Introduction/Background

Telemedicine is a rapidly progressing field with the potential to improve access to care by overcoming barriers of proximity. Existing literature on telemedicine has demonstrated decreased cost and a favorable perception of telemedicine.¹  The efficacy of tele-ophthalmology has been demonstrated in diabetic retinopathy and glaucoma screening.^2-6 However, few studies have evaluated the environmental impact of telemedicine visits.⁷ Teleophthalmology-based vision centers (VC) in rural India provide accessible and affordable eye care to approximately 75,000 to 100,000 people in a radius of 10 kilometers (km)^8,9 in each of over 100 VCs attached to Aravind Eye Care System, in south India. In addition to providing accessible and cost-effective primary eye care, VCs save patients a trip to the base hospital (BH), which can cumulatively add to the carbon footprint of healthcare. The Kyoto Protocol identifies six main gases important to climate change out of which carbon dioxide (CO₂) is used as the reference gas.¹⁰ The total emissions of the activity/product are expressed in the units of CO₂ equivalents (CO₂eq). The carbon footprint of healthcare is defined by the greenhouse gas emissions resulting from the full life cycle of a product or service.  For ophthalmology outpatient visits, the largest contributors to greenhouse gas emissions are direct emissions from travel and building energy use, and indirect emissions associated with the production, consumption, and disposal of supplies and equipment.¹¹

 Additionally, with the presence of convenient VCs, we believe that patients are more likely to utilize eye care rather than delaying care with resultant visual disability and blindness with costs to the individual, their families, and society.

Aim:

·         To assess the total carbon emission generated by patients presenting 1) first to a VC with synchronous tele-ophthalmology appointment, and 2) first to the base hospital (BH) (Aravind Eye Hospital in Pondicherry) until resolution of the presenting symptoms or 3 months whichever comes earlier.

Objectives

Primary objective

·         To quantify carbon emissions of VC visits vs BH visits

Secondary objectives

·         Survey patients who present to a VC and are referred to the BH for additional evaluation for likelihood of attending follow up visit.

·         Survey patients who report low likelihood of follow up to identify barriers to presentation to BH for follow up visits.