Unequal eye care practices threaten sustainability across health care, study finds

Health care services are substantial contributors to national greenhouse gas emission totals, representing 10% in the USA, 7% in Australia, 5% in Canada and Japan, and 4% in the UK.

Eye care, as a high-volume service, likely forms a substantial part of these emissions. For example, in the UK, ophthalmology is the highest volume speciality, accounting for 8·1% of hospital outpatient visits nationally in 2018–19. Globally, the demand for eye care is increasing, and there is therefore a need for these new services to be environmentally sustainable.

A new study, led by the International Centre for Eye Health (ICEH) at the London School of Hygiene & Tropical Medicine (LSHTM) has summarised the data available on sustainable practices within eye care.

Using a comprehensive search strategy to identify any relevant research , this study was carried out as part of the Lancet Global Health Commission on Global Eye Health. The 16 peer-reviewed articles found were analysed with the aim of describing the environmental costs of delivering eye care services, identifying interventions to diminish the environmental impact of eye care, and identifying key sustainability themes that are not yet being addressed.

The main finding was the vastly unequal environmental cost of delivering clinical services in different regulatory settings, despite similar clinical outcomes. For example, a phacoemulsification cataract extraction in a UK hospital produced more than 20 times the greenhouse gas emission of the same procedure in an Indian hospital. Both surgeries however have excellent outcomes for patients, implying that guidelines in high-income countries are unnecessarily wasteful for limited improvement on patient safety.

The authors note that it is extremely hard to quantify the health risk to individuals due to specific environmental activities, but this may often outweigh a small gain in patient safety or quality of life due to an unsustainable practice. Furthermore, researchers in high-income countries could struggle to obtain ethical committee approval to trial sustainable interventions that contradict existing policies. Real-world evidence instead needs to be generated in low and middle-income countries (LMICs).

The paper also highlighted the paucity of research in the area, despite the clear and growing environmental impact of eye care services globally. Very little data was available from the eye-care sector that quantified the environmental impact of services, and few studies exist that designed, trialled, and implemented interventions to reduce this impact. In fact, no significant interventional studies were found. This lack of evidence in turn leads to a lack of incentive for policy change in the area.

In order to combat this shortcoming in the area, the authors recommend:

• Generating robust evidence to assess the impact of eye care services on the environment and set relevant goals to reduce it
• Including environmental impact when developing safety policy
• Using Life Cycle Assessment tools (that quantify the emissions of a process across its whole lifecycle) to assess the carbon footprint of the most common eye care treatment: cataract surgery
• Enabling researchers from LMICs to share learning from safe yet resource-efficient practices in their countries

The buying power of a large speciality such as ophthalmology gives it the opportunity to have an impact across health care, encouraging sustainable manufacturing, packaging, and energy supplies. With sufficient research and planning, the eye care sector will be able to contribute to the improvement of our planet.

Publication

Buchan C, Thiel CL, Steyn A, Somner J, Venkatesh R, Burton MJ, Ramke J. Addressing the environmental sustainability of eye health-care delivery: a scoping review. Lancet Planetary Health. June 2022. https://doi.org/10.1016/S2542-5196(22)00074-2

Image on top: pre op examination Fuyang region China by Aeesha