Osher: Most of the videos on this issue have received awards,
including the next video,
which won the grand prize at ASCRS.
The video is entitled "A Model
for Green Cataract Surgery," by Dr.
Veena, Mishra, and Venkatesh from India.
Malek Sukkar: The human race produces more waste than it really should.
-: [Heather Koldewey] We only recycle 9% of all plastic.
That means that unless it's been burnt, every single piece
of plastic ever made still exists on our planet.
Sukkar: The consumer has to be the one
that forces everyone's hand to say, I will not buy from you
unless you have a sustainability policy
and a clear transparency on the whole supply chain
of the product that I'm buying.
Brune Poirson: Never compromise. What you're doing today will have an
impact on the planet for thousands and thousands of years.
Narrator: Cataract surgery is the most widely performed
surgery in the world.
A single cataract surgery in the United Kingdom emits 132
kilograms of carbon dioxide equivalents.
Extrapolating this value
to a global scale, cataract surgery would generate 14.5
megatons of carbon dioxide equivalents every year.
To put this into perspective,
if current United Kingdom exemplar practice were followed
worldwide over the next decade,
cataract surgery alone would create annual greenhouse gas
emissions similar to entire countries such as Kenya,
Croatia, or Sri Lanka.
David Chang: Hi, this is David Chang from the United States.
I co-chair a task force
with members from AAO, ASCRS, and the Ophthalmology
ASC Society in the US, looking at
OR waste.
Last year, we conducted a survey.
We had more than 1300 surgeons and nurses respond,
and 90% are concerned about global warming.
Ninety-seven percent feel that our OR waste is excessive.
The survey showed
that the number one cause is a combination
of our surgical manufacturers who mandate single use,
the liability is an issue, partly also perhaps for profit,
and then we have overly stringent regulations
that take away any surgeon discretion over
what can be safely reused.
We should look for ways to reduce the carbon footprint
of our surgeries and to reuse things.
Narrator: More than half of these emissions originate from largely
disposable medical supplies.
Aravind Eye Hospital delivers eyecare
to over 4 million outpatients
and performs over 500,000 surgeries every year.
The postoperative infection
and complication rates are equivalent to
or better than Western standards.
Every 1 phaco surgery,
Aravind generates only 0.25 kilograms of waste, compared
to 2.25 kilograms generated in the United States.
If compared to driving a car,
one phaco surgery in the United Kingdom leads
to emissions equivalent to driving a car for 500 kilometers,
while at Aravind, emissions are equivalent
to driving the same car for 25 kilometers.
At Aravind, our practices are aligned with our goal
of responsible consumption.
All pharmaceuticals, including antibacterial eyedrops,
local anesthetics, and balanced salt solution are used on
multiple patients until the bottle is empty
or until the end of the operating day.
The phaco cassette and tubing, which are usually discarded
after every surgery in the West, are instead used
for the entire surgical day.
Gloves are rinsed between cases
with chlorhexidine or alcohol.
The surgical team's caps, masks, gowns,
and sandals, as well
as the patient's blanket, are laundered at the end of the day
by the Central Sterile Supply Department or CSSD team.
Our surgical system uses largely reusable instruments
and materials, which means that a majority
of Aravind's lifecycle environmental emissions occur in the
sterilization process.
Stainless steel instruments, syringes, cannulas, blades,
and phaco tools that come in contact
with the patient's eye are removed from the operating room
after every case, washed by hand in reverse-osmosis water,
and sterilized in a 30-minute flash autoclave cycle.
These autoclaved items can be reused in the operating room on
the same day. At the end of the operating day,
these instruments are washed by hand,
sterilized via ultrasound
and autoclaved for a full 1-hour cycle in the CSSD.
After they have dried, the instruments are stored
for use on the next operating day.
The backbone of waste management at Aravind Eyecare System is
how waste is segregated at the source.
The practice of segregating even tiny bits of plastic paper
and metal generated during the surgery according
to designated international waste management guidelines
has become almost muscle memory to our staff.
Staff Member: This method of waste segregation is very convenient and helps save us a lot of time.
Narrator: All of the OR-segregated waste goes
to the waste disposable room, where it is either sent
for incineration or recycling based on type.
As one-third of waste is biomedical,
it is sent to the biomedical waste disposal
plant near Pondicherry.
The remaining two-thirds is typically recyclable
and is collected by vendors.
Plastic waste is converted into small plastic pellets
that are later recycled into plastic utensils,
thus creating a sustainable and eco-friendly environment.
In the same way, paper waste is also effectively recycled.
Some paper waste is upcycled into decorative items such
as jewelry and flower art.
David Chang: We in the so-called wealthier nations have to look
to our colleagues
in low- to middle-income countries
who are already doing a better job of resource conservation.
And I think we can learn how
to be more sustainable in this way.
Our task force is working with industry
and collaborating on ways to lower the carbon footprint.
We're trying to work with some of the regulatory agencies,
even the FDA, in terms of reusing things like drugs.
And finally, we have the backing of our societies,
so hopefully we can make some progress.
Narrator: The greatest threat to our planet is our belief
that someone else will save it.
Rather, each individual
and system should try
to leave the earth a better place than how we found it.
At Aravind, our efforts are centered on not just providing
affordable eye care to all,
but doing so while creating environmentally sustainable
and efficient systems.
At the end of the day, the earth is
what we all have in common.
Osher: Thank you faculty for a beautiful tribute to science,
and thank you sponsors for believing in our singular mission
to provide the highest quality of video education
to ophthalmologists around the world.
The first 40 years have attempted to achieve that goal,
and as editor, I promise
to make the next 40 years even better.
Thank you for watching,
and we'll see you on the next issue of the Video Journal
of Cataract, Refractive, and Glaucoma Surgery.