The Environmental Sustainability of Eye Drops in Surgery
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Unused drugs impact
In 2019, a study in NY found that each of the four centres analysed spent $195,200[1][2] annually on unused pharmaceutical products after routine phacoemulsification,[3][2][4] equivalent to over 50 cataract operations at each location.[1] This included 65.7% of unused eyedrops, 24.8% of unused injections, and 59.9% of unused systemic medications, resulting in 6-30kg CO2e per case from the unused drugs, equivalent to driving 1,025-6,120 miles in an average passenger vehicle or to burning 47-281 gallons of gasoline monthly.[2]
Additionally, the lack of patient-specific labelling on multi-dose drug bottles required them to be thrown out and repurchased by the patient in a pharmacy following surgery,[1][2] increasing costs and decreasing efficiency.[2]
Perioperative topical antibiotics impact
Perioperative topical antibiotics are commonly used in standard cataract surgery, despite limited evidence of their efficacy in preventing endophthalmitis.[2]
Solutions from perioperative topical antibiotics
Intracameral antibiotics at the end of cataract surgery have been proven to be more effective in reducing endophthalmitis rates compared to topical antibiotics.[5] Along with the environmental impact of antibiotics, the lenient use of antibiotics is contributing to antibiotic resistance, becoming a significant global health issue.[5]
The RANZCO launched a guideline in 2021 for reducing cataract surgery waste, where intracameral antibiotics alone in routine surgeries were considered the best practice.[6] In the USA, 24% of those surgeons using intracameral antibiotics have stopped giving postoperative topical antibiotics.[6] Thus, there is a trend towards reducing perioperative topical antibiotic prophylaxis, as several studies reported no additional benefit to topical antibiotics when intracameral prophylaxis is used.[7]
Solutions from perioperative topical steroids
In uneventful cataract surgery, intra or perioperative topical steroids can be as effective as postoperative cortisone drops therapy,[8] potentially reducing environmental impact.
Solutions from multiple patients’ drugs
Regarding multiple-patient drugs, a survey of major ophthalmological societies showed that a high percentage of surgeons would consider reusing topical (97%) and intraocular (90-95%) drugs in multiple patients.[9] The American Society of Cataract and Refractive Surgery supports using multi-dose eyedrops for multiple patients when appropriate safety protocols are followed,[2] as multi-dose eye drops have demonstrated no adverse effects but large cost savings.[2] However, despite the evidence, many practices still insist on using single-dose eye drops due to concerns about cross-contamination.[10]
Solutions from multi-dose drugs
Surprisingly, far away from using the same drugs in multiple patients, there are still settings where surgeons are mandated to discard antibiotic eyedrop bottles immediately after surgery with 80-100% of unused weight, resulting in significant waste and increased costs.[2] However, the FDA has established a testing methodology to set an additional level of protection that enables drug products to be used in multiple patients until the stated expiration date with no limited number of different individuals, as long as they are not specifically labelled for single-use.[11]
References
- ↑ 1.0 1.1 1.2 Carbon and Cataracts: How to Make Your Service Sustainable. Buchan, J., Thiel, C., Thomas, P. (2021). Cataract Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-38234-6_14
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Quantification of the Cost and Potential Environmental Effects of Unused Pharmaceutical Products in Cataract Surgery. Tauber J, et al. JAMA Ophthalmol. 2019. PMID: 31369052
- ↑ [Position paper and recommendations for action for ecologically sustainable ophthalmology: Statement of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA)]. Deutsche Ophthalmologische Gesellschaft (DOG), et al. Ophthalmologie. 2023. PMID: 36625883
- ↑ Factors contributing to the carbon footprint of cataract surgery. Taboun OS, et al. J Cataract Refract Surg. 2023. PMID: 37390323
- ↑ 5.0 5.1 69. Endophthalmitis following cataract surgery: the role of prophylactic postoperative chloramphenicol eye drops. Råen M, et al. Acta Ophthalmol. 2013. PMID: 22151787
- ↑ 6.0 6.1 Preferred Practice Guidelines for Reducing Waste in Cataract Surgery. https://ranzco.edu/wp-content/uploads/2021/12/RANZCO-Guidelines-Preferred-Practice-Guidelines-for-Reducing-Waste-in-Cataract-Surgery.pdf
- ↑ Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: results of the 2021 ASCRS member survey. Chang DF, et al. J Cataract Refract Surg. 2022. PMID: 34282070
- ↑ [Sustainability in ophthalmology: Adaptation to the climate crisis and mitigation]. Birtel J, et al. Ophthalmologie. 2022. PMID: 35451609
- ↑ Survey of cataract surgeons' and nurses' attitudes toward operating room waste. Chang DF, et al. J Cataract Refract Surg. 2020. PMID: 32773547
- ↑ How Ophthalmologists Can Decarbonize Eye Care: A Review of Existing Sustainability Strategies and Steps Ophthalmologists Can Take. Sherry B, Lee S, Ramos Cadena MLA, Laynor G, Patel SR, Simon MD, Romanowski EG, Hochman SE, Schuman JS, Prescott C, Thiel CL. Ophthalmology. 2023 Jul;130(7):702-714. doi: 10.1016/j.ophtha.2023.02.028. Epub 2023 Mar 6. PMID: 36889466
- ↑ Waste No More. Chambers WA. Ophthalmology. 2021. PMID: 34530007
See also
- Ophthalmology and Climate Change
- Sustainability practices implementation made easy
- The Environmental Sustainability of:
