Reducing Waste Lens by Lens

In ophthalmology, we are rightfully obsessed with precision – from surgical microns to biometric accuracy. We demand perfection, measure rigorously, and continuously refine our techniques. And yet, amid all this refinement, there’s one blind spot we often overlook: our environmental footprint.

Cataract surgery is the most frequently performed surgical procedure worldwide. As an intraocular lens (IOL) optics researcher, I’ve handled countless IOLs – and opened countless different boxes. While working with prof. Damien Gatinel at the Rothschild Foundation, one glaring inefficiency caught my attention: the sheer size and wastefulness of IOL packaging.

An IOL typically weighs around one gram and measures 12 mm. Yet it's commonly packaged in boxes weighing over 140 grams and exceeding 20 cm in size. So, why so much material for something so small?

A look inside the box

Beyond the oversized packaging lies an even greater culprit: printed instructions for use (IFUs). These multilingual pamphlets, often running dozens of pages and weighing up to 50 grams, are rarely consulted. In some cases entire sections are labeled, “This section intentionally left blank.” Or worse, blank pages are simply included in anticipation of future translations. This is not just inefficient – it’s absurd.

Some manufacturers have started to introduce digital alternatives, offering e-IFUs via QR codes. These are not only more sustainable, but often more accurate and up-to-date. Still, paper IFUs remain standard, leading to immense paper waste globally.

Together with prof. Damien Gatinel, I conducted a study analyzing this paper waste. We estimated that transitioning all IOL manufacturers to e-IFUs could save 128 tons of paper annually — the equivalent of around 2,000 trees (1). Inspired by this work, my colleague and friend, Myriam Safrai, a gynecologist, applied similar principles to contraceptive packaging and found that simplifying IFUs there could save a staggering 3,780 tons of paper per year (2).

Small changes, big impact

This is how meaningful change begins – with a single, small domino falling into place. As ophthalmologists, we can no longer afford to ignore our role in this chain. Yes, we’re busy. Yes, clinical outcomes matter most. But making small, mindful changes in how we source, choose, and use our materials can lead to significant long-term environmental gains.

During the AECOS 2024 – in large part due to Radhika Rampat, who founded the AECOS Green Group in 2022 – these concerns have reached manufacturers; face-to-face conversations with industry representatives showed that they’re beginning to understand that these issues genuinely do matter to ophthalmologists.

Currently, many IOL boxes are deliberately oversized to convey a sense of luxury, a product with a premium aesthetic. But what we must now cultivate is a different instinct – to recoil at excessive packaging, not admire it. Marketing has taught us to equate bulk with quality. It's time to unlearn that message.

Rethinking inventory and access

Oversized packaging is not only harmful to the environment, it also increases the environmental cost of transportation. This cost was evidenced in a study on intraocular lens models I conducted with Alice Grise Dulac (3). Additionally, unnecessary packaging can lead to inefficient storage in our operating room pharmacies, inadvertently affecting clinical decision-making. Smaller, more compact packaging would enable us to stock a broader range of toric and premium IOLs on-site, reducing dependence on special orders and making these lenses more accessible to surgeons without adding administrative burden.

Our research revealed another systemic issue: the underutilization of premium lenses. Only 7 percent of implants were toric IOLs, and just 5 percent were presbyopia-correcting lenses (EDOF/multifocal). While logistics may not be the only barrier, it’s evident that improved access — such as routinely stocking these lenses in hospital pharmacies — would encourage more surgeons to use them when clinically appropriate.

Our data show that just three toric powers (1.5D, 2.25D, and 3.0D) account for two-thirds of all toric IOLs used. Similarly, most spherical powers fall within a relatively narrow diopter range. With smarter packaging and streamlined logistics, clinics could routinely stock these commonly used lenses, reducing both unnecessary shipping emissions and access barriers. Compact packaging would make this not only feasible but also sustainable, without increasing storage requirements.

Reducing plastic and carbon from preloaded systems

Another major source of waste comes from preloaded IOLs – especially those with single-use plastic injectors. In our institution, we found that 84 percent of implants used were in such systems. While they can be convenient, they also generate a significant amount of unnecessary plastic and contribute to the larger box size.

And viable alternatives do exist – preloaded IOLs designed for reusable injectors offer the same precision and surgical efficiency while dramatically reducing environmental impact. Unfortunately, only 5 percent of implants used in our facility were of this type, despite them coming in packaging that weighs half as much.

The path forward

We pride ourselves on being minimally invasive surgeons, and yet our specialty’s ecological footprint tells another story. If we can demand nanometer precision from our technology, we can also demand sustainability from the systems we use.

So what can we do?

• Ask manufacturers the hard questions: Why the oversized box? Why paper IFUs instead of e-versions? Why default to single-use injectors?

• Opt for smaller, standardized, and more sustainable packaging.

• Encourage the use of reusable injector systems with compact, preloaded cartridges.

• Push for localized production and smarter logistics to reduce transportation impacts.

• Educate colleagues and train staff to consider environmental impact in procurement decisions.

Precision, with purpose

Every lens we implant is a small act, but multiply that by more than 20 million procedures performed worldwide annually and the scale becomes enormous. The same scientific mindset we apply to vision correction can — and must — be applied to making ophthalmology more sustainable. As a community, let’s commit to making ophthalmology lighter on the Earth. A lighter footprint starts with a conscious step. And so let’s take that first step, lens by lens.