{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:05:36Z","timestamp":1790697936525,"version":"4.1.0"},"reference-count":28,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Virginia Lions Eye Institute Foundation Richard A. Falls Research Grant"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of VitreoRetinal Diseases"],"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To quantify the annual environmental impact of intravitreal (IVT) injections at a retina group practice and explore methods to reduce waste.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this retrospective analysis, environmental waste generated by IVT injections was quantified by weighing each disposed item and recording its mass in kilograms. Variation in the use of optional items was investigated by comparing the injection techniques of all 6 physicians at 1 of our office locations. The total annual waste was extrapolated based on the total number of injections of each medication administered across the entire practice in 2024. Potential targets for waste reduction were identified and calculated in percentages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The total amount of environmental waste generated by the items strictly necessary for administering 92 622 injections of 7 medications in 2024 was 3.81 metric tons. Analysis of individual packaging components revealed that the outer packaging box was the greatest contributor to the packaging mass for most medications, accounting for 46.3% to 72.6% of the total packaging weight. Among the medications evaluated, bevacizumab generated the least packaging waste, while dexamethasone generated the most.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This practice-wide analysis identified key contributors to environmental waste produced from IVT injections and highlighted several opportunities for waste reduction. Strategies such as the use of prefilled syringes, improved packaging efficiency, digital package inserts, and the elimination of optional injection components can help minimize environmental waste generation. These findings may help physicians and manufacturers reduce environmental waste through procedural modifications and improved packaging efficiency.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/24741264261467251","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T07:06:06Z","timestamp":1784271966000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantification of Annual Environmental Waste Generated by Intravitreal Injections: A Practice-Wide Analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4559-8028","authenticated-orcid":false,"given":"Priscilla S.","family":"Chang","sequence":"first","affiliation":[{"name":"Retina Group of Washington, Reston, VA, USA"},{"name":"Carle Illinois College of Medicine, Urbana, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Abou-Samra","sequence":"additional","affiliation":[{"name":"Retina Group of Washington, Reston, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dal W.","family":"Chun","sequence":"additional","affiliation":[{"name":"Retina Group of Washington, Reston, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Melamud","sequence":"additional","affiliation":[{"name":"Retina Group of Washington, Reston, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua D.","family":"Levinson","sequence":"additional","affiliation":[{"name":"Retina Group of Washington, Reston, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian K.","family":"Do","sequence":"additional","affiliation":[{"name":"Retina Group of Washington, Reston, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason M.","family":"Huang","sequence":"additional","affiliation":[{"name":"Retina Group of Washington, Reston, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan K.","family":"Sobol","sequence":"additional","affiliation":[{"name":"Retina Group of Washington, Reston, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1077-2341","authenticated-orcid":false,"given":"Mohsin H.","family":"Ali","sequence":"additional","affiliation":[{"name":"Retina Group of Washington, Reston, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41433-023-02753-z"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1159\/000486145"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.oret.2020.10.006"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2022.4401"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/2474126420971982"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajpath.2012.06.006"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/eye.2014.13"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.2147\/OPTH.S128509"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41433-021-01620-z"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2017.12.019"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/24741264241308496"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/24741264211028441"},{"key":"e_1_3_2_14_2","volume-title":"Intravitreal Injection Technique and Monitoring: Updated Clinical Statement","author":"American Academy of Ophthalmology Retina\/Vitreous Panel","year":"2014","unstructured":"American Academy of Ophthalmology Retina\/Vitreous Panel. Intravitreal Injection Technique and Monitoring: Updated Clinical Statement. American Academy of Ophthalmology; 2014. Updated 2019."},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2019-313823"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/IAE.0000000000002351"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2018.7089"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.oret.2020.04.006"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.oret.2018.09.013"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/8567912"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2016.08.022"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/IAE.0000000000001800"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/0734242X241310658"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cogsc.2022.100695"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/2474126420984657"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecolind.2019.105983"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.3390\/su14041951"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/24741264251388104"},{"key":"e_1_3_2_29_2","unstructured":"Electronic Distribution of Prescribing Information for Human Prescription Drugs Including Biological Products. Federal Register. Published December 18 2014. Accessed March 16 2026. https:\/\/www.federalregister.gov\/documents\/2014\/12\/18\/2014-29522\/electronic-distribution-of-prescribing-information-for-human-prescription-drugs-including-biological"}],"container-title":["Journal of VitreoRetinal Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/24741264261467251","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/24741264261467251","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/24741264261467251","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:24:19Z","timestamp":1790695459000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/24741264261467251"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,17]]},"references-count":28,"alternative-id":["10.1177\/24741264261467251"],"URL":"https:\/\/doi.org\/10.1177\/24741264261467251","relation":{},"ISSN":["2474-1264","2474-1272"],"issn-type":[{"value":"2474-1264","type":"print"},{"value":"2474-1272","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,17]]},"article-number":"24741264261467251"}}