Reducing the Carbon Footprint of Neovascular Age–Related Macular Degeneration Therapy: Environmental Impact of Transitioning to Aflibercept 8 mg

Purpose: To quantify and compare the carbon footprint associated with neovascular age–related macular degeneration (nAMD) treatment using real-world intravitreal aflibercept 2-mg injections versus a simulated aflibercept 8-mg regimen with extended dosing intervals. Methods: A life cycle assessment (LCA) combining process-based and input–output methodologies was conducted using real patient data from a tertiary ophthalmic center. The analysis included 101 patients treated with aflibercept 2 mg and modeled the environmental impact of transitioning to aflibercept 8 mg. The simulated aflibercept 8-mg cohort was generated by replicating the demographic and logistical characteristics of the real-world aflibercept 2-mg population while applying extended dosing intervals. Emissions were estimated in CO2 equivalents (CO2e) and included drug manufacturing, clinical materials, patient transportation, energy use, and waste disposal. Emission factors were derived from Defra and ecoinvent databases. Results: Patients treated with aflibercept 2 mg generated an average carbon footprint of 1150 kg CO2e per treatment cycle (2 years), compared to 746 kg CO2e for those modeled to receive aflibercept 8 mg. This corresponds to an absolute reduction of 404 kg CO2e and a relative reduction of 35%. The main driver of emissions was pharmaceutical procurement, followed by patient transportation. The lower injection frequency enabled by aflibercept 8 mg significantly reduced both sources of emission. Conclusions: A transition from conventional aflibercept 2-mg therapy to an aflibercept 8-mg regimen with extended dosing intervals reduces the treatment’s carbon footprint by over one-third. These findings support the integration of environmental considerations into therapeutic decisions in ophthalmology, particularly for high-frequency procedures, such as intravitreal injections.