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How Cataract Surgery Could Be Changed To Reduce Greehouse Gas Emissions and Affect Climate Change

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Medical specialties are beginning to look at the environmental impacts of their areas of medicine. A review published in Ophthalmology homed in on cataract surgery and steps that might be taken to reduce greenhouse gas emissions associated with one of the most commonly performed surgeries.

The healthcare sector is responsible for around 8.5% of all greenhouse gas emissions in the United States.

Brooke Sherry, M.P.H., at NYU Langone, reviewed the research about cataract surgery and its association with greenhouse gas emissions that lead to climate change.

Brooke Sherry, M.P.H., at NYU Langone, reviewed the research about cataract surgery and its association with greenhouse gas emissions that lead to climate change.

In a recent review, Brooke Sherry, M.P.H., a research data associate at NYU Langone Health in New York, and colleagues, explored how to cut down or eliminate greenhouse gas emissions associated with cataract surgery, one of the most common surgeries in the U.S. and worldwide

Initially published online in March 2023, the review was published in the July issue of Ophthalmology.

Climate change can lead to a host of immediate and long-term health threats, ranging from extreme heat waves to insect-borne diseases. The eyes are exposed and vulnerable, note Sherry and colleagues.

“For eye care, climate change will likely increase ocular trauma (from extreme weather events), vector-borne diseases, such as trachoma and onchocerciasis; and diseases affected by exposure to heat, ultraviolet radiation, ozone, and other environmental pollutants,” they wrote. What’s more, as the global and American population ages, demand for cataract surgery will increase. Last year, the World Health Organization issued a report that projected that by 20250, the world population of people ages 60 and over will double and reach 2.1 billion

Previous research has shown that in high-income countries, the manufacturing and distribution of single-use surgical supplies is a key driver of emissions.

To better understand interventions that could reduce emissions associated with the surgery, Sherry and colleagues searched PubMed, SCOPUS, and Cochrane Library for relevant articles. They sorted potential interventions into the following domains: advocacy, education, pharmaceuticals, process changes, supplies and waste.

The analysis revealed several interventions that are potentially safe, cost-effective and environmentally friendly, including training staff to sort medical waste and limiting the number of supplies used during cataract surgery.

According to one survey cited in the review, 57% of clinicians were unclear about which operating room items can be recycled.

Because surgeons typically only need access to the patients’ eyes during surgery, having patients wear street clothes instead of gowns could serve as a potential intervention to reduce waste. However, more research is needed to better understand the practical considerations of gowns, authors noted.

Dispensing medicine to patients at home after surgery, multi-dosing appropriate medications and carrying out immediate sequential bilateral cataract surgery (ISBCS) when appropriate , all also hold potential to reduce GHG emissions, the review found.

It’s estimated as many as $560 million worth of medications associated with cataract procedures may be discarded each year.

Research has also been published supporting ISBCS as it leads to expediated patient rehabilitation and saves money and time.

“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,” Sherry and colleagues cautioned. In a hub-and-spoke setup, the surgeon completes the operations as the ‘hub’ and midlevel personnel serve as ‘spokes’ to carry out preoperative and postoperative care.

But they also added that notwithstanding the limitations of existing literature, “there is sufficient evidence that reducing environmental emissions in the operating room is achievable and cost-efficient.

In the future, individual stakeholders at each hospital or health system will need to decide which interventions will work best for their institution, Sherry and colleagues concluded.

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