54 EyeWorld Asia-Pacific | September 2024 NEWS & OPINION 1. Surgical Waste (Figure 1) Cataract surgery generates waste which can be classified into hazardous (e.g. instruments/drapes contaminated with bodily fluids) or non-hazardous (e.g. product packaging and inserts) categories. The surgical manufacturing industry has also been driven towards single-use instrumentation and this may be related to liability protection as well as profit motives, adding further to waste generation. 2. Energy Consumption The entire cataract surgical pathway contributes to carbon emissions through energy consumption in the manufacture of instruments, devices and machines, the logistics involved with delivery of goods and travel of patients and the use of electricity and water when expediting cataract surgery itself, all of which can account for up to 36.1% of total carbon emissions6. Economic Viability Healthcare cost is an important consideration in developing countries, which the majority of the Asia Pacific region comprises. The cost-effectiveness of cataract surgery has to be taken into account when implementing widespread strategies to address cataract blindness intermixed with sustainable practices. Cataract surgical techniques such as Manual Small Incision Cataract Surgery (MSICS), which utilizes less expensive surgical equipment (compared with conventional phacoemulsification) is particularly important in resource-poor settings. Social Implications Sustainability in cataract surgery also encompasses social factors, including the equitable distribution of healthcare services and the empowerment of communities through improved vision. In the Asia Pacific region, rural and remote areas often face significant challenges in accessing healthcare services. It is fundamental to ensure that cataract surgery is accessible to all, regardless of socioeconomic status, geographic location, or gender. Strategies to Improve Sustainability The future of sustainable cataract surgery in the Asia Pacific region depends on the adoption of innovative practices and technologies that promote environmental, economic, and social sustainability. There has been a focus on sustainability practices in our profession recently, with the EyeSustain initiative (www.eyesustain.org), spearheaded by organizations such as the American Society of Cataract & Refractive Surgery (ASCRS), European Society of Cataract & Refractive Surgeons (ESCRS) and the American Academy of Ophthalmology (AAO). The Asia Pacific Association of Cataract & Refractive Surgeons (APACRS) is also part of this global coalition of eye societies and organizations intending to influence more environmentally-friendly eye care outcomes. Figure 17: Surgical waste from a phacoemuslification procedure in the UK (A) compared with 32 cases in India (B) Figure 28: Instructions For Use (IFU) pamphlets printed in multiple languages. Held up on the right are instructions for monofocal IOL and on the left, instructions for IOL cartridges. A B
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