Eye Care and Carbon Footprint Working together toward a sustainable future and patient-centric care

Like any other industry, ophthalmology also contributes to waste and greenhouse gas emissions. As such, it is important for all parties to make an effort to foster sustainability in our industry.

During The Royal Australian and New Zealand College of Ophthalmologists’ (RANZCO 2022) 53rd Annual Scientific Congress — held in Brisbane, Australia, in October last year — experts shared their thoughts on the topic.

Ophthalmology and CO2 emissions

Ever since the industrial revolution, atmospheric carbon dioxide (CO2) emissions have been steadily increasing, noted A/Prof. John Landers from Flinders Medical Centre, South Australia.

In Australia, healthcare contributed to 7% of total CO2 emissions, of which 40% come from low-value healthcare. According to A/Prof. Landers, major sources of CO2 emissions from ophthalmology can be divided into energy, travel, and procurement (mainly due to single-use medication such as eye drops and tonometry equipment, medical records in servers, personal protective equipment [PPE], and intravitreal injections).

“Servers account for 2% of global emissions and are predicted to rise to 14% by 2040. In terms of PPE, globally, plastic waste almost tripled in 2020, discarded PPE increased by 10 times, and discarded masks increased by 84 times,” he shared.

Taking the lead on climate change

Meanwhile, Dr. Sarah Welch from New Zealand noted that humans are living in a climate emergency that is more severe than anticipated and threatens the fate of humanity. She said medical colleges play an important role in helping doctors take the lead on climate change.

“Doctors are good in emergencies,” she opened. “We understand complex systems, work well in teams, understand the long-term view, and advocate for health. Health causes 5% to 10% of national carbon emissions, and so it is an important area to focus on to reduce waste and carbon footprint,” Dr. Welch said.

“A recent survey of medical and dental colleges in Australia and New Zealand found that nearly 60% had published statements or policies about sustainability,” she continued. “Colleges can demonstrate by example by embedding sustainability in college governance, quantifying and reducing college carbon footprints, investing responsibly and divesting from polluting industries, advocating for sustainability in all levels of government, and promoting sustainability among members, such as by facilitating the learning about sustainability at all levels of college membership,” she said, adding that she is pleased that RANZCO’s Vision 2030 has a sustainability focus.

Decarbonizing clinics and intravitreal injections

Intravitreal injection, the most common intraocular procedure worldwide, has been rising exponentially since its introduction 15 years ago, according to Dr. Michelle Gajus, a RANZCO Sustainability Committee Member. Last year alone, about 600,000 procedures have been performed in Australia.

Dr. Gajus noted that the largest contributions of carbon emissions in intravitreal injections are patient/staff travel and procurement. “Therefore, the sustainability committee decided to survey our members to see what we use in order to encourage us to think about our carbon emission,” she shared.

Out of 1,100 RANZCO fellowship members, 707 responses were received and some of the results are as follows. More than 96% of the responders said that they perform intravitreal injections in the office/ treatment room, and only 3.5% inject exclusively in the operation theater. In terms of PPE, more than 99% use masks and more than 90% use sterile gloves. About 3% to 11% also use shoes, head covers, and gowns. In terms of local anesthetic, 31% of the responders use topical drops only, while 60% use a combination of topical and subconjunctival injection. When it comes to consumables, 55% use custom IVI packs, 37% use basic dressing packs, and the rest use individual items.

The survey also asked the members what they would like to change, if any. And many of them expressed concerns that the free IVI dressing packs that they receive are not often being used and had to be thrown away.

“About a third of the responders do not use any callipers or speculum. If you do, perhaps it’s time to rethink the prepackaged equipment and disposal equipment,” added Dr. Gajus.

“A UK study found that the removal of four items from the IVI pack reduced 0.5kg CO2eq, hence it is worthwhile to reduce even the little things in your pack. I encourage you to reflect on what you do and whether they are necessary, reject things that you don’t need, and react by doing something about it. There’s no place for post-treatment antibiotics as well,” she concluded.

Improving the quality life of the vision impaired

Often, people with vision impairment need continuous care that extends beyond the clinician’s office. Following the talks on sustainability, Mr. Nabill Jacob from Vision Australia shared about the organization’s efforts in helping vision-impaired patients live better lives.

Vision Australia is a not-for-profit organization and the country’s leading provider of specialized blind or low-vision services to support people of all ages and stages.

“We know that the impact of vision impairment is profound and risks increased with vision loss,” Mr. Jacob said, noting that in order to help these patients to live the life they choose, Vision Australia adopts strategies that include vision enhancement, vision substitution, and environmental adaptations.

Among the various services provided by Vision Australia include emotional support groups, occupational therapists, mobility specialists, orthoptists, education and employment support, aids and equipment, technology, and training, among others.

The technology used include devices with refreshable Braille, WeWALK Smart cane, desk magnifier, wireless virtual reality headset IrisVision, and Orcam — an artificial intelligence device that enables people who are blind or visually impaired to read text from any surface, recognize faces, identify colors, products, among others.

Mr. Jacob noted that an emphasis is placed on children’s vision loss as well, and efforts are made to prepare them for employment and meaningful life-long participation starting from school-age years.

He also shared the parameters of patient referral. “These parameters include a diagnosis of a permanent non-correctible or progressive eye condition: visual acuity of <6/12 (both eyes open [BEO]) and or a visual field of ≤ 30 degrees (BEO); when vision loss is putting the patient at risk of accidents and health conditions; and when they experience grief or loss related to vision changes or difficulty completing everyday tasks,” he concluded, adding that referrals can be done easily via Vision Australia’s homepage.

Editor’s Note

The Royal Australian and New Zealand College of Ophthalmologists’ (RANZCO) 53rd Annual Scientific Congress was held on October 28 to November 1, 2022, in Brisbane, Australia. Reporting for this story took place during the event.