How Ophthalmologists Can Decarbonize Eye Care: A Review of Existing Sustainability Strategies and Steps Ophthalmologists Can Take

Abstract

Topic: Understanding approaches to sustainability in cataract surgery and their risks and benefits.

Clinical relevance: In the United States, health care is responsible for approximately 8.5% of greenhouse gas (GHG), and cataract surgery is one of the most commonly performed surgical procedures. Ophthalmologists can contribute to reducing GHG emissions, which lead to a steadily increasing list of health concerns ranging from trauma to food instability.

Methods: We conducted a literature review to identify the benefits and risks of sustainability interventions. We then organized these interventions into a decision tree for use by individual surgeons.

Results: Identified sustainability interventions fall into the domains of advocacy and education, pharmaceuticals, process, and supplies and waste. Existing literature shows certain interventions may be safe, cost-effective, and environmentally friendly. These include dispensing medications at home to patients after surgery, multi-dosing appropriate medications, training staff to properly sort medical waste, reducing the number of supplies used during surgery, and implementing immediate sequential bilateral cataract surgery where clinically appropriate. The literature was lacking on the benefits or risks for some interventions, such as switching specific single-use supplies to reusables or implementing a hub-and-spoke-style operating room setup. Many of the advocacy and education interventions have inadequate literature specific to ophthalmology but are likely to have minimal risks.

Conclusions: Ophthalmologists can engage in a variety of safe and effective approaches to reduce or eliminate dangerous GHG emissions associated with cataract surgery.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.

Keywords: Carbon emissions; Cataracts; Climate change; Efficiency; Greenhouse gases; Health care delivery; Life cycle assessment; Quality; Surgery; Sustainability; Value.

Figure 1:

Decision Flow Chart for Selecting Sustainability Interventions related to Supplies in Cataract Surgery (in the US)

Figure 2:

Decision Flow Chart for Selecting Sustainability Interventions related to Pharmaceuticals in Cataract Surgery (in the US)