Impacto ambiental de un programa de telescreening de retinopatía diabética en Argentina

Tomás Ortiz-Basso; María Florencia Ricard; María Soledad Córdoba; Ariel Paladini

doi:10.70313/2718.7446.v17.n01.288

Authors

Tomás Ortiz-Basso IMTIB. CONICET. Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
María Florencia Ricard Universidad Nacional de La Pampa, Santa Rosa, Argentina
María Soledad Córdoba Centro Oftalmológico Venero, Santa Rosa, La Pampa, Argentina
Ariel Paladini Dirección de Atención Primaria y Gestión Sanitaria, Ministerio de Salud de La Pampa, Argentina

DOI:

https://doi.org/10.70313/2718.7446.v17.n01.288

Keywords:

diabetic retinopathy, telemedicine, environmental pollution, carbon footprint, global warming

Abstract

Background: Tele-screening programs for diabetic retinopathy are implemented worldwide, but the environmental impact has not been studied yet. The aim of this study was to evaluate the emission reduction achieved by a tele-screening program for diabetic retinopathy in La Pampa (Argentina).

Methods: A descriptive study was performed comparing the emissions generated with and without the program. A retinal camera was transported to 60 rural cities, and the images were classified asynchronously as “referable” and “non-referable”. An ophthalmologist then traveled to each location to assess the identified “referable” cases. The eqCO₂ emissions generated by the program were compared with those that patients would have generated if they had traveled from their location to the nearest ophthalmology center in the conventional manner.

Results: Emissions generated per patient without the program were equivalent to 63 kg, whereas with program implementation they ranged from 4 kg to 18 kg. The reduction in emissions per patient for 2019, 2020, and 2021 was 45 kg, 41 kg, and 62 kg, respectively. The absolute reduction in eqCO₂ emissions by the program for 2019, 2020, and 2021 was 166Tn, 28Tn, and 161Tn, respectively.

Conclusion: CO₂ emissions were significantly reduced by the tele-screening program for diabetic retinopathy prevention in La Pampa. Ophthalmologists should consider the environmental impact when implementing their practice

References

Woodward AJ, Samet JM. Climate change, hurricanes, and health. Am J Public Health 2018; 108: 33-35.

United Nations Framework Convention on Climate Change. Adoption of the Paris agreement. 2015 [online], 2015 (FCCC/CP/2015/L.9/Rev.1). Available in: https://unfccc.int/resource/docs/2015/cop21/eng/l09r01.pdf

Karliner J, Slotterback S, Boyd R et al. Health care’s climate footprint: how the health sector contributes to the global climate crisis and opportunities for action. Eur J Public Health 2020; 30 Suppl 5: ckaa165.843.

Pichler PP, Jaccard IS, Weisz U, Weisz H. International comparison of health care carbon footprints. Environ Res Lett 2019; 14:064004.

Zikhathile T, Atagana H, Bwapwa J, Sawtell D. A Review of the impact that healthcare risk waste treatment technologies have on the environment. Int J Environ Res Public Health 2022; 19: 11967.

Morcillo Serra C, Aroca Tanarro A, Cummings CM et al. Impact on the reduction of CO2 emissions due to the use of telemedicine. Sci Rep 2022; 12: 12507.

Moncho-Santoja M, Aparisi-Navarro S, Defez García B et al. Health care in rural areas: proposal of a new telemedicine program assisted from the reference health centers, for a sustainable digitization and its contribution to the carbon footprint reduction. Heliyon 2022; 8: e09812.

Filfilan A, Anract J, Chartier-Kastler E et al. Positive environmental impact of remote teleconsultation in urology during the COVID-19 pandemic in a highly populated area. Prog Urol 2021; 31: 1133-1138.

Blenkinsop S, Foley A, Schneider N et al. Carbon emission savings and short-term health care impacts from telemedicine: an evaluation in epilepsy. Epilepsia 2021; 62: 2732-2740.

Pickard Strange M, Booth A, Akiki M et al. The role of virtual consulting in developing environmentally sustainable health care: systematic literature review. J Med Internet Res 2023; 25: e44823.

Ortiz-Basso T, Gómez PV, Boffelli A, Paladini A. Evaluación de un programa de teleoftalmología para prevención de la ceguera por diabetes en una zona rural de la Argentina [Assessment of a teleophthalmology program for the prevention of diabetes blindness in a rural area of Argentina]. Rev Fac Cien Med Univ Nac Cordoba 2022; 79: 10-14.

Ortiz-Basso T, Boietti BR, Gómez PV et al. Prevalencia de retinopatía diabética en una zona rural de Argentina [Prevalence of diabetic retinopathy in a rural area of Argentina]. Medicina (B Aires) 2022; 82: 99-103.

Olivares JL, Belmonte V, Eppler G et al. Niveles de vitamina D en pacientes asistidos en centros de salud pública de la provincia de La Pampa (Argentina). Rev Argent Endocrinol Metab 2019; 56: 41-50.

Core Writing Team, Pachauri RK, Reisinger A. Climate change 2007: synthesis report. Geneva: Intergovernmental Panel on Climate Change, 2008. Available in: https://www.ipcc.ch/site/assets/uploads/2018/02/ar4_syr_full_report.pdf

Waldron CD. Mobile combustion. In:Eggleston S, Buendia L, Miwa K et al. (eds.). 2006 IPCC Guidelines for national greenhouse gas inventories. Hayama, Japan: By Institute for Global Environmental Strategies for Intergovernmental Panel on Climate Change (IPCC), 2006, vol. 2, chapter 3. Available in: https://www.ipcc-nggip.iges.or.jp/public/2006gl/pdf/2_Volume2/V2_3_Ch3_Mobile_Combustion.pdf

Intergovernmental Panel on Climate Change (IPCC). Climate change 1995: the science of climate change: contribution of Working Group I to the Second Assessment Report (SAR). Geneva: IPCC, 1995. Available in:

https://www.ipcc.ch/site/assets/uploads/2018/02/ipcc_sar_wg_I_full_report.pdf

Calaza H. Los autos que más y menos consumen en Argentina. In: Autocosmos [web site], April 9th, 2020. Available in: https://noticias.autocosmos.com.ar/2020/04/09/los-autos-que-mas-y-menos-consumen-en-argentina.

Instituto Nacional de Estadística y Censos (INDEC) (Buenos Aires). Censo nacional de población, hogares y viviendas 2022: resultados provisionales. 1ª ed. Buenos Aires: INDEC, 2023. Available in: https://www.indec.gob.ar/ftp/cuadros/poblacion/cnphv2022_resultados_provisionales.pdf

Argentina. Ministerio de Ambiente y Desarrollo Sostenible (MayDS). Cuarto informe bienal de actualización de Argentina a la Convención Marco de las Naciones Unidas para el Cambio Climático (CMNUCC). Buenos Aires, 2021.

Atwoli L, H Baqui A, Benfield T et al. Call for emergency action to limit global temperature increases, restore biodiversity and protect health. Br J Ophthalmol 2021; 105: e2.

Purohit A, Smith J, Hibble A. Does telemedicine reduce the carbon footprint of healthcare? a systematic review. Future Healthc J 2021; 8: e85-e91.

Rodler S, Ramacciotti LS, Maas M et al GE. The impact of telemedicine in reducing the carbon footprint in health care: a systematic review and cumulative analysis of 68 million clinical consultations. Eur Urol Focus 2023; 9: 873-887.

Ravindrane R, Patel J. The environmental impacts of telemedicine in place of face-to-face patient care: a systematic review. Future Healthc J 2022; 9: 28-33.

Thiel CL, Mehta N, Sejo CS et al. Telemedicine and the environment: life cycle environmental emissions from in-person and virtual clinic visits. NPJ Digit Med 2023; 6: 87.

Morris DS, Wright T, Somner JEA, Connor A. The carbon footprint of cataract surgery. Eye (Lond) 2013; 27: 495-501.

Thiel CL, Schehlein E, Ravilla T et al. Cataract surgery and environmental sustainability: waste and lifecycle assessment of phacoemulsification at a private healthcare facility. J Cataract Refract Surg 2017; 43: 1391-1398.

Ferrero A, Thouvenin R, Hoogewoud F et al. The carbon footprint of cataract surgery in a French university hospital. J Fr Ophtalmol 2022; 45: 57-64.

Latta M, Shaw C, Gale J. The carbon footprint of cataract surgery in Wellington. N Z Med J 2021; 134: 13-21.

Goel H, Wemyss TA, Harris T et al. Improving productivity, costs and environmental impact in International Eye Health Services: using the ‘eyefficiency’ cataract surgical services auditing tool to assess the value of cataract surgical services. BMJ Open Ophthalmol 2021; 6: e000642.