Multiuse Phaco Cassettes
Position paper on multiuse phacoemulsification supplies released by the major multinational societies of cataract and refractive surgeons.
The four regional multinational societies of cataract and refractive surgeons have jointly endorsed a position paper on the importance of multiuse phacoemulsification cassettes to safely reduce unnecessary surgical waste. Calling this a major unmet need in cataract surgery, the position paper calls on industry to prioritize development of multiuse supply options for every phacoemulsification machine platform, and for regulatory agencies to facilitate review and approval of these products.
This is the first time that the American Society of Cataract and Refractive Surgery (ASCRS), the European Society of Cataract and Refractive Surgeons (ESCRS), the Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS), and the Latin American Society of Cataract and Refractive Surgery (LATAMSCRS) have collaborated on a joint position paper – in this case speaking to industry and policy makers with a unified voice on behalf of cataract surgeons worldwide. The paper was developed in conjunction with EyeSustain, a global coalition of 55 ophthalmology societies collaborating to advance sustainability in eye care through education, research, innovation, and advocacy.
This position paper is an evidence-based review of the global phacoemulsification cassette market, global survey data on surgeon practices and opinions, and published evidence supporting cassette reuse safety and the impact on unnecessary carbon emissions and non-recyclable plastic waste from this practice. As we are now performing 30 million cataract surgeries/year worldwide, the paper argues that multiuse cassettes and other supplies should be offered as an option for every phacoemulsification machine. Because of the significant savings in manufacturing, packaging, and shipping costs, this option should reduce facility costs, improve operating room efficiency, and dramatically reduce unnecessary waste without compromising safety. It also need not necessarily penalize manufacturers financially in strictly single use markets such as the United States.
Considering that lens material and irrigation fluid are sterile, available evidence has not demonstrated that single-use phacoemulsification cassettes are safer compared to reusable cassettes. Many facilities worldwide reuse single-use cassettes off-label, particularly in Asian Pacific markets. Day cassettes that are reused for multiple consecutive patients without sterilization are available for a few machines in some markets but are not offered by the largest machine manufacturers accounting for the majority of global market share. The paper reviews studies regarding the safety of multiuse cassettes, regional differences in reuse of cassettes, and projected savings in carbon emissions and non-recycled plastic waste. Most of this discarded plastic ends up in landfill or incinerators. Finally, the paper educates surgeons and their facilities to consider adopting waste and cost-reducing multiuse phacoemulsification supply options when they are available.
Dr David Chang discussed the background for this position paper at the 2025 ESCRS meeting in this 15-minute lecture. He covers the benefits and the evidence supporting the safety of reuse of supplies such as phaco cassettes.