Trainees: Keys to a Green Future

The following essay was a runner-up in this year’s ESCRS Henahan Prize Essay Competition. Writers were asked to address the question, “What can the field of ophthalmology do to meet the pressing challenges of climate change, sustainability, and social equity?”.

The metallic clang echoes in the quiet serenity of the operating theatre as the eyelid speculum slips out of my hand and drops onto the floor. I glance sheepishly at my scrub nurse colleague and mouth an apology.

“Not to worry,” she smiles back, “we will get you another. Which speculum would you like?”

“One of these disposable ones would be fine, thank you,” I reply.

I put the second speculum in place and continue with my cataract surgery operation—not sparing any further thoughts on the eventual fate of the two disposable speculums that I have used in this case.

Since commencing ophthalmology residency training, I confess that I had not spent much time pondering on the disposal of the surgical equipment (and its packaging) that I use every week. As trainees, we focus on training to become polished ophthalmologists, inadvertently taking for granted the apparent endless supply of surgical stock which we almost nonchalantly discard after use. We keep count of how many ocular surgeries we perform. But what about the number of surgical drapes that we have used? The array of instruments? How many of them are ever used again? How are they disposed of and what are the consequences?

We may be vaguely aware of the potential effects on sustainability and climate change. After all, they do occasionally come up as examination questions, no less. But such notions remain a distant whisper in the recesses of our minds, drowned out by busy clinics, on-calls, post-graduate examinations, research projects, and teaching roles.

Sometimes it is easy to lose sight of the bigger picture. The emergence of COVID-19 underlined just how complacent we were as a human race to the dangers of a worldwide crisis. In contrast to the immediate effects of infectious diseases, the effects of climate change are more insidious and can take generations to culminate into natural disasters that can affect us all. Hence, as ophthalmologists, it goes without saying we must all act now to make the world a better place for future generations. As a father to a toddler, keeping the dangers of climate change at bay has never been so imperative, and dare I say it, so personal.

EVERY LITTLE HELPS

It is almost staggering that during an average year as a UK trainee performing cataract surgery, my carbon footprint is about 10 tonnes CO2eq, which is the equivalent of several return flights to the Big Apple from London! Promoting better practices to deliver a sustainable ophthalmology service which minimises negative effects on climate change, as well as catering for all our patient groups is essential. And educating ophthalmology trainees early may be the key for effective progress in the long run. In the UK for example, the GMC guidance for new junior doctors emphasises the importance of sustainability in healthcare.

Incorporating compulsory teaching on climate change and healthcare and making participation in “greener ophthalmology” or “sustainable healthcare” projects mandatory, will leave ophthalmology trainees better prepared and more motivated to bring forward positive change. Offering opportunities for research in these fields will also encourage trainees to take more active roles and make a difference on a larger scale.

We have all encountered patients in the cataract post-op clinic who anxiously seek a date for their second eye surgery. And at times, we have all wondered whether those patients would have made suitable candidates for immediate sequential bilateral cataract surgery (ISBCS). There is growing evidence on the safety and refractive outcomes of ISBCS. Performing more ISBCS cases can reduce patient hospital visits and their subsequent carbon footprint. I was pleased to present the findings of our time and motion study at the winter ESCRS meeting where we found that performing consecutive ISBCS cases under local anaesthesia can potentially lead to a more efficient OR, with more cases performed per list compared to lists with only unilateral eyes. Making more efficient use of the operating room therefore has potential for significant improvements in service provision.

LESS IS MORE

Conferences are one of the yearly highlights for all trainees where we attend lectures from experts, keep up to date with emerging research, meet friends and colleagues, and occasionally treat ourselves to the odd freebies on offer! However, the option of hybrid conferences allows us to tune in virtually and limit our carbon footprint, not to mention leaving us with a healthier bank balance in the process!

Over the past two years, I have learnt to appreciate the role I can play in contributing to a more sustainable ophthalmic healthcare system which can cater to a diverse patient group. Educating myself on the subject matters has been an important turning point. Emphasising the importance of these issues in ophthalmology residency programs for the future generations of trainees can contribute to a better and greener future.

Khayam Naderi MD is a ST5 Ophthalmology Trainee at Western Eye Hospital Imperial College Healthcare Trust, UK. kaynad03@gmail.com