The Lean, Green Sophi Phaco Machine
CAKE Magazine
The latest and greatest in cataract, refractive and anterior segment. Published by Media MICE.
In the heart of the Philippines, The Medical City (TMC) is pioneering a greener approach to cataract surgery. By adopting Sophi (Rayner; Worthing, UK), a phacoemulsification system designed for sustainability and efficiency, the hospital has drastically cut its operating room waste while setting a new benchmark for OR productivity.
Eye care is in a race against time—not just to save sight, but to save the planet. Operating rooms (ORs), while essential, are among the most resource-intensive parts of any hospital, producing staggering amounts of waste.
At the forefront of this challenge is cataract surgery, where traditional phacoemulsification machines with single-use cassettes have long been the norm. Each surgery leaves behind piles of discarded plastic and packaging, adding up to an enormous environmental footprint.
Enter Sophi, a phaco machine designed with sustainability at its core. Unlike conventional systems, Sophi replaces disposable cassettes with “day-pack” alternatives, drastically reducing waste. But its impact doesn’t end with the environment—it’s also a game-changer for OR efficiency.
At TMC, the shift to Sophi is transforming the way cataract surgeries are performed. Beyond slashing waste, the hospital has seen smoother workflows, quicker turnarounds and a renewed sense of purpose among its surgical team. Could this be the model for the sustainable future the eye care industry so desperately needs? Let’s take a closer look.
Phaco’s carbon footprint
Operating rooms are often described as the beating heart of a hospital, but their pulse comes with an environmental cost. For cataract surgeries, conventional phacoemulsification machines with single-use cassettes are a major culprit.
“The prescribed practice… is to change cassettes, tubings and hand pieces with each case,” said Dr. Victor Caparas, chair of TMC’s ophthalmology department. “With multiple cases day after day, week after week, this will pile up and create a tremendous amount of waste.”
The numbers back this up. A 2024 observational study conducted in Belgium revealed that machines using single-use cassettes produced 306.7 kilograms more plastic waste per 1,000 surgeries than their multi-use counterparts—a 75.3% increase. The environmental toll didn’t stop there; these systems required 67.7% more storage space, translating into higher transport emissions.(1)
This troubling reality inspired Dr. Isabela Bondoc, a resident at TMC, to delve deeper. “What inspired me to conduct this research was being in the OR every day,” she shared. “I saw the significant amount of single-use items used in the operating room to treat our patients.”
Dr. Bondoc’s study is rigorous, tracking power consumption, staff travel, pharmaceutical use and surgical waste. Her preliminary findings reveal a startling truth: in November, TMC performed 240 phacoemulsification cases, each generating waste equivalent to 3.4 kilograms of CO2 emission. In total, phaco surgeries produced 816 kilograms of CO2 equivalent of waste in that month alone. “To put this into perspective, it would take 656 square meters of forest or 82 medium to large-sized trees one year to absorb this amount,” she explained.
Sophi’s edge
In the bustling operating rooms of TMC, where cataract surgeries dominate the surgical calendar, the need for innovation was clear. For many years, the hospital relied on conventional phacoemulsification machines—functional but far from sustainable. When the time came to choose a new system, Sophi emerged as the clear winner, meeting the hospital's twin goals of environmental responsibility and operational efficiency.
“Cataract surgery is by far the most performed procedure [here],” explained Dr. Caparas. “Whatever can be done in reducing waste, as the Sophi system does, would definitely be in line with TMC’s vision.” The decision wasn’t solely about cutting back on waste; Sophi’s unique design promised a smoother, more efficient workflow, an essential feature in the fast-paced environment of TMC’s operating rooms.
Conventional machines require disposable cassettes and time-consuming priming before each procedure. Sophi’s day-pack system, by contrast, eliminates much of the hassle. The Belgium study highlighted a seven-minute priming advantage for every 10 procedures with day-pack systems, a small but impactful time-saving that adds up in busy ORs.(1)
The system’s innovative design also drew praise from TMC surgeons. “You have [its] ergonomic design, its customization option and a very sensitive response,” noted TMC surgeon Dr. Abbey De Guia. “These are the major advantages…especially when it comes to both user experience and surgical precision.”
Sophi in action
In TMC’s operating rooms, the introduction of Sophi has sparked a quiet revolution—not just in reducing waste, but in redefining efficiency and enhancing patient care. For senior residents like Dr. Michelle Talusan and Dr. Rexelle Piad, the day-to-day benefits of Sophi are palpable.
“The learning curve with Sophi has been surprisingly smooth,” shared Dr. Talusan. “It has an interface that caters to various levels of surgical experience…The transition was much less daunting than we anticipated.”
Efficiency gains have been a standout feature, with Sophi’s lean cassette system leading the charge. “The process of loading the cassette is intuitive and hassle-free,” explained Dr. Piad. “The lean cassette system slips into the machine with ease and…the machine has a lot of fail-safe mechanisms that ensure correct loading each time.” This streamlined process has translated to fewer interruptions and quicker turnaround times in the OR.
Sophi is equipped with a high-power battery that can handle up to 20 surgeries a day, has also won praise for its design and functionality. “It’s free from any disturbing cables or tubes, making it very flexible for surgeons during surgery,” noted Dr. Piad. The wireless dual-linear foot pedal showcases a lot of switches, and those switches are very customizable.”
The system’s surgical performance is equally impressive. “Sophi’s IOP control pump maintains stable intraocular pressure throughout the procedure,” said Dr. Talusan. “This is significant for me as a beginning surgeon since it allows me to focus on my technique.”
Dr. De Guia emphasized how Sophi benefits both surgeons and patients, particularly in challenging cataract cases. “Its advanced features, such as finely tuned power modulation, enhanced vacuum control and real-time feedback, allow for precise management of difficult procedures while minimizing risks,” she explained.
She also highlighted Sophi’s innovative safety measures. “The Clean Venturi Pump has a special patented ceiling foil,” Dr. De Guia noted. “Patient liquids are safely sealed between a foil and a cassette, preventing them from escaping into the environment.” This design adds an extra layer of protection against contamination, ensuring a safer surgical experience.
Broader implications
The story of Sophi at TMC extends beyond its walls, illustrating the transformative potential of sustainable innovations in eye care. By proving that waste reduction and efficiency can coexist, Sophi paves the way for hospitals in the Philippines—and globally—to reimagine surgical care with environmental consciousness at the forefront.
“Minimizing medical waste from surgical procedures without compromising patient care or outcomes would significantly enhance the long-term sustainability of the healthcare system,” Dr. Bondoc emphasized. “Such efforts would also encourage policymakers to advocate for more sustainable methods in conducting surgery, benefiting not only our patients but the environment as well.”
The financial implications are equally compelling. “Increasing efficiency, lowering costs and reducing waste all translate into savings for both the hospital and the patient.” noted Dr. Caparas. These savings are particularly critical in high-volume surgical settings like TMC, where resource optimization directly impacts operational budgets.
Sophi’s success at TMC offers a blueprint for other institutions striving to align with global environmental and healthcare goals. It challenges the industry to think differently about sustainability—beyond compliance, toward proactive leadership in environmental stewardship.
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