Real and perceived barriers to effective use of cataract surgical supplies

Introduction: Cataract surgery, among the most common procedures worldwide, significantly contributes to climate change through both solid waste and air pollution, highlighting the urgent need for targeted interventions. Implementation faces hurdles including legal constraints and concerns about infection risks and malpractice. Methods: This article examines federal and state regulatory structures around two key waste reduction strategies: reduction of multidose medications and distribution of partly-used operating room medication to patients post-surgery. Results: We find little-to-no legitimate regulatory barriers to either waste reduction practice. Dispensing and redistributing partly-used medication has been codified in law in some states. Evidence-based reports indicate minimal risks for infection with proper handling. From 1998 until August 2024, according to the Ophthalmic Mutual Insurance Company, there were no reported endophthalmitis lawsuits from using multidose eye drops perioperatively. Malpractice fears also appear to be generally unfounded considering guidelines by various professional organizations identifying these practices as acceptable standards of care and lack of related lawsuits. Conclusion: In order to implement evidence-based sustainability interventions, more education and training is needed to ensure clinicians and staff are aware of real and perceived barriers.