Addressing the environmental sustainability of eye health-care delivery: a scoping review
Scoping review of 16 peer-reviewed articles published since 2009 (eight date from 2020 or later) to establish the nature and extent of the literature describing the environmental costs of delivering eyecare services, identify interventions to diminish the environmental impact of eyecare, and identify key sustainability themes that are not yet being addressed. Only one of reviewed articles trialed an intervention to diminish environmental damage. The single interventional study in this review, although conducted in an ophthalmic theatre, is really an anesthetic study. Beyond the low engagement with the issue of climate change by the international research community, the other finding of this review is the difference between the carbon footprint of similar services delivered in different settings: one phacoemulsification in the U.K. produces more than 20 times the greenhouse gas emissions of one phacoemulsification in India, with both having excellent clinical outcomes. Summarizing, there is an urgent need for more research in this area, which should include quantifying emissions from a broader range of eyecare services and activities and expanding analyses to include environmental consequences beyond greenhouse gas emissions.