Presented by Health Care Without Harm in partnership with the Global Consortium on Climate and Health Education, this is the fourth session in a five-part virtual grand rounds series. It explores strategies to reduce healthcare emissions and features the leadership of climate-smart ophthalmologists. In this session, the ophthalmologists Barbara Erny and David Palmer discuss the environmental impact of ophthalmic practice and share how ophthalmologists are leading the climate-smart surgery movement, reducing pharmaceutical waste, and advocating for policy change. Dr. Erny outlined that ophthalmologic surgeries produce the most waste of any surgical specialty due to cataract surgery, which is the most common surgery performed in the U.S. She highlighted how EyeSustain is committed to make services in ophthalmology more economically and environmentally sustainable. Dr. Palmer pointed out how one person can make a difference in the fight against climate change and shared his own history advocating for reduction of unused pharmaceutical products in ophthalmological surgery. Dr. Palmer successfully led efforts to get legislation passed in Illinois, permitting topical medications used for surgeries to be given to patients to take home for postop care, after a colleague in his state was reported for violating hospital policy by doing this.