Journal of Ophthalmic and Vision Research
ISSN: 2008-322X
The latest research in clinical ophthalmology and vision science
Analyzing the Carbon Footprint of an Intravitreal Injection
Published date: Jul 29 2021
Journal Title: Journal of Ophthalmic and Vision Research
Issue title: July–September 2021, Volume 16, Issue 3
Pages: 367 - 376
Authors:
Abstract:
Purpose: To estimate the carbon footprint of a single intravitreal injection in a hospital-based intravitreal service.
Methods: Greenhouse gas emissions attributable to the delivery of an intravitreal injection were calculated using a hybrid lifecycle analysis technique. Data were collected regarding procurement of materials, patient travel, and building energy use.
Results: Carbon emissions associated with a single intravitreal injection, excluding the anti-VEGF agent, were 13.68 kg CO2eq. This equates to 82,100 kg CO2eq annually for our service. Patient travel accounted for the majority of emissions at 77%, with procurement accounting 19% for and building energy usage for 4% of total emissions. The omission of items considered dispensable from injection packs would reduce carbon emissions by an estimated 0.56 kg per injection – an annual saving of 3,360 kg CO2eq for our service. Similar savings, if extrapolated to a country the size of the United Kingdom, could yield annual carbon savings of 450,000 kg CO2eq. For context, a single one-way economy transatlantic flight produces 480 kg CO2eq per person.
Conclusion: Wasteful practice in healthcare increases greenhouse gas production and drives climate change. The healthcare sector should be a leader in sustainable practice promotion and changes to high volume procedures have the largest impact on emissions. Long-acting agents offer the greatest future potential for meaningful reductions.
Keywords: Anti-VEGF, Climate Change, Medical Retina, Sustainability
References:
1. Santer BD, Taylor KE, Wigley TML, Johns TC, Jones PD, Karoly DJ, et al. A search for human influences on the thermal structure of the atmosphere. Nature 1996;382:39– 46.
2. Hegerl G, von Storch H, Hasselmann K. Detecting greenhouse-gas-induced climate change with an optimal fingerprint method. J Climate 1996;9:2281–2306.
3. Ramaswamy V. Anthropogenic and Natural influences in the evolution of lower stratospheric cooling. Science 2006;311:1138–1141.
4. Santer B. Contributions of anthropogenic and natural forcing to recent tropopause height changes. Science 2003;301:479–483.
5. National Research Council. Surface temperature reconstructions for the last 2,000 years. Washington, DC: The National Academies Press; 2006.
6. Ravindranath N, Sathaye J. Climate change and developing countries. Dordrecht: Springer Netherlands; 2003.
7. United Nations Framework Convention on Climate Change. Kyoto protocol reference manual on accounting of emissions and assigned amount. UNFCCC; 2008 [cited 2020 February 10]. Available from: https://unfccc.int/resource/docs/publications/ 08_unfccc_kp_ref_manual.pdf
8. Sustainable Development Unit and UK National Health Service. Carbon footprint update for the NHS in London, England. London: NHS; 2015 [cited 2020 February 10]. Available from: https://www.sduhealth.org.uk/policystrategy/ reporting/nhs-carbon-footprint.aspx
9. Eckelman MJ, Sherman J. Environmental impacts of the US healthcare system and effects on public health. PLoS One 2016;11:e0157014.
10. NHS England Sustainable Development Commission. Carbon emissions: carbon footprinting study, London. London: NHS; 2008 [cited 2020 February 10]. Available from: https://www.sduhealth.org.uk/policy-strategy/ reporting/nhs-carbon-footprint.aspx
11. Connor A, Lillywhite R, Cooke M. The carbon footprint of a renal service in the United Kingdom. QJM 2010;103:965– 975.
12. Connor A, Lillywhite R, Cooke M. The carbon footprints of home and in-center maintenance hemodialysis in the United Kingdom. Hemodialysis Intl 2011;15:39–51.
13. Zander A, Niggebrugge A, Pencheon D, Lyratzopoulos G. Changes in travel-related carbon emissions associated with modernization of services for patients with acute myocardial infarction: a case study. J Public Health 2010;33:272–279.
14. Morris D, Wright T, Somner J, Connor A. The carbon footprint of cataract surgery. Eye 2013;27:495–501.
15. NHS England Sustainable Development Unit. Carbon reduction strategy 2009, London. London: NHS; 2009 [cited 2020 February 10]. Available from: https: //www.sduhealth.org.uk/policy-strategy/engagementresources/ nhs-carbon-reduction-strategy-2009.aspx
16. Williams GA. IVT injections: health policy implications. Rev Ophthalmol 2014 [cited 2020 February 10]. Available from: http://www.reviewofophthalmology.com/content/d/ retinal_insider/c/48732
17. Hollingworth W, Jones T, Reeves B, Peto T. A longitudinal study to assess the frequency and cost of antivascular endothelial therapy, and inequalities in access, in England between 2005 and 2015. BMJ Open 2017;7:e018289.
18. DEFRA. Specification for the assessment of the lifecycle greenhouse gas emissions of goods and services. London: British Standards, Carbon Trust, PAS2050; 2011 [cited 2020 February 10]. Available from: http://shop.bsigroup. com/upload/shop/download/pas/pas2050.pdf
19. DEFRA. Guidelines to DEFRA/ DECC’s GHG conversion factors for company reporting: Methodology Paper for Emission Factors. London: DEFRA; 2011 [cited 2020 February 10]. Available from: https://assets.publishing. service.gov.uk/government/uploads/system/uploads/ attachment_data/file/69314/pb13625-emission-factormethodology- paper-110905.pdf
20. DEFRA. Greenhouse gas reporting: conversion factors 2018. London: DEFRA; 2018 [cited 2020 February 10]. Available from: https://www.gov.uk/government/ collections/government-conversion-factors-forcompany- reporting
21. NHS. Estates return information collection, England, 2016– 17. England: NHS; 2017 [cited 2020 February 10].Available from: https://digital.nhs.uk/data-and-information/ publications/statistical/estates-returns-informationcollection/ estates-return-information-collection-2016-17
22. Crawford RH, Bontinck P-A, Stephan A, Wiedmann T, Yu M. Hybrid life cycle inventory methods – a review. J Clean Prod 2018;172:1273–1288.
23. Suh S, Lenzen M, Treloar GJ, Hondo H, Horvath A, Huppes G, et al. System boundary selection in life-cycle inventories using hybrid approaches. Environ Sci Technol 2004;38:657–664.
24. Ruão M, Andreu-Fenoll M, Dolz-Marco R, Gallego-Pinazo R. Safety of bilateral same-day intravitreal injections of anti-vascular endothelial growth factor agents. Clin Ophthalmol 2017;11:299–302.
25. Juncal V, Francisconi C, Altomare F, Chow DR, Giavedoni LR, Muni RH, et al. Same-day bilateral intravitreal antivascular endothelial growth factor injections: experience of a large Canadian retina center. Ophthalmologica 2019;242:1–7.
26. Somner J, Connor A, Benjamin L. Eyes, economics and the environment: should green issues drive changes in ophthalmic care? –Yes. Eye 2010;24:1309–1311.
27. Somner J, Scott K, Morris D, Gaskell A, Sheperd I. Ophthalmology carbon footprint: something to be considered? J Cataract Refract Surg 2009;35:202–203.
28. Grzybowski A, Told R, Sacu S, Bandello F, Moisseiev E, Loewenstein A, et al. 2018 update on intravitreal injections: euretina expert consensus recommendations. Ophthalmologica 2018;239:181–193.
29. Carbon Footprint Ltd. Flight carbon footprint calculator [Internet]. Hampshire UK: Carbon Footprint Ltd. Available from: https://calculator.carbonfootprint.com/calculator. aspx?lang=en-GB&tab=3
30. European Parliament. A European strategy for plastics in a circular economy. Brussels: European Commission; 2018 [cited 2020 February 10]. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/?qid= 1516265440535&uri=COM:2018:28:FIN
31. Xanthos D, Walker T. International policies to reduce plastic marine pollution from single-use plastics (plastic bags and microbeads): a review. Mar Pollut Bull 2017;118:17–20.
32. Parvatker A, Tunceroglu H, Sherman J, Coish P, Anastas P, Zimmerman JB, et al. Cradle-to-gate greenhouse gas emissions for twenty anesthetic active pharmaceutical ingredients based on process scale-up and process design calculations. ACS Sust Chem Eng 2019;7:6580–6591.
33. Ghosh J, Nguyen A, Bigelow C, et al. Long-acting protein drugs for the treatment of ocular diseases. Nat Commun 2017;8:14837.
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10.1289/EHP14754
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