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The aim of this study is to quantify the difference in the carbon emissions from factory gate to patient between aflibercept 2\u2009mg pre-filled syringe (PFS) and aflibercept 8\u2009mg PFS when used over the first 2 years in treatment-na\u00efve patients with nAMD in the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The carbon footprint per injection was calculated by adding carbon emissions\u2014obtained from internal corporate and published data\u2014for packaging creation, transport, patient travel and waste disposal for each product. Results were extrapolated to a UK population using an estimate of the number of injections from real-world evidence and\/or clinical trial data and the published incidence of nAMD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between factory and patient, the carbon emissions for aflibercept 2\u2009mg PFS are approximately 2.3\u2009kg CO\n                      <jats:sub>2<\/jats:sub>\n                      per injection, compared with 2.1\u2009kg CO\n                      <jats:sub>2<\/jats:sub>\n                      for aflibercept 8\u2009mg PFS. Using aflibercept 8\u2009mg PFS instead of aflibercept 2\u2009mg PFS for treatment-na\u00efve patients with nAMD in the UK would result in ~68,000\u2013272,000 fewer hospital visits over the first 2 years and decrease emissions by ~277,000\u2013736,000\u2009kg CO\n                      <jats:sub>2<\/jats:sub>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Using aflibercept 8\u2009mg PFS instead of aflibercept 2\u2009mg PFS in treatment-na\u00efve patients with nAMD has benefits for the environment and National Health Service (NHS) capacity and would therefore help meet NHS sustainability goals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41433-025-04020-9","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T08:57:20Z","timestamp":1759741040000},"page":"3160-3166","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sustainability in medical retina: the environmental impact of using aflibercept 8\u2009mg instead of aflibercept 2\u2009mg in treatment-na\u00efve patients with nAMD"],"prefix":"10.1038","volume":"39","author":[{"given":"Neil","family":"Bowley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sobha","family":"Sivaprasad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M. 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Based on the current text, this calculation looks erroneous, therefore making the environmental impact appear falsified.","order":8,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 July 2026","order":9,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":10,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":11,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1038\/s41433-026-04663-2","URL":"https:\/\/doi.org\/10.1038\/s41433-026-04663-2","order":12,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"NB has received financial support from Alimera Sciences, Allergan, Bayer, Roche and Th\u00e9a Pharmaceuticals. PT is co-founder and CEO of Cascader Ltd and has received financial support from Bayer and Haag-Streit. SS has received direct financial payment for attending advisory boards for AbbVie, Alimera Sciences, Amgen, Apellis, Astellas, Bayer, Biogen, Boehringer Ingelheim, Clearside Biomedical, Eyebiotech, EyePoint Pharmaceuticals, Iveric Bio, Janssen Pharmaceuticals, Kriya Therapeutics, Novo Nordisk, Ocular Therapeutix, OcuTerra, Optos, Ripple Therapeutics, Roche, Sanofi and Stealth BioTherapeutics; and has received travel and research grants from AbbVie, Apellis, Astellas, Bayer, Boehringer Ingelheim, Novo Nordisk and Roche. She is also the Editor-in-Chief of\n                      Eye\n                      . RMJP has received educational grants for conference attendance from Bayer and Roche, and payment for attending advisory boards for Roche. EB, RG, AC and TC are employees of Bayer plc, UK.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}