Purpose To measure the waste generation and lifecycle environmental emissions from cataract surgery via phacoemulsification in a recognized resource-efficient setting. Setting Two tertiary care centers of the Aravind Eye Care System in southern India. Design Observational case series. Methods Manual waste audits, purchasing data, and interviews with Aravind staff were used in a hybrid environmental lifecycle assessment framework to quantify the environmental emissions associated with cataract surgery. Kilograms of solid waste generated and midpoint emissions in a variety of impact categories (eg, kilograms of carbon dioxide equivalents). Results Aravind generates 250 grams of waste per phacoemulsification and nearly 6 kilograms of carbon dioxide-equivalents in greenhouse gases. This is approximately 5% of the United Kingdom’s phaco carbon footprint with comparable outcomes. A majority of Aravind’s lifecycle environmental emissions occur in the sterilization process of reusable instruments because their surgical system uses largely reusable instruments and materials. Electricity use in the operating room and the Central Sterile Services Department (CSSD) accounts for 10% to 25% of most environmental emissions. Conclusions Results show that surgical systems in most developed countries and, in particular their use of materials, are unsustainable. Ophthalmologists and other medical specialists can reduce material use and emissions in medical procedures using the system described here.

Aim: To analyse the outcome of high volume cataract surgery in a developing country, community based, high volume eye hospital. Methods: In a non-comparative interventional case series, the authors reviewed the surgical outcomes of 593 patients with cataract operated upon by three high volume surgeons on six randomly selected days. There were 318 female (54%) and 275 male (46%) patients. Their mean age was 59.57 (SD 10.13) years. The majority of the patients underwent manual small incision cataract surgery (manual SICS). Extracapsular cataract extraction with posterior chamber intraocular lens (ECCE-PCIOL) and intracapsular cataract extraction (ICCE) were also done on a few patients as clinically indicated. Results: Best corrected visual acuity of >6/18 was achieved in 94% of the 520 patients who could be followed up on the 40th postoperative day (88% follow up rate). Intraoperative and immediate postoperative complications as defined by OCTET occurred in 11 (1.9%) and 75 (12.6%) patients, respectively. Average surgical time of 3.75 minutes per case (16-18 cases per hour) was achieved. Statistically significant risk factors for outcomes were found to be age .60, sex, and surgeon. Conclusion: High volume surgery using appropriate techniques and standardised protocols does not compromise quality of outcomes.O f the total estimated 38 million blind people in the world, 9-12 million are in India.1 2 Estimates report that 50%-80% of these people are blind because of cataract.1 2 In addition to the backlog, an additional 3.8 million become blind each year because of cataract.3 In 2000, 3.5 million cataract operations were performed, 4 but this remains insufficient to treat the backlog and the newly blind. In 1994, Natchiar et al suggested that productivity per individual surgeon/unit should be increased through a high volume, high quality cataract surgery approach to solve the problem of India's curable blind.5 More recently, the World Health Organization global initiatives have called for a dramatic increase in surgical volumes worldwide. 6 However, it is becoming more evident that outcomes of cataract surgery are not always good and this aspect of surgical services must be further examined.7 Some recent studies of high volume cataract surgery in India and Nepal report good results. [8][9][10][11][12][13][14] In order to investigate whether high volume surgeries can be performed routinely, without compromising quality, we retrospectively reviewed the results of 593 surgeries performed by three experienced surgeons, achieving surgical times of 3.75 minutes/case (16-18 cases/hour), utilising the technique of manual small incision cataract surgery (manual SICS). PATIENTS AND METHODSSurgeons consistently performing more than 80 surgeries per day in six operating hours at Aravind were defined as ''high volume surgeons.'' There were six such high volume surgeons during the period of analysis from April 2002-March 2003. From these six surgeons, three were randomly chosen using a lot method. There were 28 days (clusters) dur...

Both techniques achieved excellent visual outcomes with low complication rates. Because manual SICS is significantly faster, less expensive, and less technology-dependent than phacoemulsification, it may be a more appropriate technique in eyes with mature cataract in the developing world.

Exfoliation syndrome (XFS) is the commonest known risk factor for secondary glaucoma and a significant cause of blindness worldwide. Variants in two genes, LOXL1 and CACNA1A have been previously associated with XFS. To further elucidate the genetic basis of XFS, we collected a global sample of XFS cases to refine the association at LOXL1, which previously showed inconsistent results between populations, and to identify new variants associated with XFS. We identified a rare, protective allele at LOXL1 (p.407Phe, OR = 25, P =2.9 × 10−14) through deep resequencing of XFS cases and controls from 9 countries. This variant results in increased cellular adhesion strength compared to the wild-type (p.407Tyr) allele. A genome-wide association study (GWAS) of XFS cases and controls from 24 countries followed by replication in 18 countries identified seven genome-wide significant loci (P < 5 × 10−8). Index variants at the new loci map to chromosomes 13q12 (POMP), 11q23.3 (TMEM136), 6p21 (AGPAT1), 3p24 (RBMS3) and 5q23 (near SEMA6A). These findings provide biological insights into the pathology of XFS, and highlight a potential role for naturally occurring rare LOXL1 variants in disease biology.

Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. We conducted a genome-wide association study (GWAS) followed by replication in a combined total of 10,503 PACG cases and 29,567 controls drawn from 24 countries across Asia, Australia, Europe, North America, and South America. We observed significant evidence of disease association at five new genetic loci upon meta-analysis of all patient collections. These loci are at EPDR1 rs3816415 (odds ratio (OR) = 1.24, P = 5.94 × 10(-15)), CHAT rs1258267 (OR = 1.22, P = 2.85 × 10(-16)), GLIS3 rs736893 (OR = 1.18, P = 1.43 × 10(-14)), FERMT2 rs7494379 (OR = 1.14, P = 3.43 × 10(-11)), and DPM2-FAM102A rs3739821 (OR = 1.15, P = 8.32 × 10(-12)). We also confirmed significant association at three previously described loci (P < 5 × 10(-8) for each sentinel SNP at PLEKHA7, COL11A1, and PCMTD1-ST18), providing new insights into the biology of PACG.