Importance: Ophthalmology faces imperatives to improve sustainability, but there is uncertainty about how to respond. Background: We sought New Zealand ophthalmologists' opinions on climate change, sustainability and the role of ophthalmologists in responding to these issues, as well as information on the extent that ophthalmology practices are acting on sustainability.Design: Anonymous online survey of New Zealand fellows and trainees (178) of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) was conducted. Participants: Forty-seven respondents (response rate 26%) were included in the study. Methods: Respondents were asked their level of agreement with statements on climate, health and sustainability and invited to comment. Current sustainability activities were collected from clinical leaders and directors of hospital departments and private practices.Main Outcome Measure: Distribution of agreement scores was the main outcome measure.Results: Agreement with mainstream positions on climate change was as expected. A minority of up to 19% expressed the opinion that climate change was not due to human activity, and did not require mitigation. Younger ophthalmologists tended to have greater agreement with the need for broad-based political action on climate mitigation than those aged over 50 years. Most practices had room to improve on reducing waste, travel and carbon footprints. Conclusions andRelevance: The majority of New Zealand ophthalmologists are concerned about anthropogenic climate change. Currently, sustainability is not a performance indicator for New Zealand district health boards, so there is limited incentive to drive improvements. These data form a reference point to compare future opinions and ophthalmology carbon footprinting. K E Y W O R D S carbon footprint, climate change, greenhouse gas, ophthalmologist, sustainability, waste

As the imperative to decarbonize the health sector grows more urgent, ophthalmologists are called to reduce low-value care and minimise carbon emissions of procedures. 1 There is a strong appetite amongst ophthalmologists in Australia, New Zealand and the United States for options to do this. 1,2 Intravitreal injections (IVI) are now the most common procedure in ophthalmology, performed in our cities at a rate of at least 15 000 injections per million people each year (unpublished observations).We estimated the carbon footprint of 226 IVI at four public injection-only clinics in the Wellington region, and quantified the disposable materials used by injectors across New Zealand. Our methods were based on a recent cataract surgery footprinting project, using the same emissions coefficients from New Zealand and United Kingdom.

Clinically relevant examples are needed to support knowledge application of Immunology teaching content within undergraduate Medical Sciences Education frameworks. The appropriate contextualisation of these Immunology teaching examples is essential, particularly when presenting health related issues that are of significance and relevance to Māori and Pacific population groups living in New Zealand (NZ) and the Pacific Region. Acute Rheumatic Fever (ARF) is an autoimmune condition that results from untreated Group A Streptococcal (GAS) infection of the throat (and skin). Repeated or severe episodes of ARF that remain untreated can lead to Rheumatic Heart Disease (RHD) or permanent heart damage. Māori, Pacific and Indigenous Aboriginal population groups are affected disproportionately by ARF and RHD. This work involved Immunologically related ARF and RHD teaching examples were presented to 4th year undergraduate Medical Science Education students that were contextualized, and relevant to current health priorities for Māori and Pacific population groups. Sound understanding was demonstrated by students participating in these classes. Strong interest in Immunologically related ARF/RHD research and teaching examples with positive feedback expressed by students within written and verbal teaching feedback platforms. A subset of students were motivated to undertake research placements to contribute to the NZ based ARF and RHD related Penicillin reformulation work. Overall, the contextualisation of the Immunologically related ARF/RHD research and teaching examples supported knowledge application and helped raise awareness of health issues for Māori and Pacific population groups living in NZ and the Pacific Region.