Ophthalmology and Climate Change

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Article initiated by:
Anna March de Ribot, MD, PhD, Francesc March de Ribot, MD, PhD
All contributors:
Anna March de Ribot, MD, PhD, Francesc March de Ribot, MD, PhD
Assigned editor:
Review:
Assigned status Update Pending
.


Healthcare sector

The healthcare sector significantly contributes to climate impact through its high resource and energy consumption.[1] It is among the largest Greenhouse gas emissions (GHG) polluters globally,[2][3][1][4] accounting for 4.4% of the world’s total GHGs in 2019, [5][6][7][8] equivalent to the fifth largest carbon emitter if considered a country.[5]

In the USA, healthcare services contribute nearly 10% of the country’s carbon footprint,[2][9][10][11][12][13][14][15][16][1][5][17][4][6][18][19] and it is said that it is the second largest contributor to waste in the USA[20][21][6] after the food industry.[20][6] In NZ and Australia, healthcare services contribute around 5-7% of total GHG emissions,[9][11][14][15][5][22][23] surpassing those of aviation.[22][23] In Canada, healthcare service release 5% of its GHG emissions 40 and contributes alone to 5-6% of the global healthcare GHG emissions; this disproportionate value becomes evident considering that Canada’s population constitutes less than 5% of the worldwide total.[19] Similarly, the German health sector emits 5% of the overall GHG emissions.[24][25] The UK’s health system emits 20-22 million tonnes of GHGs annually,[26][17] comprising 3-4% of annual emissions[9][16][1][5][4] and 25% of all its public sector emissions.[16][26][17]

Much of the health care carbon footprint is attributed to waste generation, particularly disposable material.[1] For instance, hospitals in the USA produce 7,000 tons of waste daily,[1][21] while Essen University Hospital in Germany produces 9 tons per day.[1] Unintentionally, healthcare is also responsible for other harmful emissions, including 9% of the toxic air pollutants in the USA.[3] Surprisingly, healthcare facilities lag in efforts to reduce, reuse, and recycle.[27] Though, healthcare professionals are responsible for addressing climate change by increasingly treating patients suffering from its effect and implementing changes to prevent further harm.[25]

Ophthalmology responsibility

Ophthalmology, with very high clinic and surgical volumes,[28][24][15][1][8] faces the challenge of the increasing prevalence of common diseases such as cataracts, age-related macular degeneration, glaucoma, dry eyes and allergies driven by aging, demographic developments and climate change.[24]

Cataract surgery is the most frequently performed surgical procedure globally[11][29][30][5][31][8] with over 65 million people affected by cataracts.[11] In the UK alone, cataract services were estimated to contribute approximately 63,000 tonnes of CO2eq emissions in 2011.[26][28]

Given this context, ophthalmologists have a compelling opportunity and obligation to lead efforts within medicine to make eye care more sustainable by reducing the environmental impact.[24][6]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Lever M, Smetana N, Bechrakis NE, Foerster A. Erhebung und Reduktion der Abfallproduktion im Augenoperationsbereich [Survey and reduction of waste production from eye surgery]. Ophthalmologie. 2023 Sep;120(9):932-939. German. doi: 10.1007/s00347-023-01840-6. Epub 2023 Apr 13. PMID: 37052707.
  2. ↑ 2.0 2.1 El Hamichi S, Gold A, Murray TG, Graversen VK. Pandemics, climate change, and the eye. Graefes Arch Clin Exp Ophthalmol. 2020 Dec;258(12):2597-2601. doi: 10.1007/s00417-020-04947-7. Epub 2020 Sep 30. PMID: 32997287; PMCID: PMC7525080.
  3. ↑ 3.0 3.1 Sherry B, Lee S, Ramos Cadena MLA, Laynor G, Patel SR, Simon MD, Romanowski EG, Hochman SE, Schuman JS, Prescott C, Thiel CL. How Ophthalmologists Can Decarbonize Eye Care: A Review of Existing Sustainability Strategies and Steps Ophthalmologists Can Take. Ophthalmology. 2023 Jul;130(7):702-714. doi: 10.1016/j.ophtha.2023.02.028. Epub 2023 Mar 6. PMID: 36889466; PMCID: PMC10293062.
  4. ↑ 4.0 4.1 4.2 Khor HG, Cho I, Lee KRCK, Chieng LL. Waste production from phacoemulsification surgery. J Cataract Refract Surg. 2020 Feb;46(2):215-221. doi: 10.1097/j.jcrs.0000000000000009. PMID: 32126034.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Buchan, J., Thiel, C., Thomas, P. Carbon and Cataracts: How to Make Your Service Sustainable. Cataract Surgery. Springer, Cham (2021). https://doi.org/10.1007/978-3-030-38234-6_14
  6. ↑ 6.0 6.1 6.2 6.3 6.4 Chang DF. Tackling the challenge of needless surgical waste in ophthalmology. J Cataract Refract Surg. 2023 Apr 1;49(4):333-338. doi: 10.1097/j.jcrs.0000000000001175. PMID: 36975008.
  7. ↑ Hyland CJ, Yates EF, Gadiraju G, Dey T, Broyles JM. Public Perceptions of Climate Change and Plastic and Reconstructive Surgery. Plast Reconstr Surg Glob Open. 2022 Nov 15;10(11):e4442. doi: 10.1097/GOX.0000000000004442. PMID: 36389612; PMCID: PMC9653180.
  8. ↑ 8.0 8.1 8.2 Chang DF, Elferink S, Nuijts RMMA. Survey of ESCRS members' attitudes toward operating room waste. J Cataract Refract Surg. 2023 Apr 1;49(4):341-347. doi: 10.1097/j.jcrs.0000000000001096. PMID: 36975010.
  9. ↑ 9.0 9.1 9.2 Buchan JC, Thiel CL, Steyn A, Somner J, Venkatesh R, Burton MJ, Ramke J. Addressing the environmental sustainability of eye health-care delivery: a scoping review. Lancet Planet Health. 2022 Jun;6(6):e524-e534. doi: 10.1016/S2542-5196(22)00074-2. Erratum in: Lancet Planet Health. 2022 Aug;6(8):e644. PMID: 35709809.
  10. ↑ Thiel CL, Schehlein E, Ravilla T, Ravindran RD, Robin AL, Saeedi OJ, Schuman JS, Venkatesh R. Cataract surgery and environmental sustainability: Waste and lifecycle assessment of phacoemulsification at a private healthcare facility. J Cataract Refract Surg. 2017 Nov;43(11):1391-1398. doi: 10.1016/j.jcrs.2017.08.017. PMID: 29223227; PMCID: PMC5728421.
  11. ↑ 11.0 11.1 11.2 11.3 Goel H, Wemyss TA, Harris T, Steinbach I, Stancliffe R, Cassels-Brown A, Thomas PBM, Thiel CL. Improving productivity, costs and environmental impact in International Eye Health Services: using the 'Eyefficiency' cataract surgical services auditing tool to assess the value of cataract surgical services. BMJ Open Ophthalmol. 2021 May 20;6(1):e000642. doi: 10.1136/bmjophth-2020-000642. PMID: 34104796; PMCID: PMC8141432.
  12. ↑ 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.
  13. ↑ Mamalis N. Reducing the environmental impact of cataract surgery: Sustainability versus safety: A tradeoff? J Cataract Refract Surg. 2018 Jan;44(1):1-2. doi: 10.1016/j.jcrs.2018.01.001. PMID: 29502595.
  14. ↑ 14.0 14.1 Murray N, Mack HG, Al-Qureshi S. The case for adopting sustainability goals in ophthalmology. Clin Exp Ophthalmol. 2019 Sep;47(7):837-839. doi: 10.1111/ceo.13607. PMID: 31631490.
  15. ↑ 15.0 15.1 15.2 Namburar S, Pillai M, Varghese G, Thiel C, Robin AL. Waste generated during glaucoma surgery: A comparison of two global facilities. Am J Ophthalmol Case Rep. 2018 Oct 10;12:87-90. doi: 10.1016/j.ajoc.2018.10.002. PMID: 30364583; PMCID: PMC6197147.
  16. ↑ 16.0 16.1 16.2 Power B, Brady R, Connell P. Analyzing the Carbon Footprint of an Intravitreal Injection. J Ophthalmic Vis Res. 2021 Jul 29;16(3):367-376. doi: 10.18502/jovr.v16i3.9433. PMID: 34394865; PMCID: PMC8358765.
  17. ↑ 17.0 17.1 17.2 Chandra P, Gale J, Murray N. New Zealand ophthalmologists' opinions and behaviours on climate, carbon and sustainability. Clin Exp Ophthalmol. 2020 May;48(4):427-433. doi: 10.1111/ceo.13727. Epub 2020 Feb 20. PMID: 32048791.
  18. ↑ Di Simplicio S, Fowler S, Burt S, Hogg HDJ. Cross-sector collaboration for carbon reduction and offsetting in cataract surgery. Br J Surg. 2023 Mar 30;110(4):506-507. doi: 10.1093/bjs/znad024. PMID: 36772812.
  19. ↑ 19.0 19.1 Taboun OS, Orr SMA, Pereira A, Choudhry N. Factors contributing to the carbon footprint of cataract surgery. J Cataract Refract Surg. 2023 Jul 1;49(7):759-763. doi: 10.1097/j.jcrs.0000000000001204. PMID: 37390323.
  20. ↑ 20.0 20.1 Yap A, Wang K, Chen E, Melhado C, Ahmad T, O'Sullivan P, Gandhi S. A mixed-methods study on end-user perceptions of transitioning to reusable surgical gowns. Surg Open Sci. 2022 Nov 8;11:33-39. doi: 10.1016/j.sopen.2022.10.003. PMID: 36444285; PMCID: PMC9700296.
  21. ↑ 21.0 21.1 Kwakye G, Brat GA, Makary MA. Green surgical practices for health care. Arch Surg. 2011 Feb;146(2):131-6. doi: 10.1001/archsurg.2010.343. PMID: 21339421.
  22. ↑ 22.0 22.1 TLatta M, Shaw C, Gale J. The carbon footprint of cataract surgery in Wellington. N Z Med J. 2021 Sep 3;134(1541):13-21. PMID: 34531593.
  23. ↑ 23.0 23.1 Ferrero A, Thouvenin R, Hoogewoud F, Marcireau I, Offret O, Louison P, Monnet D, Brézin AP. The carbon footprint of cataract surgery in a French University Hospital. J Fr Ophtalmol. 2022 Jan;45(1):57-64. doi: 10.1016/j.jfo.2021.08.004. Epub 2021 Nov 22. PMID: 34823888.
  24. ↑ 24.0 24.1 24.2 24.3 Deutsche Ophthalmologische Gesellschaft (DOG); Berufsverband der Augenärzte Deutschlands e. V. (BVA). Positionspapier und Handlungsempfehlungen für eine ökologisch nachhaltige Augenheilkunde : Stellungnahme der Deutschen Ophthalmologischen Gesellschaft (DOG) und des Berufsverbands der Augenärzte Deutschlands (BVA) [Position paper and recommendations for action for ecologically sustainable ophthalmology : Statement of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA)]. Ophthalmologie. 2023 Jan;120(1):52-68. German. doi: 10.1007/s00347-022-01792-3. Epub 2023 Jan 10. PMID: 36625883; PMCID: PMC9838365.
  25. ↑ 25.0 25.1 Birtel J, Heimann H, Hoerauf H, Helbig H, Schulz C, Holz FG, Geerling G. Nachhaltigkeit in der Augenheilkunde : Adaptation an die Klimakrise und Mitigation [Sustainability in ophthalmology : Adaptation to the climate crisis and mitigation]. Ophthalmologie. 2022 Jun;119(6):567-576. German. doi: 10.1007/s00347-022-01608-4. Epub 2022 Apr 22. PMID: 35451609; PMCID: PMC9024069.
  26. ↑ 26.0 26.1 26.2 Morris DS, Wright T, Somner JE, Connor A. The carbon footprint of cataract surgery. Eye (Lond). 2013 Apr;27(4):495-501. doi: 10.1038/eye.2013.9. Epub 2013 Feb 22. PMID: 23429413; PMCID: PMC3626018.
  27. ↑ Cameron TW 3rd, Vo LV, Emerson LK, Emerson MV, Emerson GG. Medical Waste Due to Intravitreal Injection Procedures in a Retina Clinic. J Vitreoretin Dis. 2021 Feb 10;5(3):193-198. doi: 10.1177/2474126420984657. PMID: 37006514; PMCID: PMC9979047.
  28. ↑ 28.0 28.1 Wong YL, Noor M, James KL, Aslam TM. Ophthalmology Going Greener: A Narrative Review. Ophthalmol Ther. 2021 Dec;10(4):845-857. doi: 10.1007/s40123-021-00404-8. Epub 2021 Oct 11. PMID: 34633635; PMCID: PMC8502635.
  29. ↑ Palmer DJ, Robin AL, McCabe CM, Chang DF; Ophthalmic Instrument Cleaning and Sterilization Task Force. Reducing topical drug waste in ophthalmic surgery: multisociety position paper. J Cataract Refract Surg. 2022 Sep 1;48(9):1073-1077. doi: 10.1097/j.jcrs.0000000000000975. PMID: 35608314.
  30. ↑ Kohnen T. Becoming more eye-ficient. J Cataract Refract Surg. 2022 Sep 1;48(9):983-984. doi: 10.1097/j.jcrs.0000000000001011. PMID: 36026471.
  31. ↑ Råen M, Sandvik GF, Drolsum L. Endophthalmitis following cataract surgery: the role of prophylactic postoperative chloramphenicol eye drops. Acta Ophthalmol. 2013 Mar;91(2):118-22. doi: 10.1111/j.1755-3768.2011.02324.x. Epub 2011 Dec 13. PMID: 22151787.

See also

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