NEWS & OPINION EWAP DECEMBER 2023 45 reusable instruments. The results of the OICS and ESCRS surveys highlight a global paradigm shift among ophthalmologists toward OR practices promoting sustainability in the context of climate change. The concordant responses from surgeons in these studies call into question the conventionally held premise that surgeons prefer single-use products and historical OR standards and protocols. In fact, many respondents thought we should develop ways to reduce waste and were currently reusing or willing to reuse pharmaceuticals and other OR supplies. Among the OICS group, those working in ASCs were more likely to reuse products, demonstrating that institutional policy may be limiting reuse. Most ESCRS respondents work in hospital settings and still were more likely to reuse items compared to their OICS counterparts. Instead of relying on OR protocols intended for general surgery cases, ophthalmologists around the globe are redefining OR standards of care to promote environmental sustainability, efficiency, and high-quality patient outcomes. The Aravind Eye Hospitals in India have adopted sustainable practices and achieved postoperative endophthalmitis rates lower than the U.S. while significantly decreasing the carbon footprint of phacoemulsification. 7,8 In 2022, a multi-society position paper was released by the OICS Task Force demonstrating the safety of: 1) using multidose topical eye drop bottles on multiple patients until expiration C limate change is undeniably making a significant impact on our lives and we are faced with increasingly frequent occurrences of natural disasters, food, and water insecurity with the associated health problems and spread of infectious diseases. Human activities are to blame and ironically, the healthcare sector has also been shown to contribute substantially. As mentioned in this article, ophthalmologists are concerned about climate change and we have an opportunity to make a difference as cataract surgery being such a high volume procedure globally, changes made to reduce the carbon footprint of cataract surgery will likely have a significant environmental impact. Efforts to reduce the environmental impact of cataract surgery can be centred around 3 main aspects 1,2: 1) Consumption of energy related to cataract surgery (such as electricity and water usage, production and maintenance of phaco machines) – up to 36.1% of total carbon emissions. 2) Carbon emissions related to travel of patient and staff (10.1%) 3) Emissions related to procurement or production of materials, drugs or instruments related to cataract surgery (53.8%) Changes can be made to each of the above categories to reduce the carbon footprint of cataract surgery. For example, maximising efficiency of preoperative processes, shortening duration of surgery and turnaround time in operating room will decrease per-case electricity and water usage. Minimising the number of patient visits with the use of tele-ophthalmology and performing Immediate Sequential Bilateral Cataract Surgery can contribute to carbon reduction related to travel. Moving towards the use of reusable instruments, reprocessing of single-use devices, reducing the size of surgical drapes are also some strategies which may be employed. The Asia-Pacific region in terms of its diversity of population as well as the level of development of the healthcare sectors in different countries, however, poses significant challenges in this aspect. The cost-effectiveness of cataract surgery is an important consideration particularly in developing countries and a balanced approach is often necessary to ensure the delivery of safe, high quality yet sustainable eye care. The EyeSustain intiative is the first step the global ophthalmology community has taken to combat climate change and as ophthalmologists, we all have the responsibility to be part of it. Please visit EyeSustain.org to find out more and join me in taking the pledge to reduce the environmental impact of cataract surgery. References 1. Venkatesh R, Landingham SW, Khodifad AM, et al. Carbon footprint and cost-effectiveness of cataract surgery. Curr Opinion Ophthalmol 2016;27(1):82-88. 2. Morris DS, Wright T, Somner JEA, et al. The carbon footprint of cataract surgery. Eye. 2013;27:495 - 401. Lee Mun Wai, MD Medical Director, LEC Eye Centre 44-46 Persiaran Greenhill, 30450, Ipoh, Perak, Malaysia munwai_lee@lec.com.my ASIA-PACIFIC PERSPECTIVES date and 2) patients using partially used medication at home for postoperative use. These examples of scientific research and guideline position papers endorsed by multiple ophthalmological societies hint at the outdated nature of current OR protocols and highlight that surgeons can have more discretion over reuse of medications and supplies.
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