Eyeworld

14 | EYEWORLD | SUMMER 2024 ASCRS NEWS EYESUSTAIN UPDATE Contact Winklmair: nicolas.winklmair@sydney.edu.au by Nicolas Winklmair, MD About the physician Nicolas Winklmair, MD Optic Nerve Researchz Collaborative Australia (ORCA) Vienna Institute for Research in Ocular Surgery (VIROS) University of Sydney Hanusch Hospital Sydney, Australia Vienna, Austria References 1. Eckelman MJ, Sherman JD. Estimated global disease burden from US health care sector greenhouse gas emissions. Am J Public Health. 2018;108:S120–S122. 2. Eckelman MJ, et al. Life cycle environmental emissions and health damages from the Canadian healthcare system: An economic- environmental-epidemiological analysis. PLoS Med. 2018;15:e1002623. 3. Nansai K, et al. Carbon footprint of Japanese health care services from 2011 to 2015. Resources, Conservation and Recycling. 2020;152:104525. 4. Malik A, et al. The carbon footprint of Australian health care. Lancet Planet Health. 2018;2:e27–e35. 5. MacNeill AJ, et al. The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems. Lancet Planet Health. 2017;1:e381–e388. 6. Kagoma Y, et al. People, planet and profits: the case for greening operating rooms. CMAJ. 2012;184:1905–11. 7. Chang DF, et al. Survey of ESCRS members' attitudes toward operating room waste. J Cataract Refract Surg. 2023;49:341–347. 8. Morris DS, et al. The carbon footprint of cataract surgery. Eye. 2013;27:495–501. 9. Winklmair N, et al. Potential environmental effect of reducing the variation of disposable materials used for cataract surgery. J Cataract Refract Surg. 2023;49:628–634. reducing waste resulting from single-use prod- ucts seems to be a relatively simple and signifi- cant step to reduce the environmental impact of cataract surgery, as the procurement of surgical supplies accounts for 54% of cataract surgery's environmental footprint. 8 An Austrian study assessed the potential for material reduction in cataract packs by com- paring packs used within the country, revealing considerable variation in pack sizes (~0.5 kg for the smallest and ~1.2 kg for the largest) and suggesting that adopting smaller packs could reduce associated emissions by approxi- mately 34%. The greatest contribution to this reduction would be by decreasing the number and size of drapes and covers, as they constitute the most significant portion and show consid- erable differences between packs (two in the smallest and nine in the largest pack). 9 ESCRS analyzed and compared cataract packs from 44 surgical centers across 12 Euro- pean countries and nine different suppliers to develop the Sustainability Index for Disposables in Cataract Surgery (SIDICS). SIDICS aids oph- thalmologists in selecting sustainable cataract pack options without compromising clinical judgment or patient outcomes. The calculator, available on the ESCRS website (www.escrs. org/sidics), encourages the consideration of sus- tainability alongside cost and quality in procure- ment decisions. By incorporating SIDICS into the decision-making process and consequently reducing single-use surgical products, a feasi- ble first step toward more sustainable cataract surgery could be established. It is essential to continue exploring and implementing additional sustainable practices, such as improved ventilation strategies, in- creased use of reusable materials, and reduction of packaging for disposable items, with careful consideration of their feasibility, environmental benefits, and implications for patient safety. With SIDICS, ophthalmologists can take responsibility for the sustainability of their prac- tice and meaningfully reduce the environmental impact of cataract surgery. This sets the foun- dation for a sustainable practice, which aims to be responsible not only for individual health but also to the broader goal of collective well-being and environmental sustainability. SIDICS: Measuring the sustainability of cataract packs Accurately measuring surgical waste in operating rooms can yield significant benefits for climate change mitigation and health outcomes. By quantifying waste, hospitals and surgery centers can identify areas for waste reduction, leading to decreased carbon emissions from disposal and production. Moreover, minimizing waste can lower healthcare costs and improve resource utili- zation. In this issue's EyeSustain Update column, Nicolas Winklmair, MD, discusses the utility of the Sustainability Index for Disposables in Cataract Surgery (SIDICS) calculator developed by the European Society of Cataract and Refractive Surgeons (ESCRS) as a tool for ophthalmolo- gists to create data driven sustainable changes in operating practices. SIDICS promotes the use of eco-friendly materials, recycling initiatives, and waste reduction strategies in cataract surgery. Its implementation underscores a commitment of re- sponsible healthcare practices and environmental stewardship within ophthalmology. —Amy Mehta, MD, EyeSustain Update Guest Editor T he increasing concern and action within the health sector regarding climate change highlight a signifi- cant paradox: While healthcare aims to promote health, it inadvertently contributes to climate change, accounting for approximately 5% of global carbon emissions, 1-4 which in turn adversely affects health outcomes. Surgical areas in particular are critical due to their high energy and resource consumption and the significant amount of waste generated in operating theatres. 5,6 Surgeons are thus posi- tioned to take a leading role in promoting more sustainable practices, a necessity underscored by the slow pace of political change in address- ing climate issues. Ophthalmic surgeons are notably aware of the urgent need for sustainable practices in response to global warming. A survey conducted by ESCRS revealed that 99% of surgeons were concerned about climate change, recognizing the excessive waste in operating rooms (92%), and showing preference for reusable over disposable items, given cost parity (77%). 7 A need for action seems present, and focusing on

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