COOKIE Issue 07: The ebook version (The Sustainability Issue) by Media MICE

THE WORLD’S FIRST FUNKY OPTOMETRY MAGAZINE

THE SUSTAINABILITY ISSUE

May 2022

cookiemagazine.org

Environmental impacts of optometry practice and ways to reduce them P16

LETTER TO READERS

patients to donate rather than discard their old spectacles. We also educate our patients on the importance of properly discarding their used contact lenses. Flushing them down the sink or toilet causes more harm to the environment than they think. Not to mention, eco-friendly and biodegradable accessories, such as frames, are now widely available. What’s more, major eye care companies such as CooperVision, Bausch + Lomb, Johnson & Johnson, and Alcon are investing in technologies that make their manufacturing processes more sustainable. They now use renewable energy resources to power their plants. Some are using recycled water in their chillers to reduce water consumption. They are also shifting to recyclable packaging for their products.

Start making small changes now!

Research is also underway to produce biodegradable contact lenses. Companies now recommend disposing of contact lenses in trash bins rather than flushing them down the sink. Landfills provide a better environment for these products rather than the sewage system (and then out to open water) where there is minimal control.

ith the growing global concern over climate change, do you ever wonder how your practice affects the environment? In a report* conducted by Glocalities over six years, across 20 countries and based on 250,000 interviews, it was found that 78% of people around the world are concerned about the state of our planet.

Needless to say, in our everyday practice, we must do our part in helping save our planet. The only limit to what we can do is our imagination and desire to be good stewards of the resources entrusted to us.

With that said, sustainability is everyone’s responsibility — optometrists included. As an optometrist, it’s about time we asked ourselves: How can I be a “green” practitioner?

If you’ve been wanting to shift to an eco-friendly practice for sometime now, this issue is for you! Our “Sustainability” issue is chock-full of tips and ideas on how to jumpstart your own “green” practice.

Personally, I believe taking smaller steps is key. I recently bought practice management software that allows me to do clinical record-keeping with the least amount of paper. The aim is to someday be paperless. But now, I realize this is something I should have done years ago!

As always, we hope you enjoy this issue.

Best,

Admittedly, the “less paper” to “paperless” route is hard, but it’s one way I am helping save our planet. And, as a by-product, this shift has made record-keeping, patient communication, stock inventory, and other management tasks so much easier.

Carmen Abesamis-Dichoso OD, MAT, FIACLE, FPCO, FAAO

The good news is that the optometry profession and its support industries are catching on. ODs can now digitize their patient records and other documents, hence helping to save paper (and trees). Communication with patients can be done instantaneously through email, social media, and other platforms as well. Apart from the above, ODs now routinely encourage their

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REFERENCE: * Surging Mass Recognition of Threat to Planet & Joint Willingness for Action. Available at: https://glocalities.com/reports/environmentaltrends-2021. Accessed on May 16, 2022.

IN THIS ISSUE...

Optics

Cool Optometry Matt Young

CEO & Publisher

Hannah Nguyen COO & CFO

Robert Anderson

Walking the Talk Zeiss leads by example through its sustainability programs

Eye Care & Eco Champions Four environmentally friendly eye health companies that strongly advocate sustainability

More Than Just a Drop in The Ocean CooperVision aims to rid the world’s oceans of plastic pollution, one pack of dailies at a time

12 14

Which is Greener: Eyeglasses or contact lenses?

Media Director

Gloria D. Gamat Chief Editor Editors

Brooke Herron Mapet Poso International Business Development

Ruchi Mahajan Ranga Brandon Winkeler Writers

April Ingram Ben Collins Chow Ee-Tan Elisa DeMartino Joanna Lee Joseph Schreiber Leon Ash Matt Herman Roman Meitav Tan Sher Lynn

Environmental impacts of optometry practice and ways to reduce them

Enlightenment

Kudos

Graphic Designer

Maverick Philanthropist James Chen takes his revolutionary moonshot philanthropy to another level to provide universal access to eye care

The Option to Go Green TerraCycle offers recycling partnerships for big companies and private practitioners alike

Smashing Gender Inequality Indian twins and optometrists empower girls through football and eye care

Don’t Flush Your Contacts Educate your patients on how to properly dispose of contact lenses

A Pandemic Within a Pandemic? Myopia is on the rise during COVID-19

Media MICE Pte. Ltd. 6001 Beach Road, #19-06 Golden Mile Tower, Singapore 199589 Tel: +65 8186 7677 / +1 302 261 5379 Email: enquiry@mediamice.com www.mediaMICE.com

Society Friend

He Eye Specialist Hospital

Cover Story

Eyeing a Greener Future

Maricel Salvador

Published by

Eco-Friendly Eyewear Five best sustainable brands to help you reduce your carbon footprint

Innovation

Allies in Myopia Management Breakthroughs and updates on myopia control innovations

Is it a Drug? Is it a Device? No, it’s a new way of delivering ophthalmic treatment!

We are looking for eye doctors who can contribute articles to COOKIE magazine. Interested? Let's talk! Send us an email at editor@mediamice.com. To place an advertisement, advertorial, symposium highlight, video, email blast, or other promotion in| COOKIE magazine May 2 022 3 contact sales@mediamice.com.

ADVISORY BOARD MEMBERS

Dr. Carmen Abesamis-Dichoso OD, MAT, FPCO, FIACLE, FAAO

Dr. Carmen Abesamis-Dichoso received her Doctor of Optometry from the Central Colleges of the Philippines in 1989, and earned her Master of Arts in Teaching from the Central Colleges of the Philippines in 2001. Her specialties include special contact lens design for keratoconus, children and high astigmatism; and visual assessment of the mentally challenged, autistic, ADHD, cerebral palsy and learning disabilities. In addition, Dr. AbesamisDichoso has been an orthokeratology practitioner in the Philippines since 2005. Since 1998, she has been self-employed in a private practice at Medical Plaza Makati. She was awarded Outstanding Optometrist of the Year in 2017 by the Optometric Association of the Philippines. Currently, Dr. Abesamis-Dichoso serves as the International Affairs Committee chair of the Optometric Association of the Philippines; director of the Special Olympics Opening Eyes in the Philippines; program manager of Optometric Association of the Philippines Vision Screening

Dr. Joseph J. Allen is a practicing optometrist in Minnesota (USA) and the founder of Doctor Eye Health – an educational YouTube channel with more than 640K subscribers. In that channel he provides information about eye health, ocular disease and vision products. His videos cover a range of topics that his subscribers frequently ask about: eye floaters, glaucoma, dry eye syndrome,

Program and provision of eyeglasses with the United Nations Development Program in 10 areas and four Regions in the Philippines; and chairperson of the Special Olympics Healthy Athletes Program in the Philippines. Dr. Abesamis-Dichoso is a fellow of the American Academy of Optometry; a founding fellow at the Philippine College of Optometrists; a fellow of the International Association of Contact Lens Educators; an Asia-Pacific Regional advisor for the Special Olympics Opening Eyes; treasurer at the Asia-Pacific Council of Optometry; and is an AsiaPacific Council of Optometry (APCO) representative for the World Council of Optometry, in addition to being a member of the Legislation, Registration and Standards Committee. She has also authored numerous published papers and is a popular lecturer at industry meetings. carmen.dichoso@gmail.com

contact lenses, eyeglasses, and more. Dr. Allen has been featured in Ask Men and Oprah Daily and was awarded the Media Advocacy Award from the American Optometric Association in 2021. In his free time, he enjoys rock climbing, running, playing video games, hiking, and biking. hello@doctoreyehealth.com

Dr. Joseph Allen OD, FAAO, Dipl ABO

Prof. Monica Chaudhry MSc

Professor Monica Chaudhry is a consultant optometrist and educator who have more than three decades of experience as an academic and a clinician. With her extraordinary skills in optometry education, she has recently ventured to be a freelancer educator, strategy advisor and practitioner. She is the founder of an online optometry up-skilling education platform – Learn Beyond Vision. Also, she has instituted some centers of excellence and vision centers, which aim to be a unique referral, academic and research units. Her name is well-known as a contact lens and low vision specialist and has a far and wide patient referral in India. Prof. Chaudhry has served at the All India Institute of Medical Sciences (AIIMS) in New Delhi, had academic experience with various universities, including the Indira Gandhi National Open University (IGNOU) and Amity University (India), and has recently retired as director of School of Health Sciences at Ansal University (Gurgaon, India). She has been associated with leading eye care companies such as Menicon, Johnson&Johnson , Baush +Lomb , Alcon,

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Essilor, among others, as a key opinion leader, faculty, consultant or advisor. In recognition of her contribution to the field of academic medical service, she has been awarded the Shreshtshree Award by the Delhi Citizen Forum, the Australian Leadership Fellowship award in 2012 and the IACLE Contact Lens Educator of the Year (Asia Pacific) award in 2015. Prof. Chaudhry was chairman of the Optometry Council of India. She has been actively involved in organizing conferences, seminars, national and international workshops, faculty development programs and many corporate training programs. She has chaired many scientific sessions and presented many papers in national and international optometry and ophthalmology conferences. She has travelled abroad extensively and attended many international trainings and conferences. She has written chapters in books and has published three books. monica.rchaudhry@gmail.com

ADVISORY BOARD MEMBERS Dr. Kristie Nguyen is a board-certified optometrist. She currently serves as a contract doctor for Perez and Associates and Phan-Tastic Eye Care in Altamonte Springs, Florida, USA.

Dr. Kristie Nguyen OD

After graduating in the top 10 of her high school class with honors, she went on to obtain her Bachelor of Science degree from the University of Houston, Texas. While at U of H, she volunteered at a local hospital and worked as an optometric assistant. Dr. Nguyen obtained a Doctorate of Optometry (O.D.) in 2005 from Nova Southeastern University College of Optometry in Fort Lauderdale, Florida. She conducted her medical internships at the Chickasaw Nation Health Clinic in Ardmore, Oklahoma and the Lake Mary Eye Care in Lake Mary, Florida.

Dr. Nguyen is a member of the American Optometric Association, the Florida Optometric Association, Young ODs of America, OD Divas, Optometry Divas and the Central Florida Optometric Society. In addition, she has been an executive board member for Optometry Divas for the past two years. She is also a brand ambassador for an independent eyewear brand called Kazoku Lunettes and director of business development for an online optical company called Optazoom. She is also an independent consultant for Rodan+Fields, which is a global clinically tested skincare brand. Dr. Nguyen is married and has two beautiful daughters. She enjoys going to the beach, hanging out at Disney, and reading. kristie817@gmail.com

With almost twenty years of experience, Dr. Mark Eltis has practiced Optometry in New York, California, and Toronto. He is a graduate of the University of Waterloo School of Optometry and has taught there for over a decade.

Dr. Mark Eltis OD, FAAO

Dr. Eltis is a fellow of the American Academy of Optometry and a diplomate of the American Board of Optometry. He is also a faculty member of the Academy of Ophthalmic Education and has completed his California Glaucoma Certification at UC Berkeley. Dr. Eltis has served as an examiner for national licensing assessment in both Canada and the United States. He has presented and published internationally and has been sought as an expert on optometric issues for national television and print. In 2013, Dr. Eltis was honored as a member of the Optometric Glaucoma Society (OGS) having “demonstrated excellence in the care of patients with glaucoma through professional education and scientific investigation.” Dr. Eltis is a reviewer for over a dozen publications including Journal

Dr. Elise Brisco OD, FAAO, CCH, FCOVD

Dr. Elise Brisco is the founder of NearSight – a new vision wellness company that is revolutionizing solutions to keep people comfortable and productive on their devices in our digital culture. Dr. Brisco has dedicated her career to helping others through her multidisciplinary wellness group and integrative optometric and homeopathic practice. She has written many articles, been a Key Opinion Leader, and has presented lectures extensively. She has been interviewed in over 400 TV, radio, internet, and print. She sold her practice in 2019 to focus on launching NearSight. She continues her mission to educate and motivate others to live their best

of Glaucoma and Canadian Journal of Optometry. In 2017, he was recognized for his “outstanding contribution in reviewing” by the editors of Journal of Optometry and Elsevier. He is also on the editorial board of scholarly publications and is a US optometric residency program evaluator. Dr. Eltis has been a consultant for academic institutions overseas, contact lens/pharmaceutical companies, law firms, and a subject matter expert for competency evaluations. He serves on the board of directors of the Council for Healthy Eyes Canada and was elected to council at the College of Optometrists of Ontario. Dr. Eltis is currently focusing his practice on dry eye patients employing the latest diagnostic and therapeutic options. He loves connecting with optometry students and the public by sharing his eye care tips on social media. drmarkeltis@vieweyecare.com

life as a Health, Beauty and Fitness Influencer. She collaborates with wellness and fashion brands to promote healthy living through social media. You can find her on Instagram @HollywoodEyes or Facebook and YouTube Hollywood Eyes – Dr. Elise Brisco. Dr. Brisco is also the reigning Ms. Woman California United States and a runway and published model. Her platform is Healthy Living for Healthy Aging. In her personal life she is passionate about her family, boxing, fitness and travel. elisebrisco@hollywoodeyes.net

May 2022

COOL OPTOMETRY |

SUSTAINABILITY

Walking the Talk

ZEISS leads by example through its sustainability programs by Roman Meitav

ith an ever-growing emphasis on industrial responsibility, when asked about the main sectors in need of a sustainability program, one might suggest the automotive industry, or perhaps, oil refineries? Maybe weapons manufacturing? These are all good answers. However, you’d be surprised to know that one of the industries that are actively picking up the glove in building a better, more sustainable future is actually in the field of optics. One such company is Germany’s ZEISS, which is strongly pushing for a greener future with its remarkable sustainability programs.

Upholding Carl Zeiss's legacy Carl Zeiss AG — founded in Jena, Germany, in 1846 by optician Carl Zeiss and branded as ZEISS — is an international technology enterprise operating in the fields of optics and

optoelectronics. ZEISS develops, produces, and distributes innovative solutions for industrial metrology and quality assurance, as well as medical technology solutions for diagnostics and treatment in ophthalmology and microsurgery, and microscopy solutions for the life sciences and materials research. Sustainability is a topic that is taken very seriously at ZEISS, so much so that it has its own sustainability department that is spearheading innovations in the field, headed by Dr. Nicole Ziegler. In the ZEISS Group Sustainability Report 2020/2021,1 Dr. Ziegler remarked: “Sustainability is a key driver for innovations as we aim to create greater added value for society and thus set ourselves apart from our competitors. The range of sustainable product solutions will help ZEISS customers, in particular, to be more successful and more sustainable.”

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The ZEISS Sustainability Program highlights five main fields of action: the environment, social engagement, products, the value chain and integrity, and compliance. With that, ZEISS aims to focus on three particular areas in order to advance said goals by 2025: climate protection, circular economy, and added value for society.

Climate protection ZEISS has set a pretty ambitious goal regarding climate impact and aims to operate in a carbon-neutral way in all of its global activities by the goal date of 2025. To achieve this, the company has already begun operating green buildings at worldwide hubs that meet the highest standards in environmental protection and sustainability, together with VR solutions for training courses and service calls, which aim to reduce the environmental impact of business trips and directly reduce CO2 emissions.

On the production side of things, ZEISS began implementing new resourcefriendly sunglass lenses made with eco-friendly organic material, as well as retrofitting plants and machinery.

residual oil on metal chips. Residual coolant is thus separated and reprocessed, while the chips are compacted, enabling the metal chips to be recycled at a better rate.

“When procuring energy, we focus squarely on green energy, both in Germany and at our sites worldwide,” Dr. Ziegler explained. “We attach tremendous importance to green power being truly green and insist on seeing certificates of origin and power purchase agreements that attest to this. This is how ZEISS in Germany is sourcing renewable energy from wind power.”

Another example is ZEISS's Plano line of resource-saving sunglasses. While the majority of sunglass lenses are made of plastic, ZEISS has developed new, more resource-friendly lenses. Plano sunglass lenses use 39% recycled bio-based material instead of fully relying on fossil fuels. This organic material is recycled from the waste generated by agriculture and the wood industry.

In their 20/21 sustainability report, ZEISS elaborated that they aim to achieve a 20% reduction in relative energy use by the fiscal year 20242025, 15% reduction in relative water consumption, and 10% reduction in relative waste accumulation.1 “Our new ZEISS Innovation Center in the USA is powered by solar energy, and it features use-based light and air controls and a heat recovery system,” Dr. Ziegler added. “Meanwhile, a state-of-the-art facility is being built in Jena, the ZEISS high-tech site. It was designed to meet the requirements for the gold certificate awarded by the German Society for Sustainable Building.”

Circular economy What does “circular economy” mean exactly? According to ZEISS, they aim to use resources more smartly, opting to deploy more renewable and recycled materials into the production chain, thereby lessening the impact it has on the environment. As an optics and optoelectronics company, ZEISS opts to primarily use materials and production lines that have a low environmental footprint, while being easy to monitor. Wherever possible, potentially hazardous materials are replaced with more environmentally friendly substances. Recyclability is a key criterion when selecting said materials. At ZEISS's Oberkochen site, for example, efforts are made to reduce the amount of

Because of this, ZEISS was able to reduce the relative amount of waste by 14% when compared to the sustainability report of 2018/19, as well as a reduction in relative water consumption by 17%.2

Value for society Through its actions, ZEISS aims to create added value for a more sustainable society by providing as many people as possible with access to high-quality healthcare. In 2020/21, Carl Zeiss AG invested a total of 1.6 million euros into 106 projects, as opposed to almost 1 million euros in 107 projects the year prior. “Our task as a foundation-owned company is to ensure our business success and take responsibility for our employees, as well as our social and societal engagement, and promote science and education,” shared Joachim Kuss, head of communications at ZEISS Consumer Markets and head of the Social Engagement working group.1 “We take action at the local and global levels to achieve this. Through our social engagement, we work with partners to offer disadvantaged people practical assistance and more opportunities.” ZEISS's efforts help people across the globe through various projects, one of which tackles the fight against cataracts in Pune, India. Cataracts affect approximately onethird of all blind people worldwide. Together with the Christoffel Blind Mission (CBM) and a local partner, the

Poona Blind Men’s Association, ZEISS is supporting a new training center for treating cataracts locally. The center trains ophthalmologists and medical personnel in phacoemulsification, a cataract surgical technique. Since 2015, ZEISS has been committed to improving the lack of access to proper eye care in India, where over 800 million people live in underserved rural areas. The company uses the Aloka Vision Programme to tackle this issue. The program intends to supply basic eye care to people in 10 states across India. Simple digital platforms and an optimized supply chain, which is realized by working with local partners, make it possible to supply several thousand pairs of glasses each month, as well as perform several thousands of eye exams which would not have been possible for the patients otherwise. Despite the limitations induced by COVID-19, in the fourth quarter of 2020/21 alone, Aloka helped 60,500 patients.

Practicing what they preach While ZEISS has, indeed, set itself some very ambitious goals to be reached in only a few years, it seems this claim is not just all talk but also a lot of show. Since 2018, ZEISS has made significant improvements in sustainability with no signs of slowing down. Suddenly, the goals of switching to green power at its sites worldwide by 2022 and operating in a carbon-neutral way in its own activities by 2025 do not seem like clever corporate talk, but a real commitment from a company that cares about its impact on our future and the environment.

REFERENCES: 1.

Challenge the Limits of Imagination. ZEISS Group Sustainability Report 2020/21. Available at: https://mamcache.zeiss. com/314_1643353749651.original.html. Accessed on April 28, 2022.

Green, Safe, Responsible. Sustainability in Eyeglass Lens Production. Available at: https:// www.zeiss.com/vision-care/int/about-us/ newsroom/news-overview/2019/sustainabilityin-eyeglass-lens-production.html. Accessed on April 28, 2022.

May 2022

COOL OPTOMETRY |

SUSTAINABILITY

More Than Just a Drop in

the Ocean

CooperVision aims to rid the world’s oceans of plastic pollution, one pack of dailies at a time by Matt Herman

hat’s in a contact lens? Well, plastic, mostly — and that is not welcome news for aquatic ecosystems the world over. Pollutive polymers like hydrogel, silicone hydrogel, and hypergel that constitute the majority of contact lenses in circulation are not known for their environmental friendliness. And this poses a major threat to a planetary ecosystem increasingly under siege. Fortunately, CooperVision — a key player in the contact lens industry — has answered the call with its “Plastic Neutral Contact Lens Program” in an attempt to offset this increasingly problematic source of plastic waste.

The cost of clear vision Contact lenses, and especially those which are disposed of improperly (like those flushed down the toilet), end up in the waterways and soils in the form of microplastics that wreak havoc on the environment. With over 145 million contact users worldwide and counting,1 an eye-popping amount of microplastics end up being thrown away. At issue here is not only the volume of contact lenses being disposed of, but also the manner in which they are thrown away. Instead of recycling them or simply throwing them away, Americans alone flush between 2.6 and 2.9 billion contact lenses down the

drain, leading to about 50,000 pounds ending up in sewage sludge every year.2 These contact lenses end up in our soils, waterways, and oceans. And the damage they do goes well beyond being an eyesore. We’ve all seen the well-circulated, gut-wrenching images of plastic straws and other detritus tangled up in various denizens of the marine depths. But the real problem lies deeper. Contact lenses degrade partially into microplastics, which have a nasty habit of absorbing a higher level of contaminants than the surrounding natural environment, threatening any organism they come into contact with and those that feed on it.3

CooperVision’s commitment to environmental consciousness California-based CooperVision is a company already well-entrenched as an industry leader in sustainability. They view good environmental hygiene as a core component of their business and have divided their efforts into four key areas: water, energy, recycling, and people. From its conservation efforts in Puerto Rico, to using a 100% biomasspowered facility in the United Kingdom, to adopting and protecting biodiversity-rich rainforest in Costa Rica,4 CooperVision’s array of green

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initiatives demonstrates that they are more than just talk when it comes to the environment. It is the third key area of recycling, however, where CooperVision sets itself apart. As one of the world’s largest contact lens manufacturers with distribution in over 100 countries around the globe, including many coastal nations, they have witnessed firsthand the devastating impacts that plastic pollution has on our planet’s marine ecosystems. Out of this observation came a simple yet gargantuan goal — to reduce the amount of plastic in our oceans — and with it the genesis of CooperVision’s Plastic Neutral Contact Lens Program.

Partnering with Plastic Bank The Plastic Neutral Contact Lens Program is CooperVision’s answer to the problems posed by plastic contact lenses. Its aim is simple by design and massive in scope: To create the world’s first plastic-neutral contact lens by completely offsetting the amount of plastic added to our oceans. To accomplish this, they enlisted the help of Plastic Bank, an organization on the front lines of the fight against ocean plastic. The Plastic Bank credo is simplicity epitomized — to prevent as much

plastic from entering oceans and waterways as possible. To do this, they work on the front lines of the fight, with a network of collection centers 50 kilometers from these critical marine resources for collecting plastic. Independent collectors gather plastic from riverbanks, beaches, and neighborhoods in return for either cash or bonuses in the form of digital tokens that can be converted into necessities like food, cooking fuel, school tuition, health insurance, internet connectivity, and drinking water.5 With this scheme, everyone wins by design. Vulnerable local communities are empowered and enriched via a pathway out of poverty and become guardians of the precious aquatic resources in their neighborhoods through incentivization and education. It is through this vehicle that CooperVision conceived the realization of its plastic-neutral contact ambitions.

Going plastic neutral Inaugurated in February 2021 in the United States, CooperVision’s partnership with Plastic Bank was established to create the world’s first plastic-neutral contact lens. And

with daily-use contact lenses and their accompanying packaging being one of the more egregious sources of contact lens-related plastic pollution, CooperVision decided to kick off the initiative with gusto: By committing funding for the collection, processing, and reuse of plastic equal to the weight of plastic in every Clariti® 1 Day distributed. “Plastic plays a critical role in the hygienic delivery and sterile protection of our contact lenses, and how that plastic is managed is important to us,” commented Simon Seshadri at the launch of the program.6 “Our partnership with Plastic Bank presents new opportunities to further expand our sustainability efforts and engage with eye care professionals and wearers in a new, innovative way." With over one year now under its belt, it is impossible to call the program anything but a resounding success. The credits it has purchased through Plastic Bank thus far have prevented the equivalent of a whopping 28 million plastic bottles from reaching our waterways and oceans, benefitting 171 coastal communities along the way.7 The program has also expanded significantly. As of February this year,

18 CooperVision subsidiaries in Europe and North America are on board, with nine more across Asia, South America, and Europe slated to join later this year. This could prevent the equivalent of 90 million plastic bottles7 from polluting the ocean in 2022, a significant increase from 2021 and a testament to the runaway success of this initiative. Another knock-on effect of CooperVision’s monumental achievements with the program is that it shows the rest of the industry what is possible. “By re-examining our relationship with plastic, we can help protect the world’s oceans and transform waste into a resource,” said Dan McBride, executive vice president and chief operating officer of CooperCompanies, at the first anniversary of the program.7 “There is no finish line either, so we invite contact lens wearers and the rest of the eye care industry to join us.” So let other companies and plastic polluters be officially put on notice — plastic neutral products like the humble contact lens are an achievable reality, and there’s no better time than now to protect our oceans and waterways for generations to come.

REFERENCES: 1.

Pucker AD, Tichenor AA. A Review of Contact Lens Dropout. Clin Optom (Auckl). 2020;12:8594.

Contact Lenses Are a Surprising Source of Pollution. Available at: https://www. scientificamerican.com/article/contact-lensesare-a-surprising-source-of-pollution/. Accessed on May 2, 2022.

Here’s How Your Contact Lenses May Be Polluting the Ocean. Available at: https://time. com/5369835/contact-lens-ocean-pollution/. Accessed on May 2, 2022.

CooperVision & Sustainability. Available at: https://coopervision.com/about-us/coopervisionsustainability. Accessed on May 2, 2022.

If You Could Stop Plastic From Entering the Oceans, Would You? Available at: https:// plasticbank.com/about/. Accessed on May 2, 2022.

CooperVision Expands Sustainability Commitment Through Global Partnership with Plastic Bank. Available at: https://coopervision. com/our-company/news-center/press-release/ coopervision-expands-sustainabilitycommitment-through-global. Accessed on May 2, 2022.

CooperVision Plastic Neutral Contact Lens Program Posts Industry-Leading First-Year Results. Available at: https://coopervision. ca/our-company/news-center/press-release/ coopervision-plastic-neutral-contact-lensprogram-posts. Accessed on May 2, 2022.

May 2022

SUSTAINABILITY

co C E h &

Here at COOKIE magazine, we think that’s pretty darn important, too. So we’ve decided to take a closer look at the practices of some of those companies that are “doing it right.”

Bausch+Lomb

Bausch + Lomb has partnered with TerraCycle, an organization that specializes in dealing with hard to recycle items. Their ONE by ONE Free Recycling Program1 is the first sponsored contact lens recycling program in the United States. For every 10 pounds collected, a $10 donation is made to Optometry Giving Sight, a global fundraising initiative aiming to solve unnecessary blindness and vision impairment.

“Contact lenses are one of the forgotten waste streams that are often overlooked due to their size and how commonplace they are in today’s society,” said Tom Szaky, CEO of TerraCycle.2 “It’s through beneficial partnerships, like the one we enjoy with Bausch + Lomb, and groundbreaking initiatives, like the ONE by ONE Recycling Program, that drive awareness of the issue, elicit change in the consumer, and lead to the preservation of our environment for future generations to come.” TerraCycle has won over 200 awards for sustainability and has donated over $44 million to schools and charities since its founding 15 years ago.

Four environmentally friendly eye health companies that strongly advocate sustainability by Ben Collins t’s no longer enough for today’s cutting-edge medical companies to simply be at the forefront of innovation and technology. Nowadays, people also expect these companies to be not only socially responsible but also environmentally sustainable.

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OPTICS |

To date, the program has facilitated the proper recycling of some 202,715 lbs. of lenses and plastic packaging! “Prior to the ONE by ONE Recycling Program, contact lens wearers did not have an option to ensure that their contact lenses, blister packs, and top foils were properly recycled,” said Amy Butler, vice president, Global Environment, Health, Safety + Sustainability, Bausch Health.2 “It’s not the material these products are made with that has prohibited their ability to do so, but rather their small size. We are excited to continue to give our patients and eye care professionals the opportunity to take part in our ONE by ONE program and ultimately help ensure these used materials do not end up in our environment,” she added. The ONE by ONE recycling program has over 3,500 participating eye care practitioners. Consumers simply collect their used lenses and blister packs and drop them at participating clinics. They are then passed on to TerraCycle who clean, sort, and recycle components into a raw format that manufacturers

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Johnson & Johnson

Johnson & Johnson (J&J) is one of the most easily recognizable healthcare brands worldwide. Sustainability is a core focus of the company, having been written into its business philosophy as far back as 1943. J&J Vision, the company’s eye care department, offers a broad range of eye health solutions, from protection to treatment. The product you are most likely to be familiar with is probably their ACUVUE® lenses. One of the more popular contact lens brands globally, J&J Vision and ACUVUE have made some notable progress in terms of product sustainability in recent times. They’ve managed to reduce the energy consumption and greenhouse gas emissions required in the manufacturing process of their ACUVUE OASYS 1-Day (90 pack) by 12%. J&J has also significantly reduced its products’ transportation emissions by switching from air to sea freight. On top of this, their manufacturing plants in the USA have reduced paper use in the ACUVUE OASYS 1-Day (90 pack) by a whopping 60%, saving some 57 odd tons of paper annually! J&J encourages consumers to recycle elements of their products wherever possible as well. Their contact lens boxes are fully recyclable, and the

reusable container and solution bottle can go into your recycling bin, too. The lens cup is recyclable (remove the foil first!), although some recycling centers can’t deal with them due to their small size. The lenses themselves are difficult to recycle (again, due to their proportions), but J&J goes the extra mile here, too — also teaming up with TerraCycle. So far, they have managed to recycle around 4.4 million lenses and cups between them! J&J Vision has reduced its carbon footprint to such an extent that it looks like Johnson & Johnson may, in fact, reach their lofty ambition of achieving carbon neutrality by 2030.3 Kudos to them!

CooperVision

CooperVision — another global leader in contact lens innovation and production — is also making massive strides in the move toward sustainability. The company has compartmentalized its sustainability efforts across four key areas: water, energy, recycling, and people.4 CooperVision is increasingly aware of the crucial role that water plays within the communities that support its manufacturing practice. In its Puerto Rico facility, water used during the production process is cooled and repurposed, saving tens of millions of liters annually. Rainwater is also collected for use in bathrooms and climate control systems. These initiatives have helped to reduce demand on the city water supply by around 35%, as well as limit wastewater contributions — keeping some 1.4 million gallons out of treatment plants. Their water conservation efforts have earned high praise, most recently being recognized with the Puerto Rico Aqueduct and Water Authority’s (PRASA) Pre-Treatment Excellence Compliance Award. When it comes to powering their facilities, using clean and renewable energy sources is CooperVision’s priority. Their Rochester, New York operations use entirely wind-based electricity. And in the U.K., they’re using renewable electricity generated from biomass.

What’s more, CooperVision also utilizes geothermal, hydroelectric, and solar energy. Natural lighting is used wherever possible to reduce electricity consumption, and the company has upgraded to high-efficiency lighting across many of its manufacturing and distribution centers. Always looking for ways to innovate when it comes to energy efficiency, they’re also upgrading building management systems at many of their sites around the world, installing motion lighting and adding heat protection films. Less is more, and CooperVision is all about reducing, reusing, and recycling. Around 95% of their production materials are recycled (cardboard, wood, paper, and oil), including 99% of the plastic components generated in the manufacturing process. Cardboard at their distribution centers within Puerto Rico and Hungary is reused five to 10 times before it is recycled. CooperVision is keen on empowering its people to make environmentally conscious choices, too! Around 70% of employees (across their Costa Rica and Hungary sites) utilize mass transport, saving on commuter emissions. Employees also contribute to community improvement efforts, getting involved in coastal cleanup programs, and partnering with schools to educate on the importance of recycling and conservation. Not to mention, CooperVision has also adopted five acres of Costa Rica’s Osa Peninsula, home to 2.5% of the world’s biodiversity, as part of their ongoing commitment to local environmental initiatives.

The company recently earned the GreenCircle Zero Waste to Landfill Certification for three of its ophthalmic drop and solutions manufacturing facilities — two in Fort Worth, Texas, and one in Singapore.5 Each of the three facilities, which supply Alcon products to markets around the world, diverted 100% of total waste from landfills. With this achievement, Alcon is the first healthcare company to be GreenCircle Certified for Zero Waste to Landfill operations. The company’s GreenIST (Green Innovations Surgical Team) is responsible for identifying opportunities within their surgical franchise to increase sustainability measures, aiming for high impact by focusing on waste reduction. Since its establishment last year, they’ve identified some impactful surgical projects around the world, including removing the machine cassette pak tray and Tyvek lid of their Custom Pak, thereby decreasing waste by 90%.

Want to know more? If you’d like to learn more about these fantastic sustainability initiatives or even get involved yourself, it’s well worth having a look at all of these amazing eye care companies’ websites.

REFERENCES: 1.

Bausch + Lomb ONE by ONE Free Recycling Program. Available at: https:// www.terracycle.com/en-US/brigades/bau schrecycles#@40.77027075200147:95.93705549677736zoom:4. Accessed on May 1, 2022.

Bausch + Lomb Reports More Than 9.2 Million Units Of Contact Lens Materials Diverted From Waste Stream Through ONE By ONE Recycling Program. Available at: https://ir.bauschhealth.com/news-releas es/2019/04-22-2019-130101778. Accessed on May 1, 2022.

Johnson & Johnson Vision Reinforces Sustainability Commitment. Available at: https://www.jjvision.com/press-release/johnsonjohnson-vision-reinforces-sustainabilitycommitment. Accessed on May 1, 2022.

CooperVision & Sustainability. Available at: https://coopervision.com/about-us/coopervisionsustainability. Accessed on May 1, 2022.

Alcon is the First Healthcare Company to Achieve GreenCircle Certification for Zero Waste to Landfill Manufacturing Facilities. Available at: https://www.alcon.com/media-release/alconfirst-healthcare-company-achieve-greencirclecertification-zero-waste-landfill. Accessed on May 1, 2022.

Alcon

Alcon believes that our planet is worth seeing. That is why they’re taking action to create a sustainable future where the lives of the people and the communities they serve are better and brighter. They believe that when people see brilliantly, they live brilliantly! Alcon has established a robust set of programs to advance its efforts in continuously improving environmental performance.

May 2022

OPTICS |

SUSTAINABILITY

Which is Greener: Contact Lenses?

Eyeglasses or

by Joanna Lee

greener for the environment as we are supporting our suppliers and when we’re making recommendations and educating our patients,” he said. He added that eye care professionals need to relate to this issue. One way is by offering recyclable or recycled products as an option for clients. “We do give preference to suppliers who have their own green projects, such as ‘Eco Green Frames’ where for every frame purchased, they would plant a tree, for instance,” Mr. Ho shared. Echoing Mr. Leong’s sentiments, Mr. Ho said: “The bulk of the usage of plastic comes on account of the casing and packaging, not from the frames alone.”

growing consciousness of our ubiquitous consumption of plastic is spreading worldwide. And as plastic is the third highest source of waste across the world, should optometry take note and reflect on its carbon footprint and its use of plastic? Two years ago, the global eyewear market — comprising eyeglasses, contact lenses, sunglasses, and other eyewear products — was assessed to be worth about USD140 billion. This number is expected to rise to USD197.2 billion in 2027. That’s a lot of plastic…

The carbon footprint of our eyewear of choice The above data may cause conscientious optical patients to consider: What is the impact of wearing eyeglasses or contact lenses on the environment? In 2003, a study by Eurolens Research indicated that a pair of soft contact lenses weighs about 25 mg. When one totals up to two years’ usage of contact lenses, that’s 0.6 g for monthly lenses and 18.25 g for daily lenses. How does this compare with eyeglasses? Manufacturer Vision-Ease Lens has estimated that pre-finished spectacles, the types that are ready to be fitted with lenses, weigh around 35 g. Optometrists

would tell you that consumers usually wear a pair of eyeglasses for an average of up to two years before changing to a new pair. This would be comparable to about four years’ worth of daily lenses used. It would seem that contact lenses might have an edge over eyeglasses when it comes to leaving behind a kinder carbon footprint. But the issue gets more complicated when the other plastic materials that are used together with eyeglasses and contact lenses are considered.

There’s more than meets the eye Senior optometrist and founder of Mega Opticals in Petaling Jaya city, Mr. Chai Hoong Leong, has been observing trends while practicing for 35 years in Malaysia. He said that the use of lens cases, solution bottles, and packaging should also be considered along with plastic consumption related to contact lenses. Meanwhile at Malaya Optical, thirdgeneration optometrist Mr. Ryan Ho said it is important that as practitioners and business owners, optometrists should be aware of sustainability in the industry, as globalization has given way to conspicuous consumption. “We have to keep in mind what is

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Hence, when their supplier Ryan Adda came up with an eco-friendly casing, Malaya Optical threw its support behind the brand’s green product. Many brands internationally have attempted to mitigate the issue of plastic in frames. PLAGLA by Zenbird (Fukui Prefecture, Japan) and Genusee (Michigan, USA) are two brands that have, in recent years, produced eyeglass frames made from recycled plastic water bottles. And Kite Eyewear had launched its bespoke 3D-printed eyewear service “KiteOne” in September 2018.1 Kite Eyewear Co-founder, Amar Radia, shared: “With KiteOne, we design in London and use a 3D printing workshop in Camden. The polishing and the coloring also happen there. It then comes back to our lab in Shoreditch. It’s almost a zero-kilometer carbon product.” Major eye care companies like Alcon, Bausch + Lomb, CooperVision, Johnson & Johnson Vision Care, and Menicon2 have also initiated various efforts, such as recycling contact lenses, creating more quality and environmentallyfriendly packaging, coming up with manufacturing plant best practices in recycling water, and conserving energy while increasing production efficiency.

Initiatives to educate consumers The two optical practices have started

their own recycling programs before. Mr. Leong said Mega Optical has donated eyeglass frames after sorting and cleaning them. “We had been sending them to India and Nepal for the last seven to eight years before the lockdowns, which disrupted postal services,” he said.

their own businesses due to the high costs involved in managing and recycling wastes if they choose to go this route.

Malaya Optical also practiced a similar program where they donated frames to orphanages. Both practices prefer to engage with customers on a more personal level instead of utilizing public relations or advertising campaigns.

Mass manufacturing, especially by production giants like China, is lowering the costs of plastic frames. It’s great for the consumers, but this would mean a glut of eyeglass frames in the market.

However, to sustain recycling efforts, Mr. Leong sees the scaling and costs as a hindrance.

Recycling challenges “It is costly to separate the components of spectacles for recycling,” confirmed Mr. Leong. “The cost is high and not many companies are willing to do it.” “While certain metal parts from eyeglasses could be retrieved for reuse, these metal components are simply too small and may not justify the costs for companies to recycle them,” he further said. He added that one might need a more sizable product, like an air-conditioning unit perhaps, in order to retrieve a certain volume of metal that makes the cost justifiable when it comes to recycling them. A bigger contemplation for the industry would be the mindset and real-world practices of patients when it comes to recycling. “The awareness of environmental sustainability is present in consumers. However, the infrastructure may not be in place for people to find convenience in separating their trash or channel waste into the right places,” Mr. Ho said. “It goes to a higher level where it’s about having policies that could be implemented. Countries like Japan have superb waste management policies and systems. But in Malaysia, while we do try, we are still lagging behind,” Mr. Leong shared. He further observed that businesses that practice sustainability are sometimes not even able to sustain

The trouble with disposables and mass manufacturing

“When you’re paying only a quarter of the price, you could actually use four pairs of eyeglasses in one year instead of one!” Mr. Leong further remarked. Furthermore, the trend, according to both Mr. Leong and Mr. Ho, is moving toward daily disposables. This might increase the carbon footprint of these plastics in the ocean as they are being flushed down the waterways. One of the ways to mitigate this, Mr. Ho said, might be to use more rigid gas permeable (RGP) lenses like ortho-k. “As these overnight lenses provide a greener solution, you can stop the carbon footprint for one to two years,” he said, referring to the period of the life cycle of the harder, more durable lens.

Ultimately, the onus is on us “Pragmatically speaking, recycling is seeing its sunset,” Mr. Leong said, relating to the impact of scaling and the mass production of plastic eyeglass frames globally on the costs and viability of recycling. “However, the onus still lies with optical industry practitioners like us to continue to initiate and bring awareness, rather than wait for our customers to do it,” Mr. Ho concluded. So, whether you’re partial to eyeglasses or contact lenses, your carbon footprint still depends on how mindful you are with the way you dispose of them and how conscious you are about your resources.

REFERENCES: 1.

UK company reducing the carbon footprint of eyewear manufacturing. Available at https://www.aop.org.uk/ot/industry/highstreet/2018/10/12/uk-company-reducing-thecarbon-footprint-of-eyewear-manufacturing. Accessed on May 5, 2022.

The Environmental Impact of Contact Lens Waste. Available at: https://www.clspectrum. com/issues/2019/august-2019/theenvironmental-impact-of-contact-lens-waste. Accessed on May 5, 2022.

Contributing Doctors Mr. Ryan Ho is a skilled optometrist with over 10 years of experience. He obtained his first degree in B.Sc. at the University of Kansas, USA, and continued to pursue his passion for his Bachelor of Optometry (Hons) in Malaysia. His opinions on the treatment of Ortho-k, monovision, progressive lens fitting, and myopia in children have been well sought after on national television stations, such as RTM, TV3, and national newswires, as well as publications such as Bernama, The Star, and more. He has helped build Malaya Optical from a family-owned business of three generations to become a two-time award winner of the prestigious Brand Laureate Award. During his leisure time, Mr. Ho enjoys riding his road bike on numerous road adventures. ryan@malayaoptical.com Mr. Chai Hoong Leong has been an optometrist at Mega Optical ever since graduating in 1989 with a degree in optometry from the University of New South Wales, Sydney, Australia. Practicing privately in primary optometry eye care in the suburbs of Kelana Jaya at Petaling Jaya city near Kuala Lumpur ever since, Mr. Leong possesses extensive experience in myopia control, especially in ortho-keratology. Besides his other specialties in fitting specially prescribed contact lenses and spectacle lenses for myopia control, he is widely known for his enthusiasm, skills, knowledge, patience, and professionalism among his loyal customers. Innovation and understanding of consumer needs are one of his practice’s key drivers, along with excellent customer service as a result of focused training among the next generation of optometrists at Mega Optical. leongch.mega@gmail.com

May 2022

OPTICS |

EYE CARE TECH

Eco-Friendly Eyewear Five best sustainable spectacle brands to help reduce your carbon footprint by Joseph Schreiber

id you know that plastic can take up to 450 years to decompose and glass up to one million years? With the amount of waste already out there, many companies have chosen to use sustainable practices in manufacturing eyewear — including upcycling discarded materials, recycling frames, and using 3D printing.

Genusee

One of the most wellknown brands in sustainable eyewear — both in style and philanthropy — has the most interesting premise. Genusee is originally from Detroit, Michigan, but chose to move its operations to Flint in order to directly benefit the city and its people during the Flint water crisis. Flint is located in Genesee county. And in 2014, the city failed to implement proper safety measures and dangerous levels of lead were introduced into the water. In 2017, during the peak of the crisis, a community study found that the average family in Flint used 14.5 cases

While the Flint water crisis has been over for a few years now, families still use 65 thousand cases of water a week. Needless to say, there will be no shortage of cool, eco-friendly eyewear coming out of Flint anytime soon.

2 Proof Eyewear Next on our list of sustainable eyewear is a rather popular brand: Proof. Not only do they have several celebrity endorsements from the likes of Macklemore, Beyonce, and Lil Wayne, but they were also featured on the popular television show Shark Tank, where Marc Cuban worried they would be so popular they would not be able to keep up with orders. Because of their aversion to mass retailers, the “sharks” passed. However, they have since partnered with Cuban and Ashton Kutcher’s Slyde, a maker of hand boards.

If you’re on the lookout for a cool pair of ecofriendly eyewear, here are our top five picks!

Genusee has a supply chain mostly within 188 miles of Flint that makes sunglasses, prescription eyewear, and blue blockers. One percent of profits go to Flint and they also offer a buyback program that gives the buyer a credit for the next order.

of water per week, amounting to up to 151 bottles per day. According to Genusee, the total comes to 200 million bottles per year and the company upcycles 15 bottles into one pair of glasses. That’s a potential 13,333,333.33333333 pairs out of one small city. The company confirms that, to date, they have recycled two tons of plastic.

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Proof was founded by three brothers from Boise, Idaho. They recycle mostly wood, as well as biopolymers and metals. Notably, they recycle old skateboards. The brothers are from a family of woodworkers and grew up working at their grandfather’s sawmill. Their “Do Good” initiative funds programs in the Philippines, India, Nepal, El Salvador, Japan, and even at home in the USA. Since the COVID-19 pandemic, they have

begun concentrating almost all of their efforts on reforestation. Each frame purchased plants five trees in Madagascar, Mozambique, Kenya or Haiti. They’ve also opened a few eye clinics worldwide, providing screenings and cataract surgery for free. Proof offers all types of eyewear, and they also have a recycling program. Their logo is a bird that represents the belief that “Everyone has wings to fly, some just need a little help.”

3 Bôhten Bôhten is an African-American-owned and African-inspired line of eyewear. It was founded after two brothers from Toronto visited their ancestral home in Ghana, which is also the location of their headquarters. Similar to Proof, they’ve been on Shark Tank, but the Canadian version with the original Japanese name, Dragon’s Den. While focused on Ghana, Bôhten sources discarded materials from across Africa, such as barley, wheat, straw, lumber, and wood. They also have a considerable tree-planting campaign in Ghana and Kenya, as well as some food crops. The brand is known for its unique designs and high-quality wood. However, their glasses are among the pricier on this list at $300 each. The brand strives to enforce the principles of respect, acknowledgment, honor, and growth.

4 Sea2See Not only have some reviewers called Sea2See’s products the best all-around

sustainable eyewear, but they also have the cleverest brand name. Somewhere between 8 and 14 million tons of plastic are dumped into the ocean every year. Conservation International estimates that by 2050, the ocean will contain more plastic than fish. Sea2See produces its eyeglasses ethically in Italy, collecting plastic waste off the coasts of Spain, France, and Ghana. They estimate that they have collected over 500 tons in total, and one ton of nets, ropes, lines, bottles, and other waste per day — which are then divided into what can be used for eyewear and what can be sold for recycling. With those numbers, they are thankfully not the only company sourcing waste materials from the ocean. Waterhaul, which just barely missed this list, is also a sustainable eyewear brand that’s worth looking into. Sea2See makes a point of proving that its methods are, indeed, sustainable by seeking certification and approval from many ecologically concerned groups. They have been approved as vegan by PETA, CRB-NG Carbon Negative, and Cradle to Cradle Certified® for their circular economy. They were also recently given B Corp status for meeting social and environmental standards. They may not have the superstar endorsements of Proof, but they do have Javier Bardem, star of The Sea Inside, and many other popular movies that don’t involve the sea.

5 Monoqool The final item on this list is probably the first and most popular company

to manufacture eyeglasses using a 3D printer instead of acetate. With headquarters deliberately located amid nature, outside any major population center, Monoqool takes the principles of Danish design and combines them with Japanese technology to create unique 3D printable eyeglasses that don’t even require screws. One of the principles of Danish design is simplicity. When you see something simplified, it seems so obvious that you’d wonder how you haven’t thought of it before. That’s exactly why the way Monoqool makes its hinges flex is so fascinating. Prior to using 3D printers, they used a brilliant spiral hinge that looked like a corkscrew, and their printed glasses flex by using a hook on the temples to connect to a bar on the rims. Orders can be printed on arrival to specs based on an imaging scan of the consumer’s face. That means they fit perfectly, every time. Printing can happen locally, and maybe someday in-store, which means the packaging can be simplified since they are literally made to order. This reduces the carbon footprint because locally printed and sourced materials require significantly less transportation and emissions. Skipping the acetate also means less waste. The system is very similar to the way McDonald’s revolutionized the restaurant industry in the 1940s. But to be clear, that does not make them the fast food of eyeglasses and, unlike whatever is in a quarter pounder with cheese, is something to be celebrated. A final note on 3D printing: With your own 3D printer, you can skip those steps altogether. GlassesUSA.com offers free templates to make your own. And with a phone app for facial scans and a little 3D modeling experience, you can do all but the lenses DIY.

A clearer and cleaner future? With that said, we don’t really see much reason why most existing eyewear companies can’t adopt these principles when they can be potentially cheaper and more stylish.

May 2022

COVER STORY

Environmental impacts of optometry practice and ways to reduce them by April Ingram

n day-to-day practice, the main focus is to provide the best possible care for patients. However, it is also important to recognize the environmental impacts of optometry — and that despite where we live or the language we speak, we all share the responsibility of showing our planet the love it deserves. The good news is that, over the past decade, there has been a notable shift

toward awareness of the importance of environmental issues and actionable practices. But, of course, there is more to do. As the saying goes: “We don’t need a handful of people taking on environmental practices perfectly. We need millions of people doing all they can imperfectly.”

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Room for improvement When we consider eye care, it’s not high on the red list of industries targeted for being at odds with Mother Nature. But it does have an impact, and there is room for improvement. Of the hundreds of millions of contact lens wearers, most prefer disposable brands. But where do the discarded lenses go? It is estimated that 97% of used contact lenses are tossed or flushed down the drain, or end up in a landfill, damaging the natural environment and filling oceans with microplastics.

They don’t all stay in the landfill or the oceans, mind you. The average person ingests upwards of 50,000 microplastic particles each year, essentially eating a credit card’s worth of plastic. Far fewer discarded spectacles end up flushed away, but they do end up in landfills. Although recycling and donation programs have existed for decades, it is estimated that fewer than 10% of donated spectacles are suitable for reuse. Even though technology and equipment within the clinic have become more advanced and use less energy (LED bulbs vs. tungsten), there are far more pieces of equipment taking up residence in the lane than ever before. Many of the instruments used have disposable pieces, which are aimed at reducing disease transmission. But again, where do each of these small, disposed pieces go when they leave the clinic?

Eye care and environmental champion Within optometry, there are many champions of the environment — those who are making the efforts to coordinate and optimize sustainability practices that improve processes, efficiency and patient outcomes — all the while strengthening the important relationship with Mother Earth. Dr. Samuel Adelman, an optometrist at Portland Eye Care in Portland, Oregon, United States, and his colleagues have taken a very thoughtful and proactive approach to implementing sustainability as part of their daily practice. Dr. Adelman recognizes the important environmental impact of discarded contact lenses on our water systems. “One of the important environmental issues related to optometry is the impact of discarded contact lenses on our water systems,” he stressed. “It is true that most patients do better in terms of eye health and comfort with daily disposable contact lenses, but this creates more plastic and microplastic pollution in the environment.” He commends members of the industry that have taken a leadership role in tackling this issue. “While we try to

be brand-neutral at our office, just selecting the best product for each patient, I do think that Bausch + Lomb deserves some credit for their partnership with TerraCycle, which allows us to recycle contact lenses and keep them out of the water,” he shared. Patient education is key, as Dr. Adelman expressed: “We try to encourage our patients to recycle their contact lenses at our office and ask everyone to at least put their contact lenses in the trash rather than down the sink or toilet if they aren’t going to recycle them with us.” Their office also shares their sustainability plan on their website for their patients, encouraging active participation and welcoming their input for ways the optometry practice can keep improving.

“We try to encourage our patients to recycle their contact lenses at our office and ask everyone to at least put their contact lenses in the trash rather than down the sink or toilet if they aren’t going to recycle them with us.” — Dr. Samuel Adelman Optometrist, Portland Eye Care Portland, Oregon, United States “Sustainability to us is about all the little things we can do so our business does less harm to the world we all share,” he added.

Putting climate action front and center Dr. Ellen Zhang is an optometrist in Clayton, Victoria, Australia. Within her practice, Ellen Zhang (EZ) Optometry, she maintains a keen focus on both patient care and sustainability. In March 2021, she set out to create a sustainable business that puts climate action front and center. Dr. Zhang is passionate about creating real sustainability. “It’s an area of

focus that is sorely needed and one that we think does not receive enough legitimate consideration and effort,” she enthused. At EZ Optometry, it’s all about walking the talk. “Sustainability has become a business model, and we’ve observed many other companies use it as a marketing tool, rather than a legitimate effort towards more ethical approaches,” she shared. “It is often a tacked-on component of a business, as opposed to being an integral part of a business’ ethos and methodology,” she added. “This attitude is what we wanted to address and rectify within our business model. We wanted to create a business that strongly considers its environmental footprint and reduces harm in whatever way possible.” Sustainability and reducing environmental impact is a “big picture” practice. As Dr. Zhang explained: “We have set ourselves apart by choosing to revolve our business around ethicallybased practices, which considers all areas of a business, not just in areas patients can see.”

“We have set ourselves apart by choosing to revolve our business around ethically-based practices, which considers all areas of a business, not just in areas patients can see.” — Dr. Ellen Zhang Optometrist, Clayton, Victoria, Australia Sustainability is echoed throughout Dr. Zhang’s practice, from waste management, to sales practices, and working culture. Keeping the focus on patient care, not the almighty dollar, is also another thing to consider. Dr. Zhang has observed growing trends in businesses, centered on excessive sales practices, leading to reduced patient care and environmental consideration.

May 2022

COVER STORY

“Our business disregards this focus in favor of a more empathetic approach, which considers everyone and everything involved, from how we source materials and products to how we consider others, including patients and employees,” she shared.

Small steps lead to big impacts Wondering how to take action in your own practice? Remember that even small steps and small changes can lead to big impacts. And it’s easy when you can follow the leads of Dr. Adelman and Dr. Zhang. The hardest part is getting started, doing research, and making plans to move toward a more sustainable practice. Luckily, COOKIE tapped these experts and pulled together some actionable steps.

The journey is easier together, so get your team involved.

Portland Eye Care makes sure to train all of its new employees on the practice’s sustainability guide. They also hold quarterly Green Team meetings, where resource use and best practices are reviewed. Once your internal team is on board, take a look at the company you keep. As Dr. Zhang suggested: “Switch to ethically sustainable electricity providers, banks, and appliances. Looking into the services we use to run our businesses is important, as they are an integral aspect of a company that needs to be sustained, usually for the duration of a business,” she shared. “This means not supporting energy companies that invest into fossil fuels, land clearing, and corrupt behavior.”

Reduce paper waste.

Commit to using post-consumer recycled paper products in the office. First, only print what you absolutely need to. But if you must, then use recycled paper. If things are printed, look at ways to reuse them. Can the backside be used for notes, or shredded for another purpose? Even better, make the shift to paperless electronic medical records and patient intake forms that can be completed online or at an in-office kiosk. Be warned of the disposable ink cartridges, designed to require frequent replacement, and built on a business model to increase repeat sales. Millions of ink cartridges make their way to the landfill (if they get there at all!) every year and take centuries to decompose. If you have to print in the office, consider printers with refillable ink tanks, which use less ink, produce less waste, and save money spent on disposables. There are also plant-based ink options available in some regions. Use drinking cups and wipes that are made from renewable or sustainable materials. Encourage your staff to bring reusable cups or water bottles from home, or have a set on hand for everyone to use. We know the volume of packaging that comes with our lens and product orders, but all or most of that packaging can be recycled and shipping boxes reused. Or maybe ask if the item needs to be shipped at all?

Avoid ‘greenwashing’ and try to keep it local.

Supporting local businesses is always a win, especially since many optometry practices are part of the local business community. It may take a little time and research, but

consider ordering sustainably sourced eyewear options, such as recycled materials, which consume the least amount of resources to acquire. When possible, order products that are available locally. You support your community and it doesn’t use tons of fuel-creating emissions to get them to you. It is important to do your homework and avoid potential “greenwashing” marketing practices that get you to believe that you are making a sustainable choice. But there is more to the story. “Plant-based plastics are still plastic and act very similar to plastic once created. And while the oil component is removed, many other harmful components still exist,” Dr. Zhang explained. “Therefore, we recommend pushing for more recycled materials like metals and timber where possible. We also understand there are currently not as many companies making sustainable eyewear compared to normal eyewear, meaning it may be difficult to source adequate stock or variety for certain retail spaces. In this event, we recommend you provide as many sustainable options as possible and slowly transition over time as more options become available to the market,” she added.

Keep it clean.

Harsh chemical smells don’t necessarily mean they are more effective. Natural cleaning products are extremely effective, so look for those with Green Seal, EcoLogo, or EPA Design for Environment (DfE) designations (Safer Choice) logos. Another great tip from Portland Eye Care: “Use old newspapers to clean windows or glass surfaces. This really works!”

Give spectacles a second life.

Patients should be encouraged to donate their old glasses, which could be used by other patients in lower-income countries that may not have access to needed spectacles.

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Also, TerraCycle is a company that runs a recycling platform that collects waste in boxes that you can have right in the office, recycles it, and transforms it into raw material for reuse.

Coffee in the break room? Make sure those small appliances have the Energy Star logo and switch them off or unplug them completely when they aren’t being used. A shift from gas appliances to electric reduces the demand for natural gas and the harmful practices aligned with its processing and distribution.

Be a perpetual student.

There is no one-size-fits-all handbook to sustainability. You just have to make the effort to continue to improve.

Stay cool.

Maintaining a comfortable temperature in the office that everyone can agree on can be a challenge in itself. A happy medium for your staff, patients, and the environment can be to set air at no lower than 22C/72F and heat no warmer than 20C/70F. A big saver is to turn off the heating and cooling system whenever there is no one working, such as on evenings, weekends, and holidays. Keeping heating and cooling units clean and regularly serviced also helps with efficiency.

Use pure energy.

Low energy LED lighting is the right choice, whenever possible. It is a simple and effective way to reduce emissions and save some money. It uses less energy and creates less heat. Another pro-tip, as our Dads would always say: “When you leave the room, turn off the lights!” How about creating your own energy, or at least tapping the sun for it? Installing solar panels is a great way to offset power usage. Although the initial installation can be quite the investment, the benefits to the environment and reduction in monthly electricity bills will pay off in the longterm.

practice. Be part of a real shift in our consciousness of the environmentrelated issues, diving into the challenges of emissions, plastics, waste management, and how we can efficiently and effectively recycle and reuse.

Wise words from Dr. Zhang: “Our next steps are to continue to improve the business, find more ways to be sustainable, and always reflect on what could be done better,” she suggested. “We don’t want to become complacent in what we do. We also have a goal of guiding others, be it optometrists, patients, other businesses, or government officials, to do more for this Earth. We want to be an example and reliable source of information to others, and we want to change the perception that it is ‘too hard’ or not doable,” she concluded.

“Our next steps are to continue to improve the business, find more ways to be sustainable, and always reflect on what could be done better.” — Dr. Ellen Zhang

Want more information? The International Agency for the Prevention of Blindness (IAPB) Climate Action Work Group developed a roadmap* with useful tips to help you in your journey to reduce your environmental impact. Let’s become part of the millions doing our imperfect best, minimizing the footprint of the modern optometry

REFERENCE: * Guide for Environmentally Sustainable Practices in the Eye Health Sector. Available at: https:// www.iapb.org/learn/resources/guide-forenvironmentally-sustainable-practices-in-theeye-health-sector/. Accessed on 29 April 2022.

Contributing Doctors Dr. Ellen Zhang is the sole optometrist at EZ Optometry. Dr. Zhang graduated with a Bachelor of Vision Science degree and a Masters of Optometry with distinctions from Deakin University. From there, she has worked in metro and rural clinics in corporate, independent, and allied health clinics. Dr. Zhang is an active organization member of Optometry Australia and the Cornea & Contact Lens Society of Australia. She has a huge passion for eye health and is an advocate for more sustainable business practices. ellen.myhealth@gmail.com Dr. Samuel Adelman is a licensed optometrist in Portland, Oregon, United States. He completed his optometrist preceptorship training in primary care optometry, management of ocular disease, refractive surgery management, and specialty contact lens fitting at institutions, including Kaiser Permanente, The Veterans Administration, Lasik Plus Refractive Surgery Centers, and Pacific Eye Clinics. Dr. Adelman enjoys all aspects of being an optometrist in Portland with a special focus on medical eye care and contact lens fittings, including finding contact lens solutions for patients who have been unsuccessful in contact lenses previously due to astigmatism, dry eye, or multifocal prescriptions. In addition to his clinical optometrist work, he stays up on current research by acting as a translator for Japanese eye care institutions, including Tokyo Medical College and Coopervision Japan. When he’s not working as an optometrist, you’ll find him at the Portland Timbers or Thorns games. www.eyepdx.com

May 2022

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May 2022

KUDOS |

PHILANTHROPY

Maverick Philanthropist James Chen takes his revolutionary moonshot philanthropy to another level to provide universal access to eye care by Matt Herman

ressed in a plain black hooded sweatshirt with morning light streaking through the blinds, James Chen may not be what one would expect from a renegade philanthropist reshaping the paradigm of giving in the eye care industry. But as he opens up about his life’s goal of bringing quality vision to every human on earth, it soon becomes clear that universal vision care is more than just a pipe dream.

The blurry beginning It is always small moments of insight that bring forth the ideas that change our world, and Mr. Chen’s undertaking to bring clear vision to all began with one such moment. “I actually didn’t realize I needed vision correction until I wanted to get my driving license,” he admitted with a grin. “That’s when I failed the eye test and realized I needed glasses.” This first eye test provided the first insight and asked that key first question — for someone whose world has always been blurry, how does one explain what clear vision looks like, let alone convince them of the need for correction? Growing up in Africa and spending a large part of his early career in developing nations, more questions began to crop up. “I always noticed others that needed glasses, but very few people wore them. I wondered, why is that? Do they not need glasses or do they not have access?” Answers to these questions would eventually lead to what Mr. Chen terms

| May 2022

the four D’s bottlenecking worldwide access to vision correction — diagnosis, dollars, distribution, and demand. And after a successful career in business, he turned his attention to removing these challenges. To do so on the scale he imagined would take a revolutionary new approach to giving.

Moonshot philanthropy Risk — a word that strikes fear into the hearts of donors to charitable causes the world over — is a concept that Mr. Chen has embraced. And it is one that underpins the philosophy that he has championed in his approach to charitable giving, which he has termed “moonshot philanthropy.” Taking an outsized risk to generate profits for shareholders and investors is the essence of the business world. For established philanthropists, however, it is a four-letter word, as they are eager to see their generosity turned into tangible real-world impact. This embrace of the possibility of failure lies at the core of moonshot philanthropy. “The way to think about it is that the philanthropists privatize their failures, but we socialize successes,” he explained. “The key driver is the ability for someone to take risks.” As unorthodox as the idea of highstakes gambling with donor and private money may be, from Mr. Chen’s perspective, it is the key to tackling the big challenges facing our world. And his first roll of the dice would be Vision for a Nation.

An award-winning eye care charity Founded in 2011, the goal of Mr. Chen’s Vision for a Nation was to sustainably provide access to vision care for every citizen of Rwanda — a moonshot by any reckoning. As with any other trailblazing venture, the pushback from the world’s vision philanthropy establishment was intense. “When we went to Rwanda, the development world, the professionals, all said ‘no, it couldn’t be done.’ Vision correction was at the bottom of

the pyramid of priorities,” shared Mr. Chen. “So we said, let’s go try it, see, and learn from that. Whether we fail or succeed, that’s secondary. Lucky for us, it succeeded,” he enthused. And what a success it was. Vision for a Nation left Rwanda, having provided universal access to eye care for the country’s 11.8 million citizens. The foundation developed a fast-track system for the education of general nurses, built a supply chain for distributing medication and glasses to Rwanda’s 502 health centers, and conducted outreach campaigns to bring awareness to all 15,000 of the country’s villages. Working with the Rwandan Ministry of Health, Vision for a Nation has also put in place a sustainable model integrated into the national health system to ensure that every Rwandan has access to vision care for generations.1 Not surprisingly, the success of the

Vision for a Nation campaign was just the beginning. “It really drove a lot of change, and drove people to think differently about how to tackle this problem,” Mr. Chen reflected. Rwanda was a massive achievement, not to mention a highly successful and proven strategy for providing vision correction for all had been established. And he was just getting warmed up.

Setting the stage for global awareness After the lessons in Rwanda, it was time to bring vision correction awareness to the world stage. Everyone, from ordinary citizens to governments to NGOs, had to take concerted action, and this required advocacy and awareness on a massive scale — another risky leap into uncharted territory. The greatest barrier was that no one seemed to pay much attention to vision correction. “We called it the issue

May 2022

KUDOS |

PHILANTHROPY

the world forgot,” Mr. Chen laughed. Afflictions like blindness that attract a lot of attention and money are no doubt urgent, but despite its obvious impact on economic well-being and quality of life, poor vision always took a back seat. Enter the Clearly campaign, founded by Mr. Chen in 2016, the conduit for bringing attention to vision correction internationally. Though the campaign scored victories in encouraging Commonwealth leaders to commit to providing access to eye care for all in 2018 and founding the Friends of Vision Group at the United Nations, widespread international recognition proved to be elusive.2

Breakthroughs and international recognition The final piece of the puzzle came from the realization that the path to the elevation of vision correction was through research. The breakthrough came with Clearly’s sponsorship of a study published in Lancet Global Health on tea pickers in Assam, India. Picking tea is a vision-intensive task that serves as a good proxy for the correlation between poor vision and worker productivity, and the results were astounding. There was a 21.7% increase in productivity difference,

equivalent to an entire day per workweek, between a control group given eyeglasses at the end of the study and those who received a pair beforehand.3 These results would prove to be the watershed moment for Clearly. “[This] was the first piece of solid evidence that was very instrumental in persuading the world community to take this seriously,” Mr. Chen remarked. With the research in place and undeniable momentum behind international recognition of eye care as a vital component of health, the Clearly campaign’s advocacy resulted in the 193 member nations of the United Nations unanimously adopting General Assembly Resolution 75/310: Vision for Everyone — Accelerating Action to Achieve the Sustainable Development Goals on July 23, 2021. The Resolution, among other things, enshrines eye health and vision correction as part of the United Nations’ Sustainable Development Goals and sets a target date of 2030 for nations to provide total access to eye care.4

A future in focus With the UN Resolution in place, the always forward-looking Mr. Chen is already hard at work, putting the

framework that Vision for Everyone has laid out into action, starting with the cornerstone that laid the foundation for success at the UN General Assembly: research. In Mr. Chen’s view, pushing the research will give government leaders the confidence to push through policy to meet the goals laid out by the UN. After all that he has accomplished, where does it end? “It’s simple — when everyone on Earth will have access to vision correction,” he concluded matterof-factly. “Our dream is that by the time someone lands the first person on Mars, everyone will be able to see it clearly.”

REFERENCES: 1.

Vision for a Nation Foundation Helps Two Million Rwandan Access Eyecare. Available at: https://www.visionmonday.com/article/vision-fora-nation-foundation-helps-two-million-rwandansaccess-eyecare-1/. Accessed on April 26, 2022.

Clearly Campaign. Available at https://www.iapb. org/campaign/clearly-campaign/. Accessed on April 26, 2022.

Reddy PA, Congdon N, MacKenzie G, et al. Effect of providing near glasses on productivity among rural Indian tea workers with presbyopia (PROSPER): a random trial. Lancet Glob Health. 2018;6(9):e1019-e1027.

United Nations General Assembly Resolution on Vision. Available at: https://www.iapb. org/advocate/eye-health-and-sdgs/unitednations-general-assembly-resolution-on-vision/. Accessed on April 26, 2022.

Contributor James Chen refers to himself as a “first-generation global nomad ,” having lived in Hong Kong, Nigeria, the U.K., and the USA, and spent significant time in all parts of Asia. He has worked for 19 years in the vision space, completing research that found glasses had the largest productivity increase of any other health intervention, partnering with the IAPB, persuading 52 countries at The Commonwealth Heads of Governments to pledge affordable eye care for all, and creating the first UN working group on poor vision — which helped pass a unanimous UN resolution ensuring eye care for all in July 2021. His philanthropic work includes Clearly, Vision for A Nation, and The Chen Yet-Sen Family Foundation. jc@legacyhk.com

| May 2022

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May 2022

KUDOS |

WOMEN IN OPTOMETRY

childhood, how it happened … but a few memories would come back to me. Sometimes when I am very hurt, I begin to remember the events, and then I would weep,” shared Chhaya, recollecting the night when their mother was strangled by their father in her sleep. “When I see women being tortured in movies, it brings back a lot of old memories. I feel helpless that I can’t do anything about it,” Chhavi also shared painful memories of her childhood. Growing up, they understood the destructive realities of gender-based violence that is inherent in the conservative patriarchal societies of India, including Bihar where they are from. Chhaya and Chhavi owed everything to their maternal grandmother who brought them up and inspired them to be confident and independent young women. Needless to say, their grandmother means the whole world to the girls.

Indian twins and optometrists empower girls through football and eye care by Chow Ee-Tan

ike most classic good stories, a childhood tragedy did not defeat twin sisters Chhaya and Chhavvi Tiwary. Instead, they turned their negative experience around and used it to motivate them to succeed in life. Today, the twins are renowned role models in breaking gender inequality in Bihar, India. At only 24, they were both trained to become qualified optometrists at Akhand Jyoti Eye Hospital, a nonprofit charity organization in Bihar that strongly pushes for blindness elimination and girls empowerment. Chhavi, the younger and more outgoing of the twins is the leading optometrist

for Akhand Jyoti’s School Screening Program and Co-coordinating Outpatient Department. Meanwhile, Chhaya is pursuing her Master’s in Optometry at Chitkara University, Chandigarh, and is in charge of the Pediatric Eye Care Unit at Akhand Jyoti.

Transforming tragedy into triumph The twins were only four years old when they witnessed gender-based violence. Their mother became the victim of domestic abuse and was eventually killed by their father. “I don’t remember that part of my

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“Grandma has sacrificed so much and gave up everything to bring us up,” shared the twins. “She is our biggest inspiration. Despite all odds, she sent us to school and motivated us to keep going far in life.” Their grandmother was determined to see the girls go far in education. However, she was not in a viable financial condition to send them for higher education. But hope came through Akhand Jyoti Eye Hospital, whose mission was to eradicate curable blindness in Bihar and other low-income regions. The hospital aims to change the lives of girls in rural Bihar by empowering and enabling them to earn an honorable livelihood.

Turning over a new leaf with the help of optometry Chhaya and Chhavi enrolled in Akhand Jyoti’s Gender Equality Program, an initiative that seeks to improve the lives of girls in the community. The hospital, which performs over 65,000 cataract

surgeries a year, offers free education and career opportunities to help mold local girls into role models and change agents who motivate and inspire others. Chhaya decided to join the optometry course after completing Standard 12, as she believes in the many opportunities that a career in optometry can offer. “I had a wonderful experience during my optometry course at Akhand Jyoti, she said. “The curiosity to learn new things is an awesome experience in itself. Akhand is strongly focused on practical work, and we do not work as mere medical professionals but as friends and teachers to each other.” Her specialty is in low vision and pediatric optometry, where they provide a special type of rehabilitation to make the lives of patients better. “I also love working with children. It is challenging, but seeing the smiles on their faces once their problems are solved gives me the greatest satisfaction,” enthused Chhaya. For Chhavi, Akhand Jyoti allowed her to do optometry through a course from NIMS University Jaipur, which opened up her eyes to learning many things.

only improve our functional skills but we also learn all the little things necessary to build a human connection with the people we serve. It is here that I was transformed from a shy little girl into a strong woman who can fight not only for her rights, but for the good of others,” she proudly shared.

Empowered to empower other girls However, having personally experienced gender-based violence and having grown up in a society where women are treated as second-class citizens, the journey has not been easy for Chhaya and Chhavi. “It was tough because I felt everyone wanted men and boys to move ahead and not girls,” confirmed Chavvi. “But when we came to Akhand Jyoti, we developed great confidence. I haven’t faced any professional discrimination here. It is a place of equal gender opportunities,” she asserted. “As a girl, for me, it is important to be a role model in my community. If more girls came up to become role models in leadership positions, they, too, will become examples for society and will

in turn inspire more and more girls to come up. Then society will change,” affirmed Chavvi. For Chhaya, while she reckons it is difficult to fight gender discrimination in a predominantly and traditionally patriarchal society, she firmly believes that women need to stand up for their rights. The twins aspire to continue to motivate and inspire the girls in rural Bihar and everywhere in the world to fight for their rights. They fully understand the destructive realities of genderbased violence, which is inherent in conservative patriarchal societies in India. “I have seen many cases of gender discrimination in my life. The sad episode that had happened in my family had left a life-long scar in me, but it has also motivated me to come forward and empower other girls to fight for their rights,” added Chhaya. In Bihar, women and girls face considerable hardships and discrimination. They are often married at a young age and lose their right to education and employment. Child marriage, dowry, domestic violence, and

“I got a chance to serve old people who got their vision back through cataract and other eye surgeries at Akhand Jyoti,” shared Chhavi. “Their smiles, appreciation, and gratitude have motivated me to do better in my field,” she added. She, too, gets immense joy from serving the children in the pediatric department and at the school screening programs. By helping the children, she feels like she is contributing to the future of Bihar. For the twins, Akhand Jyoti is family. “We treasure and practice our core values of compassion, respect, teamwork, and commitment. Irrespective of our differences, we do not face any type of discrimination. There are many opportunities to grow here,” they shared. According to Chhaya, the genuine care shown to the poor and underprivileged patients at Akhand Jyoti is very unique in eye care facilities. “Here, we not

Chhavi (above) and Chhaya (both photos below) are passionate about eye care and empowering girls to aim for better futures.

May 2022

KUDOS |

WOMEN IN OPTOMETRY

low female literacy rates are rampant. “Every girl should have a choice to decide what she wants to do in life, and not be tied down to a predestined marital life,” said Chhavi strongly. “Girls should be able to go for higher education and stand on their own feet by securing employment. This is what motivates me to want to empower more and more young women in my society.”

Breaking boundaries with football Chhaya and Chhavi are part of Akhand Jyoti’s “Football to Eyeball” program, which helps bridge the ever-widening gender divide in a male-dominated society. The program was a brainchild of Akhand Jyoti’s executive trustee and founder, Mritunjay Tiwari. The idea was to use football — traditionally a men’s sport — to be a medium to draw girls out from their homes and give them an alternative career, as well as to show their local community that traditional stereotypes that undermine females’ opportunity can be overcome. Under this program, Akhand Jyoti sponsors the cost of the girl’s education and trains her to be an optometrist or junior doctor (as referred to colloquially). The main consideration? Parents must agree to allow their daughter to play football and not marry her off before she turns 21. Chhaya loved the game immediately after playing football at the hospital for the first time. “I love it because it gave me a chance to build my confidence,” she enthused. “Playing against boys broke my false notions of being the weaker sex. It gave me both physical and mental strength. It taught me to work as part of a team. And beating the boys at their own game is a feeling that I cannot express in words.” Meanwhile, Chavvi, who loved sports since young, was overjoyed that she was given the chance to not just play football but also train professionally. “I took to football like a fish would take to the water,” she shared. “Football has taught me to be disciplined and

work as part of a team, as well as have confidence, power, and focus. “At Akhand Jyoti, we use football as an ice breaker, whereby we counsel parents to allow their girls to play football — challenging the traditional belief that it is a man’s game. When parents see the level of confidence that we have as footballers, they are motivated to send their girls to play the game,” explained Chhavi. Playing football teaches the girls how to face not only opponents on the field but also problems in real life. It inculcates discipline and a spirit to fight by creating mental resilience. The girls are given a chance to be equal to boys. By portraying themselves as footballers, they also are telling society that any girl can also become like them, and playing the game will give them the confidence to tackle other hardships in life. “When more girls join the program, it also gives them the chance for higher education, employment, and a rewarding career,” shared Chhavi. “I feel we are sending a strong message to the community that girls, too, can do anything that a boy can. My playing motivates other girls to develop themselves and dream of an alternate life apart from cooking and cleaning.”

A mission to end physical and mental blindness The twins have embraced a mission to eradicate blindness in the regions — both physical and mental. “Eradicating curable blindness will help eliminate ignorance, illiteracy, and poverty. Empowering girls to become social changemakers will further help in reducing mental blindness from within these patriarchal communities,” said Chhaya, whose main goal is to be a guide, teacher, and social changemaker who empowers underprivileged girls to become independent, strong, and awakened women. “Professionally, I want to be able to reach a position where I can influence decisions,” shared Chhavi. “This will help more girls to join Akhand Jyoti

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in rural Bihar. I want to see every girl in Bihar get an education and an employment opportunity.” “I believe that after seeing our success story, other girls can also dream big for themselves and motivate their parents to allow them to be the best versions of themselves,” she concluded. For more information on Akhand Jyoti Eye Hospital, visit www.akhandjyoti.org or email info@akhandjyoti.org.

Contributing Doctors With a larger-than-life smile, Chhaya Tiwary’s gentle demeanor brings instant hope to the many patients who walk into Akhand Jyoti’s Low Vision Clinic to seek treatment. Her outstanding patient interaction skills and professional competence help Akhand Jyoti’s Football to Eyeball program successfully empower underprivileged village girls, transforming them into professionally qualified optometrists. In addition, Chhaya plays a big role in helping Akhand Jyoti in its efforts to provide quality, affordable, and accessible eye care to the rural population of Bihar. After joining Akhand Jyoti in 2012, completing a bachelor’s degree in optometry in 2018 and an MBA in healthcare in 2021, Chhaya is presently pursuing her master’s in optometry and leading the Low Vision Clinic at Akhand Jyoti’s base hospital at Mastichak as a senior optometrist, inspiring other underprivileged rural girls. chhaya.kumari@akhandjyoti.org Chhavi Tiwari is a shining example of a girl breaking free from the shackles of traditional patriarchy. Armed with a strong determination to do something constructive with her life, she joined Akhand Jyoti’s Football to Eyeball program after completing standard 10. From that moment, her life started transforming. She loved playing football, which helped her to develop immense confidence. Going on to complete a bachelor’s degree in optometry in 2018 and an MBA in healthcare in 2020, Chhavi became instrumental in making Akhand Jyoti’s eye screening program for children in rural schools a colossal success. This talented and inspiring young lady today works as a senior optometrist and OPD coordinator at Akhand Jyoti’s base hospital at Village Mastichak of Saran District in the state of Bihar in India. chhavi.kumari@akhandjyoti.org

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May 2022

INNOVATION |

MYOPIA

Allies in Myopia Management

Breakthroughs and updates on myopia control innovations by Tan Sher Lynn

yopia in the global population is increasing drastically. It is estimated that by 2050, half of the world's population will be myopic.1 When myopia is not properly controlled, it can lead to cataract, retinal detachment, glaucoma, and even blindness. Thankfully, there is ongoing research into the management of myopia, especially in children, to reduce the progression of eye elongation — and therefore retinal damage with age. The latest innovations include atropine eye drops and myopia-controlling contact lenses and spectacle lenses.

Atropine eye drops Vyluma’s NVK002 is a low-dose pharmaceutical atropine eye drop that helps slow the progression of myopia in children. It is currently in the late phase 3 development of the CHAMP study,2 a large multinational, multicenter trial involving close to 600 pediatric patients with the aim of demonstrating the safety and efficacy of NVK002 in children aged three to 17. It is a four-year study, and data readout from the first three-year longphase of the study is expected by the fourth quarter of 2022.

| May 2022

“If approved by the FDA, NVK002 could be launched as soon as Q1 in 2024, making it the first pharmaceutical eye drop product approved for slowing the progression of myopia in children,” said Dr. Raul A. Trillo, chief commercial officer at Vyluma. According to him, NVK002 is pharmaceutically manufactured to the strictest standards, is preservativefree, and has a shelf-life of at least 24 months at room temperature. If approved, it will have a robust body of clinical data supporting its use.

“Today, low-dose atropine is provided by compounding pharmacies, and there are many inconsistencies in the way they are produced. This is not the case with a pharmaceutically produced product like NVK002,” he confirmed. “Also, because atropine solutions can be inherently unstable, they can be difficult to formulate, require refrigeration, contain preservatives, and may have a shelf life of 90 days or less. Preservatives, like benzalkonium chloride (BAK), which is used in many ophthalmic solutions, may cause damage to the corneal surface when administered chronically. This could be of particular concern in children treated for myopia chronically with preservative-containing low-dose atropine. On the other hand, NVK002 does not contain BAK or any other preservatives,” he further explained.

Myopia-controlling contact lenses Besides eye drops, one can opt for myopia-controlling contact lenses, such as CooperVision’s MiSight® — the first FDA-approved daily disposable soft contact lenses for slowing myopia progression. The MiSight contact lenses consist of concentric rings with alternating treatment and correction zones. The treatment zones provide +2D of defocus. This dual-focus lens, with the ActivControl™ technology, can create simultaneous defocus on the retina for both distance and near viewing — with an image falling on the retina to correct myopia, and the +2.00D

of defocus falling in front of the retina to create myopic defocus as a “slow-down” signal for eye growth during childhood. This helps slow the elongation of the eye and myopia progression, while fully correcting refractive error.3 Clinical studies on children between ages eight and 12 showed that over three years, MiSight reduced myopia progression by 59%, versus a single vision 1 day lens.3

Myopia-controlling spectacle lenses Myopia-controlling spectacle lenses provide the benefit of correcting and controlling myopia for those who are not ready or willing to wear contact lenses, making it a highly appealing prospect for myopia control in children. Two such lenses available are the Hoya MiYOSMART with the Defocus Incorporated Multiple Segments (DIMS) technology and the Essilor Stellest™ with the Highly Aspherical Lenslet Target (HALT) technology. DIMS works by providing a clear central zone for normal activities, as well as multiple defocus segments evenly surrounding the clear central zone which extends into the mid-periphery of the lens to control myopia progression. With this, the MiYOSMART lens can provide clear vision and myopic defocus simultaneously at all viewing distances.

REFERENCES: 1.

The Impact of Myopia and High Myopia. Report of the Joint World Health Organisation: Brien Holden Institute Global Scientific Meeting on Myopia. Available at: https://bhvi.org/news/theimpact-of-myopia-and-high-myopia/. Accessed on 30 April 2022.

ClinicalTrials.gov. CHAMP: Study of NVK-002 in Children With Myopia. Available at: https:// www.clinicaltrials.gov/ct2/show/NCT03350620?term=vylumA&cond=Myopia&draw=2&rank=1. Accessed on 30 April 2022.

Chamberlain P, et al. A 3-Year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci. 2019;96(8):556-7.

Lam CSY, Tang WC, Tse DYY, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104(3):363-368.

Bao J, Huang Y, Li X, et al. Myopia control with spectacle lenses with aspherical lenslets: a 2-year randomized clinical trial. Invest. Ophthalmol. Vis. Sci. 2021; 62(8):2888.

A two-year clinical trial results show that MiYOSMART lenses slow myopia progression by an average of 59% and slow axial eye growth by an average of 60%.4 Meanwhile, the Stellest lens is made of a cutting-edge constellation of 1,021 invisible lenslets. On top of bringing sharp vision like a standard single vision lens, this constellation creates a signal in the child's eye acting as a shield against eye elongation. Its clinical trial showed that the Stellest lens slows down myopia progression by 67% on average, compared to single vision lenses, when worn 12 hours a day.5 Moreover, just recently, the Stellest lens was designated as a “breakthrough device” by the FDA.

Contributing Doctor Dr. Raul A. Trillo, MD, MBA, is the chief commercial officer of Vyluma. He has spent over 25 years in the healthcare industry, with clinical and commercial experience in specialty pharmaceuticals, medical devices, biologics, and healthcare provider services, along with his broad commercial experience in anesthesia, critical care, cardiology, surgery, immunology, nutrition, oncology, and hemophilia. Prior to joining Vyluma, Dr. Trillo spent much of his career at Baxter International Inc., where he held corporate, regional, and country leadership roles in medical affairs, marketing, strategy and general management. He had also served as chief executive officer of Lexington Health Network, and chief commercial officer at Nevakar. Dr. Trillo received his BA and MBA from Columbia College and Columbia Business School, respectively. He earned his MD at the University of Pennsylvania, and medical internship and anesthesia training from the Hospital of the University of Pennsylvania. He obtained subspecialty training in pediatric anesthesia at the Children’s Hospital of Philadelphia. rtrillo@vyluma.com

May 2022

INNOVATION |

EYE CARE TECH

Is it a Drug? Is it a Device? No, it’s a new way of delivering ophthalmic treatment! by Leon Ash

n ophthalmologist working behind the Iron Curtain in 1960s Czechoslovakia was one of the first to propose overcoming the drawbacks of eye drops with drug-loading contact lenses. Clearly, conventional topical treatments have severe downsides. At least 95% of the pharmaceutical is lost via tear drainage, and patients also incorrectly apply drops or skip doses. Systemic toxicity is a recurrent problem, particularly among children. If a contact lens could deliver drugs directly to the tear film of the cornea, then controlled drug, released over a sustained period, could be achieved and bioavailability increased.

Delivering drugs to targeted area thru soft contact lenses Fast forward 57 years and this super technology is slowly taking shape. Soft contact lenses (SCLs) in the form of hydrogels are being deployed with the aim of delivering drugs to the targeted area more effectively, combating allergies, improving patient compliance, and reducing side effects such as dry eye. These specially manufactured contact lenses have been shown to discharge significant amounts of ophthalmic drugs in vitro. Their contact time with the tear film, reduced toxicity, and consequent improved patient compliance show

| May 2022

considerable benefits over eye drops. The principle is, according to a recently published paper, if the aqueous lens wetting solution contains enough pharmaceutically active material, the drug diffuses from the polymer matrix into the ocular tear film and interacts with the eye tissue.1 “Drugs released from SCL may remain on the corneal surface for at least 30 minutes. This is about 15 times longer compared to regular eye drops. Prolonged contact time of the drug with the cornea can increase its bioavailability up to 50% compared to the 1% to 5% efficiency of eye drops,” the investigators reported.

Properties and technology behind it The technology is based on hydrogels absorbing the solutions and using the proximity to the corneal lens to improve bioavailability. The key properties of drug-delivering soft contact lenses (DDSCLs) are transparency, wettability (lenses must be highly hydrophilic), water content (comfort for the wearer), oxygen permeability (low oxygen transfer can lead to serious side effects), and glass-transition temperature (temperature below which the physical properties of polymers change to those of a glassy or crystalline state). Biopolymer-based hydrogels are “biodegradable, biocompatible, and non-cytotoxic,” reported the study authors, and a variety of approaches have been proposed to load these structures with pharmaceuticals.

• Soaking: The earliest of the new technologies, dipping, and soaking of contact lenses have been experimented with since 1965, although it is the advent of soft, hydrophilic lenses that really made this approach more viable. The drug release occurs quickly — but retention time and efficacy of various drugs in vivo show better results for soaked contact lenses than eye drops.

• Functional monomers: The addition of ionic compounds in the polymerization process forms strong attachments between the lens and drug.

• Molecular imprinting: Imprints of cavities of the appropriate size are created in a polymer that can be further filled with drugs. It’s a technique for modifying a polymer, increasing its affinity for drug molecules and thereby enhancing the loading potential of drugs and extending their delivery time.

• Colloidal nanoparticles: These include liposomes, micelles, microemulsions, and polymer nanoparticles. Which specific eye conditions could

drug-delivering contact lenses be effectively deployed against? In the fight against glaucoma, soaking contact lenses with nanoparticles and molecular imprinting of hydrogel surfaces have shown promise. Additionally, a diffusion barrier made from Vitamin E has been shown to prolong drug release over time. These lenses required only a fifth of the drop dosage and lasted four days. However, questions remain over undesirable changes in SCL physical properties with this technique. It should be stressed that all lenses adapted for therapeutic purposes must ascribe to normal expectations of transparency, ease of use, and comfort.

Anti-viral applications of DDSCLs DDSCLs (drug-delivering soft contact lenses) could potentially have antiviral applications, such as in the treatment of viral herpes simplex keratitis. Regarding allergies, SCLs already provide a physical barrier to airborne antigens which, combined with a reservoir of antihistamines, could reinvent the treatment of ocular allergic disease. The potential to treat, and even prevent, allergic conjunctivitis is a realistic goal. Indeed, Johnson & Johnson’s ACUVUE Theravision with ketotifen is the first drug delivery lens to go to market. The lens contains an H1 histamine receptor antagonist for the prevention of itchy eyes associated with allergic conjunctivitis experienced by contact lens users to promote comfortable contact lens wear. In March 2021, ACUVUE Theravision with ketotifen received its first regulatory approval from the Japanese Ministry of Health, Labour and Welfare.2 Due to the limited number of approved antifungal medications and the strict dosing regime, fungal keratitis is always a challenge to treat. The development of SCLs can improve treatment, serving as a drug reservoir to continually release drugs into the cornea while limiting drug loss through tear drainage,

blinking, and nonspecific absorption.

The need for further studies A warning should be sounded, though: These technologies are still in their infancy. Only one product, Johnson & Johnson’s Theravision, has received any kind of regulatory approval, from Japan and Canada, respectively — and this is after almost six decades of stop-andstart development. Further research is required to produce stable, effective, and durable treatments — in addition to striving for greater degrees of bioavailability of drugs on the ocular surface. Drug loading can negatively affect soft contact lens properties, causing a reduction in oxygen and ion permeability, poor tensile strength, light transmission issues, stiffness, and low water content. Patients can suffer discomfort and dryness, with even the potential for corneal toxicity in longterm use. The hygiene issues of handling lenses compared to eye drops could introduce pathogens to the eye. Other challenges include burst release protection, protein adherence, drug integrity, durability, and ensuring that drugs retain their potency in storage. Finally, drug-delivering contact lenses appear to be in a legally indeterminate gray area vis-à-vis their status: Are they drugs, medical devices… or both? It’s worthwhile to note that DDSCL technology is precipitating a search for novel ophthalmic materials that will aid in the timely delivery of drugs to the anterior of the eye. A truly emergent field — if the regulators ever decide how to categorize them.

REFERENCES: 1.

Rykowska I, Nowak I, Nowak R. Soft Contact Lenses as Drug Delivery Systems: A Review. Molecules. 2021;26(18):5577.

Medical Product Outsourcing. Available from: https://www.mpo-mag.com/contents/view_ breaking-news/2021-06-23/canada-approvesdrug-releasing-contact-lens-for-eye-allergies/ Accessed on April 27, 2022.

May 2022

ENLIGHTENMENT |

SUSTAINABILITY

The Option to Go Green

TerraCycle offers recycling partnerships for big companies and private practitioners alike by Joseph Schreiber

ontact lens wearers sometimes throw their used contacts in the toilet — and we all know it. According to a national poll by students at Arizona State University, 15% to 20% of lens wearers are guilty of this practice, sending discarded contact lenses into our water system — and potentially into our oceans and even drinking water. And while many brands have begun using sustainable packaging, many have gone the other way and moved into materials that are more complicated to recycle.

Enter TerraCycle, a company that specializes in recycling things that are normally too small or too troublesome for traditional recycling programs to handle. Besides contact lenses, TerraCycle helps individuals and companies (through corporate-sponsored programs) recycle snack bags, pens, shampoo bottles, and even Taco Bell hot sauce packets. “Contact lenses are one of the forgotten waste streams that are often overlooked due to their size and how commonplace they are in today’s society,” said the Founder and CEO of TerraCycle, Tom Szaky.

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Corporations that care Some eye care companies (and products) that partner with TerraCycle include Acuvue® (Acuvue Contact Lens Free Recycling Program1), Bausch + Lomb (Bausch + Lomb ONE by ONE Free Recycling Program2) — both of whom recycle contacts and blister packs, but not boxes since those can be handled by traditional recycling — and Bausch + Lomb’s Biotrue® (Biotrue Eye Care Free Recycling Program3), which recycles all cases, bottles, and packaging.

Furthermore, for every pound of material recycled, these companies donate $1 to Optometry Giving Sight, an international fundraiser that helps provide vision healthcare to people who otherwise can’t afford or don’t have access to it. Be aware, however, that Bausch + Lomb will only partner with eye care professionals. All you have to do is create an account, choose a program, and wait for approval.

Find a program that works for you On the TerraCycle website (terracycle. com), there are several partnership programs: You can sponsor a recycling program, launch a recycling program, or become a public drop-off point, among others. TerraCycle will mail you a Zero Waste Box™ and once it’s full, you simply seal it, print out a free label, and drop it off at a designated courier service. The box will be shipped to local TerraCycle Material Recovery Facilities (MRFs), of which there are 35 worldwide in 21 different countries. Note that there is a notorious waitlist for the corporate programs — this is because many companies have a cap on the resources they want to expend. Hence, getting your own box can be a temporary or supplemental option if you don’t want to wait. So if you’re interested, sign up immediately. As a private practitioner, you can get your own box without the corporate programs, as mentioned above. However, private boxes can be costly, ranging from $86 to $199. You can either get the Zero Waste Box™ for all sorts of eyeglasses for $113, or a box for anything and everything for $199.

TerraCycle offers 100% free shipping for these boxes, and they generally arrive in two to three days. They are also available for nearly any other material you might be interested in recycling.

It’s all about bringing environmental awareness In a press release, Dr. Cleo Yeh from Sigma Eyecare Optometrists in Vancouver, Canada, said: “Having these recycling boxes in our clinic was an easy decision. We are happy to provide recycling options for patients who probably didn’t even realize this was available.” And that’s another point: Many patients don’t know how to recycle these products. Having the box in the clinic raises awareness that they need to dispose of their contact lenses and glasses properly.

How sustainable is it? This isn’t a perfect solution. In fact, a lot of criticisms have been leveled at TerraCycle for a number of reasons. Corporations can end up recycling an almost negligible amount of materials and sign up because they are “greenwashing” — the practice of looking sustainable by making a simple half-hearted gesture like this to claim their company cares. There has also been some criticism of the company’s recycling practices. There are claims that not only are they sometimes not very transparent about exactly where the plastic goes, but tearing apart these items can be complicated — which has been speculated to give off significant carbon emissions on its own.

On their website, TerraCycle states that recycled materials are “sold to manufacturing companies who produce the end product and complete the recycling journey.” These end products may include outdoor furniture and decking, plastic shipping pallets, watering cans, storage containers and bins, tubes for construction applications, flooring tiles, playground surface covers, athletic fields, and more! Another criticism of this program is that it’s arguably “downcycling” — a practice where your plastic will end up degraded with every recycling and still end up in the ground or water someday.

Do your own research Ultimately, TerraCycle may not be offering a perfect solution but it presents a valuable resource for education and recycling, and it’s worth a parking spot in your clinic — if only to keep those contacts out of our oceans and drinking water. However, TerraCycle is just one option for you. It’s still up to you to do your own thorough research to find the recycling programs and options that you personally believe in and that work for your practice.

REFERENCES: 1.

Acuvue Contact Lens Free Recycling Program. Available at: https://www.terracycle.com/en-GB/ brigades/acuvue. Accessed on May 9, 2022.

Bausch + Lomb ONE by ONE Free Recycling Program. Available at: https://www.terracycle. com/en-US/brigades/bauschrecycles. Accessed on May 9, 2022.

Biotrue Eye Care Free Recycling Program. Available at: https://www.terracycle. com/en-US/brigades/ biotrue. Accessed on May 9, 2022.

May 2022

ENLIGHTENMENT |

SUSTAINABILITY

Don’t Flush Your Contacts Educate your patients on how to properly dispose of contact lenses by Elisa DeMartino

Whatever the reason, the hype around going green is here to stay — and it’s a noble undertaking. However, this could be a bit challenging when it comes to daily contacts, which, even when properly disposed of, still end up in landfills along with their blister packs and the rest of our daily plastic waste.

Options beyond contact lenses There’s the obvious solution: Suggest to your patients to switch to glasses. Yet this is far from a perfect fix: Quitting

Explain proper lens disposal.

The responsibility falls on eye care providers to explain proper care and disposal of lenses. Here’s how Dr. Carmen Abesamis-Dichoso — CEO of her practice in Manila and an Asia Pacific Council of Optometry Representative for the World Council of Optometry — explains to her patients why contact lenses should not be flushed down the toilet. “Contact lenses are made of non-biodegradable materials, such as silicone and silicone hydrogels that can stay in the ocean for five decades and won’t break down. So, the way to lessen their bad effect on the environment is to NOT throw them or flush them down the sink [where they’ll] eventually find their way into the oceans and waterways.”

here are various reasons for “going green.” Maybe patients have asked if there are contact lenses with less negative impact on the environment. Or, it could be that your own values drive you to seek out greener options for your practice.

Fortunately, for those who wish to continue the contact lens lifestyle, there are habits that minimize harmful impacts on the planet.

contacts could keep people from taking part in certain activities, like swimming or contact sports. This may even impede their job performance. Meanwhile, many frames are made of acetates derived from non-renewable oil. So, whether or not it will work in the long run really depends on a number of other factors, such as frame longevity, the patient’s willingness to stick to one pair long-term, the environmental practices of the company producing the glasses, and so on. Then there’s also the possibility of laser eye surgery. However, surgery isn’t an option for everyone. It largely depends on the state of their eyes, their financial situation, or simply, personal preference.

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A study done in the U.S. revealed that 21% of people flushed their disposable lenses down the sink or other drain, reported Scientific American. If this is any indication of how many people globally are incorrectly disposing of lenses, it means hundreds of billions of contact lenses end up in our oceans every year. Contact lenses don’t decompose or dissolve in water; they break apart but the pieces of microplastic remain intact. This form of litter isn’t just a problem for the environment but for human life as well. Small fish and plankton mistake microplastics for food. The plastic eventually makes its way up the food chain and into the fish we eat. Microplastics in our diets are ultimately linked to various forms of cancer, reproductive problems, weakened immune system, and more.

Discuss switching to weekly or monthly lens options.

The future of contact lenses So, what’s in store for contact lenses in the future? Will scientists develop a more sustainable lens that’s biodegradable?

It’s not just the lenses themselves to think about, but the impact of their packaging, too. By offering patients weekly or monthly lenses, they’ll only go through a fraction of the blister packs that daily lens wearers use, which are too small to go into regular recycling and typically end up in the trash.

In 2019, Latin America-based Telesur News reported that scientists at the National Autonomous University of Mexico were working on a biodegradable lens that releases medicine to treat eye disease as it dissolves. Biodegradable packaging might be an even sooner and simpler way to minimize environmental impact.

However, for some, reusable lenses aren’t an option. Their lifestyle doesn’t allow them the time or freedom to maintain the lenses as needed. If they’re not kept clean, weekly and monthly lenses can pose health risks to the eyes. produced by the partnered companies. Regardless, whichever type of lens they use will result in plastic waste, which, according to the World Wildlife Fund’s “Lifecycle of Plastics” can take up to 500 years to break down in landfills. If patients aren’t a good candidate for non-daily lenses, what can they do instead to reduce their waste?

Consider recycling opportunities.

As society’s concern for the environment grows, unique recycling programs across the world have surfaced for hard-to-recycle materials. One such program is TerraCycle, a global recycling company founded in the U.S. that operates in 20 countries in Europe, Asia-Pacific, and the Americas. TerraCycle has partnered with both ACUVUE and Bausch + Lomb to offer free drop-off points for blister packs, foil covers, and contact lenses. Lens wearers can recycle through TerraCycle even if their lenses aren’t

Dr. Abesamis-Dichoso makes use of a similar alternative at her practice in the Philippines via contact lens manufacturer CooperVision. “CooperVision has a very good program on environmental sustainability,” she shared. “They partnered with a company called Plastic Bank, which builds ethical recycling ecosystems in communities to be able to reprocess the materials and reuse plastic waste equivalent to the weight of one box of their disposable contacts.” Depending on the region, these solutions may be available for your patients — or there might be similar opportunities with recycling programs local to you. For instance, Capital Optical, a chain contact lens store in Singapore, has its own local recycling program for blister packs and foil covers. Wherever your practice might be located, chances are, there are some ways to give patients the option of recycling.

Perhaps, as procedures get more advanced, the sustainability of contact lenses will become a moot point with no one needing to wear them at all! In the meantime, however, the best we can do is watch out for the future of the earth by remaining mindful of our waste in the present.

Contributing Doctor Dr. Carmen Abesamis-Dichoso received her Doctor of Optometry from the Central Colleges of the Philippines in 1989, and earned her Master of Arts in Teaching from the Central Colleges of the Philippines in 2001. Her specialties include special contact lens design for keratoconus, children and high astigmatism; and visual assessment of the mentally challenged, autistic, ADHD, cerebral palsy and learning disabilities. In addition, Dr. Abesamis-Dichoso has been an orthokeratology practitioner in the Philippines since 2005. Since 1998, she has been self-employed in a private practice at Medical Plaza Makati. carmen.dichoso@gmail.com

May 2022

ENLIGHTENMENT |

MYOPIA

A Pandemic Within a Pandemic? Myopia is on the rise during COVID-19

ll work and no play (or at least no play outdoors) not only makes Jack a dull boy… it could be contributing to an increase in myopia. In the last couple of years, more children stayed indoors (and on screens) as a result of the COVID-19 lockdowns and social distancing. And just like how less time spent outdoors can contribute to childhood myopia, spending more time outside can help to lower the risk of developing myopia, as well as delay its progression. This topic, along with several other findings on myopia, was discussed during a session on the final day of the

recently held 5th meeting of the ASEAN Ophthalmology Society (AOS Virtual 2022).

Myopia and the COVID-19 pandemic In the post-COVID-19 era, increased near-vision work and decreased outdoor time may increase [the number of] myopic children, said Dr. Saiko Matsumura from Toho University School of Medicine, Japan. A study on the impact of COVID-19 on Chinese children aged seven to 18 showed how the lockdown in China

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by Hazlin Hassan

changed the children’s lifestyle and myopia progression. There was an increase in screen time and a decrease in outdoor time compared to before COVID-19, and the progression of myopia also increased in all age groups after COVID-19. This was especially marked in the younger age group aged seven to 12. Even before COVID-19, myopia was already considered at risk of becoming a pandemic. “To make matters worse, with decreased outdoor time and increased myopia in this COVID-19 situation, the age of onset of myopia may become

younger and more children will require treatment,” Dr. Matsumura warned. It has been a big challenge to detect the children at higher risk of future myopia progression. Risk factors for subsequent myopia progression include younger age (at baseline), greater myopic SE (at baseline), parental myopia, age of myopia onset, and faster myopia progression in the previous year.

“To make matters worse, with decreased outdoor time and increased myopia in this COVID-19 situation, the age of onset of myopia may become younger and more children will require treatment.” — Dr. Saiko Matsumura Toho University School of Medicine, Japan In general, children with slower previous progression are at lower risk of future fast myopia progression. In summary, myopia is increasing among children in urban areas of East Asia. Increased near-work, decreased outdoor time, and parental myopia are established risk factors for myopia.

the Myopia Treatment and Prevention Center, Kaohsiung Chang Gung Memorial Hospital, Taiwan. “We encouraged children to go outside during their recess time and increased their outdoor time to 80 minutes per day,” he explained. This resulted in a significant decrease in new-onset myopia and a significant decrease in the myopic shift. The regime was especially effective in non-myopic children. In another school-based randomized trial, researchers saw a 54% lower risk of rapid myopia progression among children who spent 11 hours or more outdoors a week. This was achieved even with moderate light intensities such as in hallways or under a tree. As such, it appears that outdoor activities with strong sunlight exposure may not be necessary for myopia prevention. Relatively lower outdoor light intensity activity with longer time outdoors can be considered. Another study on the dose-response relationship between outdoor exposure and myopia indicators showed that daily outdoor light exposure of more than 120 minutes was the most effective intervention.

to seven-year-old children in China increased four times (5% versus 25%). In Hong Kong, myopia prevalence among the same age group increased 2.5 times. Home confinement may have worsened the burden of myopia, owing to substantially decreased time spent outdoors and increased screen time at home. To conclude, children are encouraged to perform outdoor activities for around two to three hours a day for myopia intervention, and moderate sunlight exposure is suggested. It seems that more (outdoor) play for Jack could very well be just what the doctor ordered when it comes to myopia.

Editor’s Note: The 5th AOS Congress was held virtually on March 2627, 2022. Reporting for this story took place during the event.

During the COVID-19 pandemic in 2020, myopia prevalence among six-

While the effect of screen time has not been established as of yet, in the postCOVID-19 era, increased near-vision work time and decreased outdoor time may increase myopic children. Past myopia progressions are moderately predictive but not adequate as a standalone indicator of whether to treat or not.

More playtime for Jack An outdoor classroom program in Taiwan has shown a significant decrease in new-onset myopia and myopic shift. The Recess Outside Classroom (ROC) program, the first using education policy intervention in myopia, found that outdoor activities during class recess in school have a significant effect on myopia onset and myopic shift, said Dr. Pei Chang Wu, director of

May 2022

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