Earth Day gives ODs a chance to promote green patient habits


The views expressed here belong to the author. They do not necessarily represent the views of Optometry Times or UBM Medica.

With the 47th observance of Earth Day taking place April 22, it is interesting to look back on how the day has evolved from a smallish movement aimed at raising environmental awareness to a worldwide celebratory effort to save our planet. 

From changing habits at home or in the workplace, we can all do our part to reduce the negative impact we have on the environment. 

Medical waste

Medical waste is any waste generated at healthcare facilities, such as hospitals, physicians’ offices, dental practices, blood banks, as well as medical research facilities, laboratories, and optometry offices. The disposal of this waste is regulated by state environmental and health departments.

Previously from Dr. O'Dell: 6 challenges when changing from a group to private practice

This waste is classified as regulated medical waste (RMW) and unrelated medical waste (UMW).

RMW accounts for 10 to 25 percent1 of the total medical waste annually. Also known as “biohazardous” waste or “infectious medical” waste, RMW is the portion of the waste stream that may be contaminated by blood, bodily fluids, or other potentially infectious materials-posing a significant risk of transmitting infection.

UMW accounts for 75 to 90 percent1 of medical waste annually. This waste is similar to typical household waste consisting of papers and plastics that have not been in contact with patients-and is categorized as non-infectious.

Here’s how the industry is helping to reduce our medical waste both in our practices and in our patients’ homes.

Related: How you can go green in the optometry practice


Industry leaders seeing green

In my practice, I’ve struggled with the idea of proper disposal for my used LipiFlow (TearScience) activators. The waste includes a cord connecting the activator to the LipiFlow machine and to the activator for patient treatment. Activators are referred to by the industry as disposables. It has felt wrong to dispose of these activators, leading me to explore better methods-including considering starting my own recycling effort with other practices.

TearScience came to the rescue.

Due to the three-fold increase volume of LipiFlow treatments performed in the last 12 months, TearScience began rolling out the LipiFlow Activator II to help reduce medical waste, says Brian Regan, vice president of TearScience.

Related: The growing green trend in optical

The Activator II is an updated design of the original. The new activator consists of an electrically wired eye cup and lid warmer combo with an air tubing interface that joins to a separate semi-permanent cable-connecting the Activator II to the LipiFlow (Figure 1).

TearScience recently launched a new design for their treatment activators - the Activator II in an attempt to reduce the medical waste generated with each LipiFlow treatment.

While the design has changed slightly, I have found that the overall method and efficacy of treatment has been maintained.

The semi-permanent cable has been designed for over 2,500 uses, according to TearScience. It should be installed and remain attached to the LipiFlow console. If you are an existing LipiFlow practice, continue using the original activator until your supply is exhausted, then contact your TearScience representative to begin the transition to the new Activator II.


The One by One recycling program allows for easy disposal of the waste associated with contact lens fitting in the office as well as the patient generated waste with the daily , bi-weekly or monthly use of the contact lenses.

One by One encourages recycle efforts

Another medical waste we incur daily is generated by our contact lens practices. This is in the shape of the boxes, blister packs, and the contact lenses themselves.

Related: It’s not easy seeing green

Bausch + Lomb (B+L) has launched the One by One recycling program. Partnering with TerraCycle, B+L is taking a nationwide effort to reduce and reuse by encouraging the recycling of contact lens packaging waste.

In our practice, we have One by One recycling bins in each exam room, and we educate patients to bring in their contact lens waste to recycle (Figure 2).


Patient-generated medical waste

As ODs, we are recommending both prescription and over-the-counter eye drops for our patients to use daily-many times several times a day. The packaging, vials, and bottles also contributes to UMW.

Let's take a closer look at a chronic dry eye patient using a topical therapy to manage his disease.

I have calculated that both Restasis (cyclosporine, Allergan) and Xiidra (lifitegrast, Shire) users’ annual waste is around 720 vials per year, 1,440 vials over two years, and 3,600 for five years of treatment. We are seeing similar numbers with daily contact lens-wearing patients as well.

Restasis mulitdose, a preservative free option with a new package to reduce patient generated medical waste.

With the recent introduction of Restasis MultiDose (cyclosporine, Allergan), we can help reduce patient waste. Allergan continued its preservative-free composition of Restasis using new technology to prevent contamination of both the eye drop bottle and remaining eye drops.

Related: The poor man’s red/green test

It takes a team effort

The end products are not only environmentally friendly but a great change for patients struggling to use the vials due to conditions like neuropathy and arthritis.

It is great to see major players in the industry making a concerted effort to reduce the environmental impact of their products-but it takes more than that.

It starts at the top with ODs leading by example. Communicate to office managers and front-line staff to do their part in reducing, reusing, and recycling.

Share these ideas and concepts at your staff meetings this month. Help inspire the team to give ideas on what you can do better at your practice. Some great policies and concepts are often introduced when the staff is empowered to find solutions to seemingly simple, but important challenges.

There’s no challenge more important than saving our planet!


1. Airlina I. Medical Waste Disposal – The Definitive Guide. BioMedical Waste Solutions. Available at: Accessed 4/18/17.


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