BLOG: Is your surgery center contributing to global warming?
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Climate change, driven by human emissions of greenhouse gases, has become a major threat to global health. Paradoxically, the health care industry is a large part of the problem.
If the health care industry were a country, it would be the fifth largest emitter of greenhouse gases on the planet. Climate change has driven a global increase in systemic illnesses, particularly pulmonary and cardiovascular disease, and an increase in ocular pathologies, especially vector-borne diseases such as trachoma, fungal keratitis and toxoplasmosis.
Although the optometry industry contributes only a modest amount to the greenhouse gas burden, we do have one significant link to it: when we send our patients in for ophthalmic surgery.
If you work in an ophthalmic surgery center, or have visited one, you will almost certainly have noticed the extraordinary amount of waste generated. The average single-eye cataract surgery in wealthy countries produces the equivalent of more than 180 kg, or 400 lbs., of carbon dioxide — the equivalent of driving a gasoline-powered car for 450 miles (Morris DS, et al). Much of the waste happens due to the production of single-use supplies like gowns, gloves, blades, cannulas, phacoemulsification tips and medication bottles.
When polled, 93% of U.S. ophthalmologists believe that operating room waste is excessive and should be reduced (Chang DF, et al). However, bureaucratic regulations and perceptions of legal exposure strongly limit the amount of discretion that nurses and surgeons have over supply decisions.
We know that surgery can be done as safely as our current standards, but with much less waste. A careful study of the Aravind Eye Care System in southern India discovered that the average waste per cataract surgery was the equivalent of 6 kg, or 12 lbs., of carbon dioxide, the equivalent of driving a car for 15 miles (Thiel CL, et al). They did so with an endophthalmitis rate of 0.02% over 555,550 consecutive surgeries — a lower incidence than we achieve in the U.S., where our rate is 0.04%.
Ophthalmologists have begun advocating for a re-examination of the regulations that mandate unnecessary waste, primarily through their organization EyeSustain. Optometrists also have a powerful voice in this process, since we recommend specific surgery centers to our patients, and we can explain to our patients why we prefer one surgery center over another.
The next time you have a chance to speak with someone at your surgery center, consider asking questions about their efforts.
- Does the surgery center strive to minimize disposable items in its prepackaged kits of sterile surgical supplies?
- Many IOLs come preloaded in disposable injectors, saving surgery staff from having to load the IOL. However, these injectors are disposable and more than double the waste from the IOL packaging. Does the center prefer these disposable injectors or does it use reusable injectors?
- Does the center sort recyclable waste?
- If they are planning on building a new facility, are they incorporating green building techniques?
- When they make purchasing decisions, do they evaluate the carbon footprint of products?
- Do they strive for a paperless workflow?
- Does the center run two adjacent operating rooms simultaneously, which can minimize some of the surgeon’s use of disposables?
- Do any of their surgeons belong to EyeSustain?
As the environment changes, so will the incidence of many ocular diseases. As doctors, we have all sworn an oath to place the health of our patients above all other priorities. If we took this responsibility seriously, we might feel empowered to use our role in the health care system to ask for change.
As counselors for our patients’ health care decisions, we have a tremendous amount of power, and letting surgery centers know that this issue is important to us will help them make good decisions.
References:
- Ocular manifestations of climate change. https://eyewiki.org/Ocular_Manifestations_of_Climate_Change. Accessed Nov. 19, 2023.
- Morris DS, et al. Eye. 2013;doi:27:495-501.
- Chang DF, et al. J Cataract Refract Surg. 2020;doi: 10.1097/j.jcrs.0000000000000267.
- Thiel CL, et al. J Cataract Refract Surg. 2017;doi:10.1016/j.jcrs.2017.08.017.
For more information:
Oliver Kuhn-Wilken, OD, practices at Pacific Cataract and Laser Institute’s Tualatin Clinic in Oregon.
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