Climate change and eye health

1. Why is it important for ophthalmic practices to adopt sustainable measures?
Ophthalmology is a branch with a large population to serve and a thirst for consumables. Cataract surgery in the West generates an average of 5 kilograms of waste per surgery. Given the ageing population of the world and the expected increase in the number of cataract surgeries to around 50 million a year by 2050, this level of waste generation is unsustainable. Is there a solution to this? Yes of course, there are plenty of ways to decrease the waste generated in ophthalmology practise. We implement quite a few ideas here at the Aravind Eye Care System that has seen our average waste generated by cataract surgery decrease to 250 grams per surgery, a twenty-fold decrease compared to the West, all while producing similar results with same or lesser infection rates. This is why it is important to adopt more sustainable measures

2. According to you, what are some of the most effective strategies to reduce carbon footprint in practices?
Most of the waste produced in an ophthalmology setting originated from the operating room(OR). With the largest number of procedures among all medical specialities – 29 million cataract surgeries in 2019 and an estimated 50 million by 2050, the OR generates a significant amount of waste, mostly due to regulations aimed at preventing infection, but lacking evidence based support. As a result modifications to operating room procedures hold the greatest potential for reducing the environmental impact.

In addition to the OR, there are ample opportunities to reduce waste generation elsewhere. For example, the use of topical medications in multi dose containers. There is compelling evidence showing that a single container can be used for multiple patients with proper precautions, yet this is not widely practised, leading to substantial drug waste.
Repurposing and recycling too are important strategies to prolong the life of a product and to move away from our use-and-throw tendencies.

3. Could you tell us more about “Aravind Eye Hospital” and its journey to becoming a trendsetter in environmentally sustainable practices?
Aravind Eye Care System is committed to providing quality, affordable eye-care in a way that is sustainable. Over 40 percent of our surgeries are done for free or at a steeply subsidized cost. In many ways, our system makes us think about ways to reduce unnecessary waste and address costs for both the patient and our organization.

Over the decades, we’ve developed policies that help us achieve the same to a large extent. For example, in the OR – We use topical drugs in multidose containers to anaesthetize and dilate patients. We employ reusable titanium phaco-tips for several surgeries. A flash sterilization system ensures quicker turnaround time for instruments, thereby reducing the need for a larger number of surgery sets.

4. How have you managed to reduce the carbon footprint, deliver quality care, and generate profit all at the same time?
We have learned from our experiences here at Aravind that quality care, environmental sustainability and profits go hand in hand with each other. Reducing the carbon footprint involves decreasing use of consumables & saving costs without compromising on quality of care, or even making it better.

For example – We have recently shifted to an Electronic-Medical-Record system that has significantly decreased paper waste while greatly improving the patient-care experience. We also have a state-of-the-art rainwater harvesting system, energy efficient lighting and cooling systems and repurposing measures, all of which propel us towards being more environment-friendly.

We have implemented an extensive network of telemedicine centres with a setup for comprehensive eye examination, including fundus imaging. Over 3000 patients avail these on a daily basis, greatly reducing emissions. The same also applies to our outreach programme wherein patients are screened at their hometowns and those needing expert-care are bussed to the main hospital. We can confidently state that providing quality care, in a sustainable manner will generate profits.

5. What were the challenge(s) in actioning these changes with respect to compliance and ensuring credibility of the improved practices?
Change, though a constant, is hard to accept. Questioning redundant practices and borrowing ideas from other streams to incorporate into patient care has always been an uphill task. Enacting and enabling policy changes, and being the forerunner or the early adaptor to changes is also quite taxing. The outcomes though are motivation enough. We have always encouraged practising evidence-based-medicine and have strived to scientifically prove that our measures are indeed better than the existing ones we replace. Examples include the use of Intra-cameral Moxifloxacin. Most of these changes are published in popular peer reviewed journals thereby lending scientific credibility and validity to these ideas. We also look back at data collected over the years to assess the impact of our policies and practices.

6. What do you think are the top priorities for the eye health sector to ensure better sustainable practices?
Sustainability needn’t necessarily equal quality. Care has to be taken to see if outcomes and patient experience are being affected by such measures. Patients also need to be educated on how these practices are improving the standard of care they avail and of how much of an environmental impact their care would be creating. This would encourage public support and perception of sustainable practices. As mentioned earlier, rigid and dated guidelines need to be re-assessed for validity and need to be altered with more sustainable ones wherever possible. Ophthalmology as a field is one that is always on the cusp of change, with many an invention radically altering practice.

We should find time and energy to involve other innovative solutions from different fields into our line of work and take from them whole-heartedly to improve our practices. This horizontal orientation and adaptability is what is going to set apart the trendsetters of tomorrow.