Our online series sees key opinion leaders discuss how they are addressing the issue of sustainability in ophthalmology
Power Lister Ben LaHood discusses sustainability at a personal level, apathy in the field, and how financial incentives could provide an answer to less waste production and greater industry compliance.
How are you working towards sustainability in ophthalmology?
At a personal level, I try to vote with my wallet to use and promote products from companies that are truly trying to make an impact in the sustainability space. I would never make a clinical decision that may be detrimental to patient outcomes for the sake of sustainability, but if I have two intraocular lens options within a category, and one comes from a manufacturer who is making a difference, I will support them. Examples of this are Rayner removing their paper instructions for use from their IOL packaging, and Hasa Optix, who are working hard to solve the problem of genuinely recycling single use instruments.
On a slightly larger scale, I use my social media presence to raise attention about sustainability issues, and promote those who are doing the hard work at the coal face. On an even larger and more structured scale, I’m also involved in changing our sustainability habits through my role representing AUSCRS (The Australasian Society of Cataract and Refractive Surgeons) along with Andrea Ang, at EyeSustain, the global network of societies championed by David Chang, which has a mission to make eye care more sustainable.
What are the most urgent sustainability priorities and challenges in the field?
The most urgent challenge we have to overcome right now is apathy. We are all guilty of this to some degree, me included. We’re all busy, stressed, overcommitted, prioritizing patient care, trying miserably to have a work-life balance, and hoping to run profitable businesses and pay staff wages. To wedge another concern into that mix – one that provides no obvious immediate benefits, is potentially expensive, and takes up more precious mental bandwidth – is a challenge. We have great resources to help guide us through the process of change, and the global benefits are obvious, but it is currently far too easy to put sustainability in the "one day" box at the bottom of your to-do list.
What has changed in terms of how practitioners and the industry have addressed sustainability in the last decade?
The biggest change has simply been awareness. Over the past decade we have continued to create a garbage-bag full of waste for every cataract operation, but at least now we know it is possible to do better. We have started to see some operating theaters take this challenge seriously by taking small steps, such as separating recyclable waste.
Industry is slowly grumbling towards real changes. We are starting to see industry recognize that there is a groundswell of surgeons demanding that it does better. As that voice gets louder, more agile companies make positive changes and market pressure drives the big players to join in. We are seeing genuine efforts, such as the Sophi phaco machine having a reusable cassette in their phaco machine. This took time, investment, and risk, which I hope is rewarded with surgeon adoption.
Sustainability is a topic that seems ubiquitous at events and meetings. But how genuinely is ophthalmology invested in it?
Attendance at most sustainability events remains poor and often we are seeing the same engaged faces at each meeting. In my opinion, actual everyday ophthalmologist investment in sustainability falls far behind other issues. This is understandable and we still must work out how we can actually make a change.
Is it realistic to achieve truly global buy-in to the sustainability mindset?
When I was asked to host the sustainability event at ESCRS in Vienna last year, my main concern was that surgeons in developed countries do not want to hear about developing countries reusing sutures, not changing gowns, and generally (in their minds) compromising standards of patient care. This is one of the key barriers to global buy-in.
In general, surgeons from developed countries have a view that they do not need to make such drastic changes to their own practices, and will rely on industry to make adjustments for them in terms of waste. Developing countries are seen as having to be more sustainable rather than necessarily wanting to. There is a view that being an outlier and changing your practice to be more sustainable may put your patients at higher risk of infection. If it was found that you as a surgeon were doing things differently, and you had a problem, then medicolegally where do you stand? The safer option is to stick with the majority and ignore that infection rates in many sustainable facilities are actually excellent. In my opinion, this disparity in thinking, and theoretical risk taking, is holding back a lot of surgeons from being more sustainable.
How can ophthalmology stakeholders – clinicians, industry, regulators – work together to reach goals in sustainability?
I would like to see benefits given to those who practice sustainably. For instance, day surgeries that are able to reduce waste by a certain percentage could receive an incentive, such as a small payment or tax incentive. Ophthalmology is a business and money talks louder than global warming at the moment. If day surgeries and surgeons saw enough benefit to change their practices, this would flow on to them using industry devices from companies who could further reduce waste and provide incentive upstream. I would much prefer to see this rather than penalties for creating waste. You catch more flies with honey!
What sustainability goals would you like to see the profession achieve in the next 5-10 years?
Within 10 years, I would like surgeons to look back on our current surgical waste the same way we remember practices such as radial keratotomy surgery, i.e., something we once did, but in hindsight we see all the problems that it created. My very simple wish is that individual surgeons begin to ask questions of their own practices, their industry partners, and their colleagues about what tiny things they could do to improve sustainability.
Ben LaHood is a cataract and refractive surgeon based at the Adelaide Eye and Laser Centre in Australia. He also treats public patients at The Queen Elizabeth Hospital, Adelaide, and serves as a Senior Clinical Lecturer at the University of Adelaide.
