures more sustainable,” he concluded.