Eyeworld

16 | EYEWORLD | SEPTEMBER 2022 EYESUSTAIN UPDATE ASCRS NEWS by Aakriti G. Shukla, MD, and David F. Chang, MD Twenty cataract surgeries at AECS create the same level of carbon emissions as one cataract surgery in the U.K. 6 More than 50% of surgeries performed at AECS are offered for free or at a steeply discounted price; despite this, the orga- nization is consistently profitable. The British Journal of Ophthalmology re- cently published a study from our group, titled "Changing Operating Room Practices: The Ef- fect on Postoperative Endophthalmitis Rates Fol- lowing Cataract Surgery." 7 When AECS resumed surgery following the April 2020 pandemic lockdown, they adopted four new OR protocols designed to reduce the risk of COVID-19 trans- mission. This retrospective, sequential, clinical registry study analyzed whether these more stringent protocols, which are mandatory in the U.S., reduced Aravind's rate of postoperative endophthalmitis following cataract surgery. The study included consecutive patients who underwent cataract surgery at the Madurai regional AECS hospital during 2020. Two groups were compared; Group 1 un- derwent surgery prior to the institution of COVID-19 protocols (between January 1, 2020, and March 30, 2020) and Group 2 underwent surgery following the new protocol adoption (between May 1, 2020, and August 1, 2020). April 2020 was not included in the analysis because surgery was limited to emergency or non-elective procedures. Group 2's time period was longer because of reduced surgical volume due to the pandemic. Outcome measures were the rate of postoperative endophthalmitis and complications such as posterior capsular rupture and zonular dialysis. T he healthcare sector is responsible for 10% of greenhouse gas emis- sions produced in the U.S. 1 ORs and labor and delivery services produce 70% of medical waste. With 29 million cataract surgeries performed globally in 2019, procedural volumes in ophthal- mology are the highest of any specialty. 2 As ophthalmologists, we have the potential to make impactful change by informing policy and modifying wasteful practices. Most ophthalmol- ogists are in agreement with this; a recent survey-based study with more than 1,000 respondents found that 93% of cataract surgeons think that approaches to reduce OR waste should be developed. 3 The Aravind Eye Care Sys- tem (AECS) is globally recog- nized for its forward-thinking eyecare models. This group of 14 regional eye hospitals in south India has consistently demonstrated delivery of safe, cost-effective, high-volume ophthalmic surgery with excel- lent outcomes. 4,5 These accom- plishments are accompanied by AECS's focus on environmental and economic sustainability. Sustaining safe, quality, cost-effective care: A clinical registry study at the Aravind Eye Care System assessing traditional and Western operating room practices Clareon ® PanOptix ® Family of Trifocal Hydrophobic IOLs IMPORTANT PRODUCT INFORMATION CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician. INDICATIONS The Clareon ® PanOptix ® Family of Trifocal Hydrophobic IOLs include Clareon ® PanOptix ® and Clareon ® PanOptix ® Toric and are indicated for primary implantation in the capsular bag in the posterior chamber of the eye for the visual correction of aphakia in adult patients, with less than 1 diopter of pre-existing corneal astigmatism, in whom a cataractous lens has been removed. The lens mitigates the effects of presbyopia by providing improved intermediate and near visual acuity, while maintaining comparable distance visual acuity with a reduced need for eyeglasses, compared to a monofocal IOL. In addition, the Clareon ® PanOptix ® Toric Trifocal IOL is indicated for the reduction of residual refractive astigmatism. WARNINGS/PRECAUTIONS: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Physicians should target emmetropia, and ensure that IOL centration is achieved. For the Clareon ® PanOptix ® Toric Trifocal IOLs, the lens should not be implanted if the posterior capsule is ruptured, if the zonules are damaged, or if a primary posterior capsulotomy is planned. Rotation can reduce astigmatic correction; if necessary lens repositioning should occur as early as possible prior to lens encapsulation. Some visual effects may be expected due to the superposition of focused and unfocused multiple images. These may include some perceptions of halos, radial lines around point sources of light (starbursts) under nighttime conditions, or glare, as well as other visual symptoms. As with other multifocal IOLs, there is a possibility that visual symptoms may be significant enough that the patient will request explant of the multifocal IOL. A reduction in contrast sensitivity as compared to that expected with a monofocal IOL may be experienced by some patients and may be more prevalent in low lighting conditions. Therefore, patients implanted with multifocal IOLs should exercise caution when driving at night or in poor visibility conditions. Patients should be advised that unexpected outcomes could lead to continued spectacle dependence or the need for secondary surgical intervention (e.g., intraocular lens replacement or repositioning). As with other multifocal IOLs, patients may need glasses when reading small print or looking at small objects. Posterior capsule opacification (PCO), may significantly affect the vision of patients with multifocal IOLs sooner in its progression than patients with monofocal IOLs. Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure available from Alcon informing them of possible risks and benefits associated with the IOLs. ATTENTION: Reference the Directions for Use labeling for each IOL for a complete listing of indications, warnings and precautions. © 2022 Alcon Inc. 05/22 US-CLI-2200118

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