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Ophthalmology and the Climate Crisis: A Wake-up Call

Title of Article: Needless Waste and the Sustainability of Cataract Surgery

What are the key takeaway points from this article?

If healthcare were a country, it would be the 5th largest carbon emitter in the world, making the industry a substantial contributor to climate change. Ophthalmologists have one of the highest surgical volumes of all surgical specialities, so it is imperative to assess whether common surgical practices, such as high volumes of single-use products in cataract surgery, truly benefit human health. It must also be considered whether the benefits outweigh the environmental consequences.

In this editorial, results from the Aravind Eye Care System (AECS) in southern India report significantly decreased (3.5-fold decline) rates of postoperative endophthalmitis (POE) rates while simultaneously using significantly less single-use products in phacoemulsification procedures. Comparatively, one phacoemulsification procedure in the AECS produced 6kg carbon dioxide (equivalent to driving a car 23km) compared to ~130 kg carbon (equivalent to driving 500km) in the United Kingdom. Furthermore, from an economical perspective, the AECS can perform ~60% of their surgical procedures as pro-bono due to the economic savings from less surgical supplies. The AECS has demonstrated that re-using certain surgical instruments, gowns, gloves, and pharmaceutical products, can not only produce 1/20th of the carbon emissions of other countries performing the same procedure, but they are still able to achieve lower POE rates than those countries (0.01% rate of infection in India compared to 0.04% in the US).

As global cataract volumes are expected to rise, current practices must be questioned. In a multi-country survey with over 1300 respondents (consisting of surgeons and experts in the field of ophthalmology), 90% agreed that OR waste is both concerning and unnecessary and 91% were concerned about climate change. An overwhelming majority were willing to use perioperative topical medications on multiple patients (97%), preferred reusable instruments (79%), and believed that medical societies must advocate for significant reductions in OR carbon emissions (87%). Now more than ever is the time where Ophthalmology as a profession must advocate for systems level change at the hospital, health authority, and national healthcare level. Ophthalmologists must advocate for change at multiple levels; however, the first step starts with assessing one’s own medical practice.

Publication Date: December 2020

Reference: Chang DF. Needless Waste and the Sustainability of Cataract Surgery. Ophthalmology. 2020 Dec;127(12):1600-1602. doi: 10.1016/j.ophtha.2020.05.002. Epub 2020 Jul 15. PMID: 32682622; PMCID: PMC7361054.

Summary by: Brooklyn Rawlyk


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