“Does the amount of waste we generate in the OR drive you crazy? Are you frustrated with nonsensical regulations about single use instruments and eyedrops? Would you like to save money and resources? Our course will give you practical information and support to make changes,” began Barbara Erny, MD, senior instructor, of the “Sustainability in Ophthalmology: How to Achieve a Triple Win for Your Practice, Patients and the Planet” session.
Dr. Erny noted that as a health-care professional, you set an example and suggested several ways to reduce waste, such as “greening” your home and workplace; community preparedness; eating a plant forward diet; not wasting food/compost; driving less; joining groups such as EyeSustain, Physicians for Social Responsibility, The Medical Society Consortium on Climate and Health, Climate Health Now; educating/advocating; divesting from funding fossil fuels; and voting.
Dr. Erny also invited attendees to take the EyeSustain surgical facility pledge.
Yee Ling Wong, MBChB, in her presentation on ocular effects of climate change, discussed the findings from a recent paper she co-authored titled, “Impacts of climate change on ocular health: A scoping review” published in The Journal of Climate Change and Health.
She noted that increasing levels of UV radiation speeds up cataract and pterygium formation, and that it also reduces corneal resistance, making it more likely for corneal infections to develop. She also explained that conjunctivitis is more likely as a result of poor tear film quality and dry eye disease, depleting important immunoglobulins and lysozymes that helps combat infection.
High temperature can also trigger an autoimmune response, making non-infectious uveitis more likely, Dr. Wong explained. Similarly, she said, UV radiation has been shown to cause rapid TERT mutations, increasing risks of periocular basal cell carcinomas.
In regard to air pollution, when coupled with low temperatures, blockages of meibomian gland happen, leading to meibomian gland dysfunction, blepharitis and evaporative dry eyes,
Dr. Wong said. The oxidative effects of air pollutants can also lead to the chronic ocular surface inflammation, including Sjögren's syndrome, she said.
Fine dusts and particles from extreme weather events like the Asian dust storm worsens allergic eye diseases and conjunctivitis among children, she said. Monsoon season is linked to pupil block and angle closure attacks in susceptible individuals; and drought causes food insecurity, leading to nutritional diseases like night blindness, xerosis or xerophthalmia.
With increasing rainfall, she said, there is also increasing incidence of reactivation of toxoplasma retinitis, from ingestion of contaminated food and water, as well as better survival of oocyst in warm humid soil. There is also growing risk of parasitic infections like microsporidia or fungal infections that are hard to treat, she said.
“There are still data gaps in literature on how extreme weather events can impact ocular health, particularly low-income countries with the most vulnerable populations. Collaborative efforts between high-income and low-income countries would help promote research opportunities and narrow these gaps,” said Dr. Wong.
In her presentation on greening your ophthalmology clinic, Ishani Majmudar, MS3, discussed how a practice can be more sustainable. She noted that in operating rooms single-use protocols and unnecessary packaging are key players in generating OR waste. Making your clinic more sustainable starts with the simplest tasks, she said. “Turn off your lights, unplug your devices and recycle when you can. It may not seem like a meaningful change, but every small action taken by you and your staff matters!”
In terms of recycling eyedrop bottles, such as Biotrue Eye Drops (Bausch + Lomb), she said that you can put the box it came in your curbside recycling but the bottle cap is often too small to be recycled (and can even cause problems for other items). She said a solution to this is sending them to TerraCycle. "The bottle is too small for many facilities to recycle so it’s best to send it to TerraCycle to ensure that it is processed properly," she said.
In his presentation on sustainability and policy, David J. Palmer, MD, told attendees that “from thoughtful sustainability ideas and advocacy, a practice, patient and planet WIN is within your reach. Only by confronting a problem can we attempt change that may have profound implications for our profession.” Several ways physicians can do this, he said, is by:
- Identifying a sustainability cause
- Interacting with state and national eye and medical societies
- Considering the Quality Improvement concept PDSA: Plan (evidence-based data collected; identify corrective actions and stakeholders; state eye and medical societies contacted), Do (solutions advocated, implemented/communicated), Study (outcomes analyzed; problems rectified), and Adjust (strategies realigned; barriers overcome)
- Modifying medical facility policies
- Participating in sustainability research
- Advocating collectively for a stronger voice
- Having patience, perseverance and optimism
Thulasiraj Ravilla, MBA, advisor, LAICO, and director, operations at Aravind Eye Care System, led a discussion on environmental sustainability initiatives that were implemented at Aravind Eye Care System.
“Ophthalmology, as one of the larger medical disciplines, has a moral responsibility to play a significant role in reducing the carbon emissions during the care giving process,” he said.
Some sustainability initiatives he noted that Aravind implemented were leveraging natural ventilation and lighting and minimizing energy consumption; minimizing maintenance with the right design and choice of materials; and providing housing for staff to reduce commuting.
Regarding reducing energy consumption, some initiatives that Aravind implemented included an energy audit, net zero building audit, replacing energy guzzlers (chillers, lights, fans, etc.), and turning off lights/fans and air-conditioners, when not in use. When switching to renewable energy, he said, Aravind made purchase arrangements with third-party solar/wind energy farms.
“While there are multiple strategies like green buildings, renewable energy and so on, the key driver is “MINDSET” of becoming responsible for the environment. Finally, it boils down to wanting to do it and each one of us can then figure out what works best for us,” he concluded.
