Driving Sustainability in Ophthalmology: A New Era of Surgical Efficiency

The field of ophthalmology is undergoing a significant transformation as clinicians and industry leaders shift their focus toward environmental stewardship. With global cataract surgery volumes exceeding 30 million cases annually, the environmental impact of surgical waste has become a critical concern. Organizations like EyeSustain are leading the charge, moving the profession away from fragmented, isolated efforts toward a unified, global strategy for waste reduction.

The Rise of EyeSustain

Founded in 2022, EyeSustain has evolved from a small initiative into a global network representing 58 ophthalmology societies. Originally sponsored by the American Society of Cataract and Refractive Surgery, the European Society of Cataract and Refractive Surgeons, and the American Academy of Ophthalmology, the organization serves as a central hub for networking and disseminating sustainable practices.

As noted by David F. Chang, MD, a member of the Healio | OSN Cataract Surgery Board, the industry is increasingly recognizing that relatively small changes in surgical protocols can lead to meaningful reductions in waste, and emissions. Because of the high volume of procedures performed, these incremental improvements compound over time, providing a scalable solution to the sector’s environmental footprint.

Key Initiatives: The Shift to Reusable Systems

One of the most impactful focus areas for EyeSustain is the transition from single-use to multiuse phacoemulsification cassettes. Currently, many single-use cassettes are discarded after every surgery, contributing to a substantial amount of plastic waste that is often labeled as contaminated and sent to landfills.

Research and real-world data suggest that “day cassettes”—which remain in the phacoemulsification machine for an entire day of surgeries—offer a safe and efficient alternative. Data from the Aravind Eye Care System in India, which has utilized this practice for over a decade, indicates that the risk of cross-contamination remains remote. In a study of more than 1.3 million cases, the endophthalmitis rate was 0.01%, compared with a 0.06% rate observed in the U.S. IRIS Registry during a similar period.

Several manufacturers, including Oertli Instruments, Rayner, Zeiss, Geuder, and Ruck, already offer multiuse cassette options approved in various international markets. EyeSustain continues to advocate for regulatory pathways that would allow for the broader adoption of these systems in the United States.

Industry Collaboration and Innovation

Sustainability is no longer an afterthought in the medical device industry; it is becoming an integral part of research and development. Major manufacturers are implementing several key changes to reduce their environmental impact:

• Packaging Optimization: Companies like Alcon, BVI Medical, and Bausch + Lomb have successfully reduced the size and weight of surgical packaging. By removing printed instructions for use—now available digitally—and eliminating unnecessary plastic trays, these companies have significantly decreased the carbon footprint associated with shipping and distribution.
• Sustainable Materials: Partnerships, such as Alcon’s collaboration with NewGen Surgical, are replacing traditional plastic surgical basins with alternatives made from sugarcane.
• Circular Economy Efforts: BVI Medical is exploring programs to recycle plastic waste from operating rooms into new products, such as eyeglasses, and is working to ensure that metal elements in procedure packs are reclaimed.
• Cold-Chain Reduction: By developing nonrefrigerated ophthalmic viscoelastic devices (OVDs), manufacturers are working to eliminate the high energy consumption associated with temperature-controlled shipping.

Looking Ahead

The collaboration between surgeons and industry stakeholders is fostering a culture of “healthy peer pressure,” where companies are encouraged to share sustainability benchmarks and innovate responsibly. While regulatory hurdles remain, the momentum toward sustainable ophthalmology is clear.

Key Takeaways

• Scalable Impact: Small changes in high-volume surgical settings lead to significant reductions in global plastic waste and carbon emissions.
• Evidence-Based Safety: Real-world data supports the safety of reusing phacoemulsification cassettes, challenging the necessity of single-use models.
• Digital Transition: Moving away from printed instructions for use and optimizing packaging size are effective, low-risk strategies for reducing waste.
• Collaborative Advocacy: Physician-led organizations like EyeSustain are essential for bridging the gap between clinical needs and industrial innovation.

As the profession continues to prioritize environmental health, the focus will remain on balancing patient safety with the urgent need to reduce the ecological impact of modern eye surgery. Through continued dialogue and innovation, the ophthalmic community is proving that high-quality care and sustainability are not mutually exclusive goals.