Reducing optometry's environmental footprint would reduce greenhouse gas emissions. Photo: Marcin Jozwiak on Unsplash.

Despite a proven connection between health and greenhouse gas emissions, little research has been done on the environmental impacts and sustainability of eyecare delivery. In a recent review, authors sought to establish the environmental costs of providing these services, identify interventions to diminish any adverse effects and identify key sustainability themes.

The team identified 16 studies that estimated the environmental footprint of eyecare services, only one of which included an intervention to diminish environmental damage. The authors noted there is an urgent need for more research in this area, which should include quantifying emissions from a broader range of eyecare services and expanding analyses to include environmental consequences beyond greenhouse gas emissions.

“Despite a paucity of research evidence, there is a need for the measurement of environmental impacts associated with eye care to be standardized along with the methodological tools to assess these impacts,” the authors explained in their paper for The Lancet. “The vastly different environmental costs of delivering clinical services with similar clinical outcomes in different regulatory settings is striking.”

In one example, a phacoemulsification cataract extraction in a UK hospital produced more than 20-times the greenhouse gas emission of the same procedure in a hospital based in India.

“Where comparable outcomes can be delivered at reduced environmental costs, an opportunity exists for the migration of practice; convenient lifecycle assessment tools such as the Eyefficiency App permit the evaluation and cyclical audit of the carbon footprint of cataract surgical services,” the authors explained. However, they also attributed the large difference between the India and UK cataract services to the policies in high-income countries that prevent the adoption of sustainable practices.

“Because of these policies, full realization of the potential gains will require changes to the regulatory environment and a change of culture, such that any incremental improvements suggested for safety or better outcomes (i.e., the introduction of laser-assisted cataract surgery), be measured against both the financial and environmental costs required to achieve those gains,” the authors noted.

They also suggested a change in thinking regarding patient safety, as well as considering the reuse of eye drops. If reusing was permitted, resources would be saved both financially and environmentally and could be diverted to purchase quality-adjusted life-years elsewhere to protect the environment.

“A truly evidence-based approach to clinical safety that considers environmental impacts is clearly necessary if we are to move to a position in global health where high-income countries do not enforce practices that would be unsustainable if done globally,” the authors concluded.

Buchan JC, Thiel CL, Steyn A, et al. Addressing the environmental sustainability of eye healthcare delivery: a scoping review. Lancet. 2022;6(6):e524-34.