Biosimilars

COVID-19

Cataract Surgery

Cataract

Cataract Therapeutics

Clinical Diagnosis

Cornea

Dry Eye Awareness

Dry Eye

Gene Therapy

Geographic Atrophy

IOL Advances

Imaging

Glaucoma Awareness

Glaucoma Insights

Therapeutic Glaucoma

Interventional Glaucoma

Ocular Allergy

Ocular Surface Disease

Optic Relief

Optometry

Pediatrics

Pharmacy

Indispensable

Practice Management

Presbyopia

Ptosis

Refractive Surgery

Refractive

Retina

Surgery

Technology

Therapeutics

Understanding Antibiotic Resistance

Workplace

News

All News

Contributors

Money Matters

Media

Expert Interviews

Medical World News

Podcasts

Case Based Roundtable Series

Case of the Quarter

EyeView

Grand Rounds

Insights

Rapid Readout

Viewpoints

What’s Your WhEYE?

Conferences

Conference Coverage

Conference Listing

Events

Publications

Digital Edition

Europe Ophthalmology Times

Modern Retina

Supplements and Featured Publications

Partners

Subscribe

Resources

Job Board

About

Advertise

Privacy

Editorial

Terms and Conditions

Contact Us

Do Not Sell My Personal Information

Ophthalmology Times - Ophthalmology news, articles, and events

Facebook

Twitter

Instagram

LinkedIn

Spotlight

Clinical

Glaucoma

1rem

Authors

Regular vision screening assessments in early childhood have been shown to reduce the risk of persistent amblyopia at 7 years of age by more than half, according to a recent retrospective record review. 

Photoscreening could detect vision-threatening conditions in early childhood

A recurring feature at the 2024 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting in Boston, Massachusetts, was the call for environmentally friendly practices worldwide, with the goal of decreasing the impact of ophthalmic surgeries on the planet.

A driving force in this movement is EyeSustain

 an organization dedicated to the development of such friendly environmental practices, that exists as a global coalition of eye societies providing education and resources to support sustainable practices in ophthalmology.

Here is a sampling of the ASCRS discussions on the topic.

Greening eye care: reducing ophthalmology’s environmental footprint

The presenters, led by first author Sarishka Desai, BA, described the EyeSustain platform and its 5-pronged mission: educate the global ophthalmic community about more sustainable practices, collaborate with industry to reduce our carbon footprint and surgical waste, support research and innovative solutions that reduce ophthalmology’s environmental impact, support advocacy and education about the public health impact of climate change, and collaborate with industry to reduce our carbon footprint and surgical waste.

Desai, of the University of Connecticut School of Medicine in Farmington, and colleagues presented EyeSustain’s approach to reducing the ophthalmic carbon footprint. She was joined in the study by Nitya Devireddy, BS, MPH, of Penn State College of Medicine in Hershey, Pennsylvania; Sofia Miguez, BA, of Yale School of Medicine in New Haven, Connecticut; and Barbara Erny, MD, of the Department of Ophthalmology at Stanford University in California.

The greenhouse gas data associated with health care are startling. Health care is responsible for 4.4% of all global greenhouse gas emissions, 71% of which arise from the manufacturing, use, and disposal of medical supplies. Ophthalmology has the highest procedural volume of any surgical specialty, with 50 million cataract surgeries expected to be performed globally each year by 2050, Desai reported.

In light of the procedural data, the authors highlighted 6 areas that are currently undergoing research and quality improvement initiatives through the EyeSustain system.

 of cataract surgeons and nurses by David Chang and Cassandra Thiel found that 93% of respondents believe that the trash associated with OR procedures is excessive, and that methods to reduce waste should be identified and implemented.

 encouraged regulatory agencies to allow electronic instructions for use be disseminated in lieu of the traditional paper instructions included with each cataract pack.

Ongoing projects spearheaded by EyeSustain members, including medical students and ophthalmology residents, are taking a look at educating surgeons and surgical staff about sustainability and the impact of OR waste, OR water consumption, and evaluation of flash sterilization associated with cataract surgery.

In recognition of the fact that medications in the OR represent an estimated $560 million in waste annually, a multisociety position paper

 recently formulated 3 key recommendations: topical drugs in multidose containers can be used for multiple patients in surgical facilities if proper guidelines are followed; topical drugs in multidose containers can be used until the manufacturer’s labeled date of expiration if proper guidelines are followed; and, when applicable, patients should be able to take their partially used medication home for postoperative use.

The Aravind Eye Care system’s low-carbon model from Madurai, India, uses alternate energy sources, transport, infrastructure, and equipment maintenance.

 Studying global systems of eye care and waste produced can provide a deeper understanding of the impact of hospitals and providers on climate change, as well as ideas on how western eye care systems can proactively reduce carbon emissions.

The EyeSustain platform includes ophthalmology-specific action steps for greening offices and clinics in collaboration with the 

Partnerships can be established with large manufacturers to reduce packaging, make instruments reusable, and streamline the manufacturing and distribution processes.

In addition to the impact of practice waste on the environment, EyeSustain also recommends studying the effects of climate change on the incidence rates of ophthalmologic conditions, including cataracts, allergic disease, and glaucoma, among others.

Desai and her colleagues recommended that institutions take the following steps:

Conduct a waste audit to quantify the carbon footprint of an institution’s OR emissions. This includes using the EyeSustain-Zasti Carbon Footprint Calculator, using the Sustainability Index for Disposables in Cataract Surgery calculator for cataract packs to evaluate the item-by-item potential for carbon dioxide savings, and surveying clinical staff to identify areas of perceived excess waste.

Identify key stakeholders at an institution and an enthusiastic, multidisciplinary team and completing the OR Sustainability Pledge (

), which has been completed by ambulatory surgery centers/hospital outpatient departments from 9 countries thus far.

Implement best practices; multisociety recommendations for sustainability are easily accessible at eyesustain.org and My Green Doctor for outpatient/clinic resources and local legislation using the American Academy of Ophthalmology Topical Medical Waste Reduction Act legislative template.

Using phacoemulsification waste to guide changes in surgical sustainability

Adjustments to improve the sustainability of ophthalmic surgical practice can have a large impact when scaled to case volume, according to author Margaret Tharp, BSc, who described this study at the ASCRS meeting. She and her coauthors Stella Protopapas, BA, MPH, and Minka Gill, BSc, are from the Indiana University School of Medicine in Bloomington, whereas David J. Palmer, MD, ABO, is from the Northwestern University Feinberg School of Medicine in Chicago, Illinois.

In their study, they sought to draw connections between results from a 24-hour waste audit at an outpatient surgical center and current resources available from EyeSustain to improve the sustainability of ophthalmic surgical practice.

The authors documented the extensive waste generated from 1 day of surgeries in an institution that included 13 phacoemulsification procedures, 5 plastic surgeries, 3 urologic surgeries, and 5 otolaryngologic cases. The waste products were sorted as medications (eg, propofol, eye drop containers), textiles (eg, surgical gowns, drapes), metals (eg, metal wiring, disposable instruments), and plastics (eg, hard, soft, wrappings).

When the amounts of the waste products were tallied, the authors found that “ophthalmology produced the greatest amount of waste in a single day relative to other operating specialties, despite producing the least amount of waste per case. Most ophthalmic waste was from textiles, hard plastics, and medications,” the authors reported.

The specific 13 phacoemulsification procedures resulted in 95.4 lb of waste broken down as follows: 18.5 lb of hard plastic, 5.5 lb of soft plastic, 8.3 lb of wrapping, 13.5 lb of medications, 41.2 lb of textiles, 6.7 lb of miscellaneous waste, and no metals. Compared with other operating specialties, ophthalmology produced the least amount of waste per case but the greatest amount of waste in total due to the relatively high case volume.

It has been reported that “discarded/unused pharmaceuticals from US cataract surgeries demonstrated waste of [approximately] $150 per case while generating carbon dioxide–equivalent emissions that approximated 25,000 to 100,000 flights from San Francisco, California, to Boston annually.

Small changes can have dramatic results. Tharp and colleagues suggested that the following would have positive consequences.

Revising the use of tetracaine bottles intraoperatively; for example, reusing the bottles between cases or sending the bottles home with patients

Optimizing packaging of surgical supplies and electronic instructions

Utilizing intravenous sedation to limit anesthesia gas carbon dioxide–equivalent emissions

Focusing on cutting waste also creates an opportunity to explore the practices of global leaders in sustainable eye care, such as the efforts of the Aravind Eye Hospitals, which provide similar surgical success rates at a fraction of the waste produced by US practices.

 A downside may be that such practices require significant reuse of materials, central sterilization, and stakeholder diligence, which can require complex interventions, according to Tharp. 

EyeSustain’s Surgical Facility Sustainability Pledge can serve as a guide for ophthalmologists to improve the sustainability of their practice in an approachable and lasting manner.

Factors contributing to the carbon footprint of cataract surgery

Omar Taboun, MSc, a medical student at Western University’s Schulich School of Medicine & Dentistry in London, Ontario, Canada, working under the direction of Netan Choudhry, MD, FRCSC, also described the negative impact of cataract surgery on the environment at the ASCRS meeting.

He commented, “We know that climate change can affect human health through various means, such as adverse weather events causing injury and exposure to pollutants [exacerbating] underlying health conditions. As health care providers, it is our responsibility to treat patients for their conditions that may ultimately be influenced by environmental factors. Counterintuitively, the health care sector is itself a greenhouse gas emitter,” Taboun said.

Surgery contributes significant emissions to the environment through the necessary materials and tools used during procedures. In addition, the need to maintain sterility increases waste.

The term footprint indicates the sum of all emissions direct and indirect resulting from this procedure, Taboun explained, the resultant value of which is typically reported in carbon dioxide equivalents

And although cataract surgery requires only a few minutes to complete, the procedural volume has increased exponentially over the past 2 decades,

Taboun and colleagues developed a 2-fold goal: they wanted to increase their understanding of the carbon footprint and waste accumulation to identify the primary contributors and pinpoint areas for improvement to enhance the sustainability of cataract surgery.

They conducted a literature search of PubMed, Google Scholar, and Medline to identify studies related to the carbon footprint and the elements of cataract surgery. The results yielded 6 studies, with 2 being the basis for this discussion,

He highlighted 3 main points extracted from the published data: the lowest footprint published was just under 6 kg of carbon dioxide equivalents; the highest published footprint was just over 180 kg of carbon dioxide; and the major factors contributing to the footprint include procurement of pharmaceuticals and materials, building and energy use, such as heating/cooling, lighting, electricity-powered tools, and travel by patients and staff to the location where the procedure is performed.

Taboun directed attention to centers that already have sustainable practices in place, such as the Aravind Eye Hospital, which reports the lowest footprint. These sustainable practices include the use of multiple operating tables in a single room; reusing gloves, gowns, and various medical equipment;

and using highly efficient autoclave settings.

Importantly, when these changes were implemented in the Aravind Eye Hospital,

 the rates of endophthalmitis remained comparable to other centers: 0.02% vs from 0.04% to 0.07% reported.

Taboun offered 3 ways that surgeons can offset the negative effects of cataract surgery on the environment—by focusing on procurement, energy use, and travel emissions.

Reduce emissions associated with procurement by collaborating with manufacturers to reduce packaging as much as possible and encouraging recycling in every OR.

Reduce building and energy use by incorporating renewable energy, such as solar panels, and more strategic lighting protocols and optimizing energy use within surgical centers.

Establish outreach clinics closer to more populous regions, whereby mostly staff members must travel, and patients less so, which will reduce travel emissions, along with performing bilateral procedures.

“Implementing sustainable practices, although challenging, will allow us to continuously provide this procedure and restore vision for millions of people at less of a cost to the environment,” Taboun said.

1. Chang DF, Thiel CL; Ophthalmic Instrument Cleaning and Sterilization Task Force. Survey of cataract surgeons’ and nurses’ attitudes toward operating room waste

. 2020;46(7):933-940.doi:10.1097/j.jcrs.0000000000000267

2. Schehlein EM, Hovasesian J, Shukla AG, Talley Rostov A, Findl O, Change DF. Reducing ophthalmic surgical waste through electronic instructions for use: a multi-society position paper. 

. 2024;50(3):197-200. doi:10.1097/j.jcrs.0000000000001381

3. Cleaning and Sterilization Task Force. Reducing topical drug waste in ophthalmic surgery: multisociety position paper

. 2022;48(9):1073-1077; doi:10.1097/j.jcrs.0000000000000975

4. Goel H, Wemyss TA, Harris T, et al. Improving productivity, costs and environmental impact in International Eye Health Services: using the ‘Eyeficiency’ cataract surgical services auditing tool to assess the value of cataract surgical services. 

. 2021 ;6(1):e000642. doi:10.1136/bmjophth-2020-000642. 2021

5. US EPA O. Greenhouse gas equivalencies calculator. United States Environmental Protection Agency. Updated January 2024. https://www.epa.gov/energy/greenhouse-gas-equivalencies-calculator

6. Gadani H, Vyas A. Anesthetic gases and global warming: [otentials, prevention and future of anesthesia. 

. 2011;5(1):5-10. doi:10.4103/0259-1162.84171

7. Thiel CL, Schehlein E, Ravilla T, et al. Cataract surgery and environmental sustainability: waste and lifecycle assessment of phacoemulsification at a private healthcare facility. 

. 2017;43(11):1391-1398. doi:10.1016/j.jcrs.2017.08.017

8. Pandey D, Agrawal M, Pandey JS. Carbon footprint: current methods of estimation. 

. 2011 ;178(1-4):135-160. doi:10.1007/s10661-010-1678-y

9. Pandey D, Agrawal M, Pandey JS. (2011). Carbon footprint: current methods of estimation. 

. 2011;178(1-4):135-160. doi:10.1007/s10661-010-1678-y

10 Rachmiel R, Trope GE, Chipman ML, Buys YM. Cataract surgery rates in Ontario, Canada, from 1992 to 2004: more surgeries with fewer ophthalmologists. 

11. Morris DS, Wright T, Somner JEA, Connor A. The carbon footprint of cataract surgery. 

. 2013;27(4):495-501. doi:10.1038/eye.2013.

12. Latta M, Shaw C, Gale J. The carbon footprint of cataract surgery in Wellington. 

13. Ravindran RD, Venkatesh R, Chang DF, Sengupta S, Gyatsho J, Talwar B. Incidence of post-cataract endophthalmitis at Aravind Eye Hospital: outcomes of more than 42,000 consecutive cases using standardized sterilization and prophylaxis protocols. 

. 2009;35(4):629-636. doi:10.1016/j.jcrs.2009.01.002

14, Pershing S, Lum F, Hsu S, et al. Endophthalmitis after cataract surgery in the United States: a report from the Intelligent Research in Sight registry, 2013-2017. 

. 2020;127(2):151-158. doi:10.1016/j.ophtha.2019.08.026

Organization eyes green practices, shifting ophthalmology landscape.

Minimizing the carbon footprint of ophthalmic surgeries

Ophthalmology Times Week in review 

. Welcome to the latest edition of This Week in Ophthalmology, a video series highlighting some of the top articles featured on the 

I recently talked to Dr. Ashley Brissette, team ophthalmologist for the New York Rangers to discuss eye injuries in hockey and other sports, as well as advancements in prevention and treatment for the players.

NHL ophthalmologist on eye injuries and eye health in professional sports

A recent report showed that 2 predisposing factors may have resulted in the development of SANS of greater severity in 1 female astronaut than cases of SANS that developed in other astronauts, according to the lead author Dr. Tyson J. Brunstetter from the NASA Johnson Space Center, Houston.

SANS was first reported in 2011,2 and described as “anatomical changes to the eyes and brain during spaceflight as well as visual performance decrements in a subset of cases.”

SANS can develop during or immediately after spaceflight and is characterized by optic disc edema (ODE), chorioretinal folds, globe flattening, and/or hyperopic refractive shifts. As many as 15% to 20% of astronauts can develop what are considered clinically concerning levels of SANS during the course of or following lengthy spaceflights onboard the International Space Station.

Potential risk factors for severe Spaceflight-Associated Neuro-Ocular Syndrome

We also delve into a study examining the impact of the COVID-19 pandemic on ophthalmology residency and fellowship training

A team of researchers in Saudi Arabia set out to study the impact of the 

 pandemic on residency and fellowship training in terms of clinical load, surgical exposure, medical education, and research opportunities.

The researchers, in the Ophthalmology Department at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, maintained in the study COVID-19 pandemic has negatively affected many aspects of the healthcare system.

The retrospective study was conducted at King Khaled Eye Specialist Hospital (KKESH), in Riyadh, Saudi Arabia, to review the impact of the COVID-19 pandemic on the training program by comparing the years 2018 and 2019 before the pandemic to 2020 and 2021 after the pandemic.

Study examines the impact of the COVID-19 pandemic on ophthalmology residency and fellowship training

Ophthalmology Times learned this week that Eyenovia, SGN Nanopharma will collaborate to develop treatment for chronic dry eye disease.

Under the terms of the agreement, the companies will work to develop SGN’s Micellar Nanoparticle platform-based cyclosporine formulation for use with Eyenovia’s Optejet dispenser.

The companies said they currently are validating the novel drug-device combination product's manufacturability to back up clinical testing and will schedule a consultation meeting with the FDA to discuss clinical development.

Michael Rowe, CEO of Eyenovia, noted the Optejet dispenser has been shown in prior studies to deliver a therapeutic dose of medication with 80% less drug volume, thereby minimizing exposure to harmful preservatives and improving tolerability.

Eyenovia and SGN Nanopharma partner to develop treatment for chronic dry eye disease

Thank you for joining me for This Week in Ophthalmology. You can read more about these and other articles on our website at OphthalmologyTimes.com. If you have an interesting idea for an article you can reach me by email.

This Week in Ophthalmology is a video series highlighting some of the top articles featured on the Ophthalmology Times website.

Videos

This Week in Ophthalmology: Week of July 28, 2024

NHL ophthalmologist on eye injuries and eye health in professional sports.

Ashley Brissette, MD, MSc, FRCSC, team ophthalmologist for the New York Rangers of the NHL sat down to talk about eye injuries in hockey and other professional sports, as well as advancements in prevention and treatment for the players.

Ashley Brissette, MD, MSc, FRCSC, team ophthalmologist for the New York Rangers sat down to talk about eye injuries in hockey and other professional sports, as well as advancements in prevention and treatment for the players. 

Luminopia and the PUPil Registry

Scott Xiao, co-founder and CEO of Luminopia, sat with 

 to discuss the PUPiL Registry and how the VR treatment for children with amblyopia works and can revolutionize amblyopia treatment.

Hi. I'm David Hutton of Ophthalmology Times. Joining me is Scott Xiao, Luminopia co-founder and CEO. The company recently announced that real world data from the patients using Prescription Luminopia Registry continues to demonstrate efficacy of the FDA approved therapy and improving vision for children with amblyopia. Thank you so much for joining us. First, tell us about the data and what it means for the treatment of amblyopia in young children.

Sure, thanks, David, and glad to be here. So at Luminopia, we've developed the first FDA approved by binocular treatment for amblyopia, which is the leading cause of vision loss in young children. And despite its prevalence, it's a space that hasn't had innovation in a long time. So the standard of care treatments up to this point have been glasses, followed by eye patches, and atropine drops for some patients. Now, compliance with these treatments is often very poor. And even in patients that are compliant, you see many of them are left with residual vision loss. So we set out on this mission about 7 years ago now to create a more engaging and a more effective way of treating amblyopia. And the technology that we developed, we like to say allows kids to watch their favorite TV show as treatment instead of having to wear a patch. So you can imagine compliance gets a little bit easier if the kids get to watch SpongeBob as treatment.

But beyond that, we're also pioneering a unique mechanism. So with patching, you're penalizing the stronger eye, and you're just getting input from one eye. So it's more of a monocular approach. Whereas we're pioneering a binocular treatment where we are rebalancing the input to the eyes, but still making sure that the brain is getting stimulated from both eyes. And we do that within a VR headset. That's what allows us to present a different image to each eye and modify the TV shows accordingly. The technology was studied in multiple clinical trials, and was granted FDA approval about 2 years ago, and has been commercially available for just over a year. And we're really happy to have a number of the top children's hospitals and eye institutes across the country already prescribing and they've really embraced the technology as a new treatment option for their patients with this condition.

Now, the recent announcement we put out is with regard to the–what we call the PUPiL Registry, which we set up about 8 months ago to look at the real world outcomes of Luminopia, now that it's commercially available. And the key difference between this and some of the clinical trial data we've published in the past, is this is the real world. So there's very little eligibility criteria when it comes to the registry, we're looking to understand the outcomes with pretty much any patient that a physician decides is a good candidate for Luminopia. And we really wanted to understand a couple of things. We wanted to understand how is this technology being used in the real world now that it's available for prescription? And how are the results? And how do they compare to what we saw in our clinical trial?

Scott Xiao, co-founder and CEO of Luminopia, sat with Ophthalmology Times to discuss the PUPiL Registry and how the VR treatment for children with amblyopia works and can revolutionize amblyopia treatment.

Talitha Dale

Articles

Latest Updated Articles