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Sustainability in eye care

Background

The United Nations (UN) World Commission on Environment and Development defines environmental sustainability as “development that meets the needs of the present without compromising the ability of future generations to meet their own needs” [1].

The UN has set 17 goals to achieve a better and more sustainable future for all [2]. The goals link to wider environmental sustainability actions. These include:

  • zero hunger: Waste less food and support local farmers
  • clean water and sanitation: Avoid wasting water
  • affordable and clean energy: Use only energy-efficient appliances and light bulbs
  • sustainable cities and communities: Bike, walk or use public transportation
  • responsible consumption and production: Recycle paper, plastic, glass and aluminium
  • climate action: Act now to stop global warming
  • life below water: Avoid plastic bags to keep the oceans clean
  • life on land: Plant a tree and help protect the environment

Our position

The College of Optometrists believes that every individual and organisation should be taking action to advance environmental sustainability. We all need to protect our environment and the planet’s natural resources, and support our social and economic networks. Climate change disproportionately impacts marginalised and vulnerable communities, so environmental sustainability helps to ensure that everyone on the planet can have a good quality, healthy life. 

We believe that all optometrists should have sustainability front of mind and use this to guide their choices and actions: as individuals, health professionals and employers or business owners. We recognise that patients and the wider general public have a growing interest in sustainability and how optometrists are minimising their environmental impact. The UK’s national health services and governments also expect health providers and professionals to take more sustainable steps [3-6]. This means that optometrists and colleagues will be increasingly asked by patients, commissioners and regulators to demonstrate how they are providing more sustainable services and care.

As the UK’s professional body for optometry, the College is also committed to taking action to reduce our own impact on the environment and improve sustainability. 

The World Health Organization has stated that climate change affects the social and environmental determinants of health [7] and the Lancet Commission on Global Eye Health has identified eye health as essential to achieving the UN’s Sustainable Development Goals [8].  The Lancet Commission states that global health care is estimated to contribute to approximately 5% of all greenhouse gas emissions. As eye care is a high volume health service, it is a substantial contributor to health care greenhouse gas emissions and its contribution is likely to rise with ageing populations [8]. 

The European Council of Optometry and Optics (ECOO) summarises these relationships [9] as follows:

  • climate change is likely to increase the incidence of some eye diseases such as trachoma infections, vitamin A deficiency, cataracts, severe allergic eye disease, glaucoma and eye injuries
  • in some places delivery of eye care will be affected because of the increased frequency of extreme weather events
  • healthcare is a major consumer of resources and emitter of greenhouse gas emissions
  • the optical business model is predicated on promoting consumption of goods – encouraging patients to regularly replace their spectacles, with all the consequences that has in terms of manufacturing, packaging, use of resources and waste management
  • plastic waste is a particular problem in the optical sector – eg packaging, dummy lenses, old frames and lenses and contact lenses

Primary and secondary eye care also contribute to carbon levels via manufacturing, energy use and patient travel. 

One study by the Centre for Sustainable Healthcare has estimated the average carbon footprint of an individual NHS sight test is 5.27 kg of carbon dioxide equivalent1 [10]. The sight test greenhouse gas emissions were broken down as 69% from travel, 14% from energy, 11% from procurement, 5% from waste and 1% from water. If this estimate is applied to the UK as a whole, with over 15 million nationally-funded sight tests carried out across the UK each year, this would add up to over 79,000 tonnes of carbon dioxide equivalent from nationally-funded sight tests alone. 

Similarly, a study in 2013 estimated that a single cataract operation in the UK generated 181.8kg of carbon dioxide equivalent [11]. Building and energy use accounted for 36%, procurement 54% (of which medical equipment accounted for 33%) and travel 10%.  While both of these studies are small and the evidence base in eye care is limited, they indicate the potential impact of eye care on greenhouse gas emissions.

The benefits of sight tests and other eye care interventions are crucial to improving vision, eye health and wider health outcomes for individuals, however it is still important to minimise as much as possible the environmental impact of care – without compromising patient safety, quality of care or patient outcomes.

1 A carbon dioxide equivalent (CO₂e) is a measure that is used to standardise the climate effects of different greenhouse gases.

Successful sustainability stems from individuals and organisations making consistent, modest changes that they can maintain over time, and building on these once the changes become embedded. There are steps we can all take, and can encourage patients and colleagues to take, that combined can make a difference. We know that environmental consciousness is becoming more widespread and will inform patient behaviour and choices. Having a strong commitment to sustainability could help set primary eye care practices and secondary eye care providers apart.

Initiatives have recently been launched that seek to reduce single-use or non-degradable plastics in optometry, and to promote recycling and carbon-neutral healthcare. However, there is a still a lot more that can be done to improve the sustainable use of materials, increase opportunities for recycling and promoting becoming carbon neutral. 

The College supports the Association of British Dispensing Opticians’ (ABDO) sector-wide social, environmental and ethical (SEE) initiative [12], which brings together key optical bodies representing practitioners, practice owners and suppliers to support the profession and sector in working towards long term sustainability goals.  Alongside other optical bodies, we have released a joint statement of intent on the environment [13]. ABDO’s SEE hub provides many useful resources, including a sustainability self-assessment tool, case studies and further resources and guidance from other bodies.

The International Agency for the Prevention of Blindness (IAPB) has produced a guide to support environmentally sustainable practices in eye health [14]. Optometrists and colleagues in eye care can also join networks such as the Eye Health Sustainability Network [15] to share ideas and access resources on sustainable eye care.

The College is taking ongoing steps to improve our own sustainability, including making the Guidance for Professional Practice and our patient leaflets available digitally, replacing bags of paper fliers at our annual conference with a virtual platform and reducing the number of envelopes we use.  We have refurbished our offices and brought in multiple new energy-saving initiatives, including a paper-free office, energy saving bulbs, energy efficient heating, lights in some common areas that turn off when the room is not in use and increased recycling and food waste facilities. Secure bicycle parking spaces have been provided as well as a shower with clothes drying facilities, to promote more sustainable methods of travel. 

We are also encouraging staff to take more sustainable actions such as turning off computers and monitors at the end of the day, turning off room lights, choosing digital over paper, reducing the amount of printing and post sent and increasing their recycling and food composting.  A section on environmental sustainability has been added to Board and Council papers to ensure that it is considered when both bodies make decisions.  We have moved to hybrid working and a preference for virtual meetings, to reduce travel, and encourage staff and members to use public transport.

We are committed to raising awareness of the importance of environmental sustainability among our members, through providing information via our Acuity journal and signposting to sector-wide initiatives such as SEE and other useful links.   

Sustainable practice should be central to professional education and research at all levels, and we would encourage researchers, students and supervisors to consider, where feasible, exploring work that relates to sustainability in eye health and optometry, including solutions to addressing challenges such as plastic waste. The College of Optometrists encourages optometry-related researchers and students to consider and contribute to the vital objectives of the 1 in 5 Project [16].

Optometry higher education providers should inspire undergraduates and postgraduates to consider how they can address the UN’s Sustainable Development Goals whilst maintaining high patient safety [17]. New registrants should be equipped with the knowledge and skills to generate and inspire innovative solutions to these challenges and existing registrants given access to CPD and other sources of learning to increase their understanding and skills.

Recommendations

Based on our position, we have made the following recommendations:

  • National and local eye care policy-makers and commissioners should work with professional bodies and optometrists to develop actions to improve and support the sustainability of nationally provided services in primary and secondary eye care, including commissioning care closer to where patients live.
  • Policy-makers, commissioners and professional bodies should collaborate to raise awareness of sustainability in eye care, including by signposting to training, by providing links to national/local sustainable services such as recycling initiatives and alternative (lower carbon) procurement and by supporting public transport.
  • Spectacle and contact lens recycling points should be set up in local areas. 
  • The optometry industry should be encouraged to measure and reduce the carbon emissions of their products and packaging.
  • Industry should also be encouraged to use or develop recyclable or compostable products and packaging, and eliminate single-use plastics where possible.
  • Sustainable delivery methods should be prioritised and used. 
  • Eye care providers are encouraged to use a sustainability self-assessment tool and to measure their carbon footprint, or use existing data to estimate their carbon footprint. 
  • Providers should assess their energy usage and energy efficiency and put in place measures to reduce energy use.
  • More sustainable procurement and deliveries should be prioritised, including considering purchasing repurposed equipment
  • Providers should consider repairing and reusing equipment before recycling, and avoiding the use of landfill.
  • Where possible, providers should prioritise the use of digital technologies and reduce use of paper.
  • Providers should encourage staff to recycle, reduce water waste and use reusable cups, cutlery, plates etc.
  • Staff should also be encouraged to use public transport, cycle, walk or lift-share
  • Providers should clearly explain to patients what environmental actions they are taking and why, provide products that are more environmentally sustainable and encourage patients to use them.
  • Relevant local or national recycling schemes should be signposted to patients (for spectacles, contact lenses and bottles).
  • Providers should encourage patients to use public transport, cycle or walk to attend appointments.
  • Optometrists should reduce their personal use of water, energy, single-use plastics and paper while at work, and increase their recycling and reuse activities, where possible.
  • Patients should be given information about the safe disposal of contact lenses and local contact lens, spectacle and plastics recycling facilities.
  • Optometrists should consider how they can use sustainable forms of transport to their places of work, for example using public transport, cycling, walking or lift sharing.
  • Optometrists should also consider becoming environmental sustainability champions in their workplaces, to support initiatives and encourage employers and colleagues to get involved.
  • Higher education providers should inspire undergraduate and postgraduate students to consider how they can address the UN’s Sustainable Development Goals whilst maintaining patient safety.
  • The understanding of and ability to address the UN’s Sustainable Development Goals through safe and effective clinical practice should be integrated, where appropriate, into all learning activities.
  • Students and registrant learners should be supported to understand the complex interlocking relationships that contribute to good eye health and climate change, in order to make informed decisions as health professionals.
  • Optometry and vision sciences researchers and students should consider and contribute to the objectives of the 1 in 5 Project.
  1. Thomsen, C. (2013). Sustainability (World Commission on Environment and Development Definition). In: Idowu, S.O., Capaldi, N., Zu, L., Gupta, A.D. (eds) Encyclopedia of Corporate Social Responsibility. Springer, Berlin, Heidelberg. 1
  2. United Nations (2015) Sustainable Development Goals
  3. HSCNI
  4. NHS England
  5. NHS Scotland
  6. NHS Wales
  7. World Health Organisation (2012) Social and environmental determinants of health and health inequalities in Europe: fact sheet
  8. The Lancet Global Health (2021) The Lancet Global Health Commission on Global Eye Health: vision beyond 2020
  9. European Council of Optometry and Optics (2023) Guidance: Environmental Sustainability
  10. The Centre for Sustainable Healthcare (2022) The Annual Carbon Footprint of NHS Sight Tests at Five Optometry Practices 
  11. Morris DS, et al. (2013) The carbon footprint of cataract surgery. Eye. 27:495–501
  12. Association of British Dispensing Opticians, Social, Ethical and Environmental Hub
  13. The College of Optometrists (2022) Optical bodies collaborate to release statement of intent on the environment
  14. International Agency for the Prevention of Blindness (2020) Guide for environmentally sustainable practices in the eye health sector 
  15. Eye Health Sustainability Network 
  16. 1 in 5 Project 
  17. Subject Benchmark Statement Optometry, April 2024

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