Standpoint on Sustainability (SOS): John Doris

In this installment, John Doris, President of the Irish College of Ophthalmologists (ICO), talks about how he is leading the College’s sustainability efforts by example and helping to establish new practices and initiatives that will shape ophthalmology in the long term.

Can you talk about your involvement in working towards sustainability in ophthalmology?
 

I became President of the Irish College of Ophthalmologists (ICO) in May 2023. Before that, I was on the service development committee, which was newly created for strategy and think-tank activities. During that period, we were looking at what other ophthalmologists colleges were doing, and we realized we were about two years behind when it came to the climate change situation. The UK was ahead of us, and the American Academy was well on their way with their EyeSustain agenda.

We decided we needed to get on board, but we approached it slightly differently. We looked at sustainability not just in terms of climate, but also in relation to careers, giving consideration to ensuring that any models we adopt will offer sustainability for the future.

I attended the American Academy of Ophthalmology meeting in San Francisco in 2023, where I participated in the eye sustain symposiums with previous ICO President Alison Blake. We were asked to take the EyeSustain pledge, which following our annual general meeting (AGM) in May, we agreed to go ahead with.

We also wanted to align with what the HSE (Health Service Executive) in Ireland was doing. So we decided to focus one of our symposiums at our annual conference on a call to action regarding climate change, aiming to activate our members. We invited the HSE’s Philip Crowley to present the organization’s climate action strategy. The HSE is one of the first health systems to put together such a strategy, with an ambitious target of net zero emissions by 2050.

We also had presentations by speakers such as Arthur Cummings and Radhika Rampat, Co-chair of the American European Congress of Ophthalmic Surgery Green Working Group, well-known names in the ophthalmology field, and from Emilie Mahon, one of our Irish ophthalmology trainees on the findings of her research on the ecological impact of phacoemulsification cataract surgery.  As a result of all this information, we decided to incorporate sustainability into every one of our meetings over the next couple of years.

We have a new integrated eyecare plan, which has been in development since 2012. It aims to address the demands of access in ophthalmology by moving services into the community. This approach brings ophthalmology closer to home, reducing transport distances and associated emissions. The plan involves a team of allied health professionals including optometrists, orthoptists and nursing staff  overseen by medical ophthalmologists, a new grade we’ve been training in Ireland over the last few years.

As the President of the college, I try to lead by example. In my own hospital at the University Hospital Waterford, we’ve implemented several initiatives. Louise Doyle, one of our theater nurses, has been working on recycling efforts. Interestingly, Louise found that about 32 percent of the material in the cataract kit is recyclable. Alison Greene, one of our surgical registrars, compared our cataract packs for their carbon footprint and identified ways we could improve. For instance, we could use shorter gowns for surgeons and remove long body drapes from the table. She also created a map showing where all the equipment in our pack came from. It was eye-opening to see how global our supply chain is, with items coming from the US, Mexico, Japan, China, Thailand, Germany, and the UK, as well as some local supplies from Ireland.

What are the barriers to implementing sustainable policies?
 

We have to balance providing the service with making sustainable changes. These are small steps, but small steps lead to big changes. In the ICO, we represent both public and private sectors, so we need to get everyone engaged. The HSE is on board because they have a target, but we need to get the private sector involved as well.

Looking at a green agenda often involves considering higher volumes of patients having surgery on any particular list, reducing unnecessary items in packs, and looking at recycling options. We need to examine the economics of autoclaves and instrument cleaning, which might be more costly. We might continue using single-use instruments long-term, but we need to look at recycling options.

It also makes sound economic sense not to waste so much. It’s not just about implementing new practices, but also de-implementing unnecessary ones. One glaring issue is the use of single-use instruments. This practice largely stems from concerns about prion transmission following the bovine spongiform encephalopathy (BSE, or mad cow disease scare) in Ireland about 25 years ago. But we need to review whether this is still a valid concern today, especially when we see countries like India reusing instruments without increased infection rates.

It’s a huge issue in ophthalmology because we’re dealing with the eye and its connections to the brain. The business model of procurement has shifted towards disposables as an ongoing income stream for companies. We need to consider alternative models. There are companies like Hasa Optix, for example, that make single-use instruments and take them back for recycling.

What would you like to have achieved by the end of your tenure?
 

I’m in the role until May 2025. In the short term, our main goals are to raise the profile of sustainability issues and get people interested. The ICO education portal is a place for people to share ideas and avoid reinventing the wheel. I want to engage with those who haven’t been involved before, and I think it has to be fun in some way to get people interested.

We need to focus on both transformational and translational change. Transformational change deals with culture and leadership, leading by example, and having some measure of how things are going. Translational change works within the existing system to make improvements.
Implementation is very difficult, and we need to look at the science of how that works. On average, it takes about 17 years to make a change in our health system, which demonstrates how resistant we can be to change. But we don’t have that kind of time when it comes to sustainability issues.

The key is to ask individuals directly how they can help and to make small steps that can inspire others to move as well. It’s not about any one person leading this – I’m just the current president of the Irish College. It’s about all of us working together to keep the momentum going forward.

At the ICO, we’re committed to keeping sustainability as a main objective. For us, it’s not just about climate, but also about sustainability in careers, ensuring that everyone has a healthy career throughout their life. We want to make sure that any new models of care we introduce take sustainability into consideration, not just from a climate perspective, but to ensure they exist for the long term.