Several steps can reduce carbon footprint of intravitreal injections

BARCELONA, Spain — Adopting specific treatment regimens, reducing patient and staff travel, and limiting the use of unnecessary personal protective equipment can help improve the carbon footprint of intravitreal injections.

Intravitreal injections are frequently performed and therefore have important consequences in terms of carbon emissions. However, no common policy is in place to date, Redmer van Leeuwen, MD, PhD, said at the Euretina congress.

“There’s a huge difference between how we do this procedure in different countries and different clinics ... and there is also a big difference in the materials we use and the waste we produce,” he said. “We all pretend to work evidence based, so why is there this difference in practice?”

Some hospitals perform injections in the operating room, which consumes more energy. Switching to office-based procedures should be “an easy change,” according to van Leeuwen. He also suggested using alcohol-based hand rub rather than water.

A study by Power and colleagues suggested that three-quarters of the footprint of intravitreal injections is caused by patient travel. Potential solutions include performing consultation and injection on the same day, adopting a treat-and-extend protocol and performing same-day bilateral injections. Decentralized injection hubs can save on travel, as shown by the experience of Moorfields Eye Hospital in London, he said.

“We would like to see longer-acting drugs, which probably will be provided in the near future, and home monitoring will reduce consultations,” he said.

The carbon footprint of producing medications is unclear and is something industry should consider.

“But we can look at the [intravitreal] packs and rationalize what we really need,” van Leeuwen said. “First, we can refuse unused materials and reduce packaging. ... Also, you may ask for different materials like paper instead of plastic.”

While face masks are needed, sterile gloves may not be necessary, and neither are gowns, patient hair covers and face drapes because “there is no way of touching the needle on the skin,” van Leeuwen said.

A speculum is not used in some clinics, with the eyes kept open by hand, but some specialists are reluctant to do so, he noted. Additionally, forceps are not necessary to fixate the eye.

As far as prophylaxis for infectious endophthalmitis is concerned, while povidone-iodine is necessary, antibiotics are not.

“It’s proven that [antibiotics] are not attributable to infection reduction,” van Leeuwen said.

Finally, separating and recycling waste can help a practice save money and increase awareness of sustainability, he said.

Reference:

Power B, et al. J Ophthalmic Vis Res. 2021;doi:10.18502/jovr.v16i3.9433.