Finally, even staunch sceptics are coming around to recognising that climate change is real and that we should do something about it. But how proximal the threat is and at what pace change has to happen is not universally agreed upon. States have, in the past, reneged on their original international commitment to climate action on the basis that it did not suit their country’s interests. It goes to show one thing: not everyone sees this matter the same way.
Let us take the case of the NHS. It employs 1.3 million people in the UK and contributes to about 5% of the UK fossil fuel emissions. It is one of the largest landowners in the country and carries a considerable sway in the way their physical spaces are maintained.
The NHS has pledged to reach carbon net zero by 2040. This is for emissions that it directly controls (The NHS Carbon Footprint). The ambition is to achieve 80% by 2028–2032. For the emissions that it can influence (our NHS Carbon Footprint Plus), NHS aims to reach net zero by 2045, with an ambition to reduce to 80% by 2036–2039. There is a plethora of ways by which it sets about to achieve that target.
Is the duty towards sustainability individual or corporate?
NHS organisations have a corporate social responsibility to support in the delivery of sustainable healthcare. The installation of solar panels, electronic medical records and better waste handling are some of the ways by which the progress is being made.
There is considerable clinical input from staff on many of these initiatives, but the question remains as to how much responsibility is assigned to an individual working for the NHS as opposed to the responsibility of the organisation. The General Medical Council (GMC) that sets the professional standards for doctors in the UK, has included this new duty in their latest version of Good Medical Practice (2024):
15. You should choose sustainable solutions when you’re able to, provided these don’t compromise care standards. You should consider supporting initiatives to reduce the environmental impact of healthcare.
The words to take note of are “should choose” and “when you’re able to”. Good Medical Practice uses the words ‘should’ and ‘must’ in the following ways. ‘Must’ is an absolute requirement and must be complied with regardless. For standards where a doctor may have to perform different to expectations in some settings due to factors outside of their control, the wording is ‘should’. After all, sustainability is delivered by a greater corporate responsibility and an individual doctor cannot be taken to task for failing to practice using sustainable solutions and certainly not all of the time, another instance where the word ‘should’ be used in place of ‘must’. GMC’s primary concern is to protect patients and has asked for sustainable solutions to be offered only if patients’ care is not compromised. This puts sustainability in its place when considering priorities. What is a lot harder to reason is why a doctor “should consider supporting initiatives” rather than simply supporting them.
There are currently four domains of Good Medical Practice. UK Alliance on Climate Change had called for a fifth domain on sustainability to be introduced in the guidelines. They believe that it is an ethical and moral duty of doctors to play their part in averting a global humanitarian disaster. There is a good chance that the next update of the guidelines, due in a few years’ time, will place more responsibilities on the doctor in this regard.
Why sustainability in ophthalmology matters
Ophthalmology, while a relatively niche field, is not immune to the global drive towards sustainability. The use of disposable instruments, single-use devices, energy consumption in diagnostic equipment, and pharmaceutical waste all contribute to the environmental footprint of eyecare.
Sustainability is not just about reducing waste; it is about improving the overall impact of ophthalmology on both human health and the planet. Climate change is known to exacerbate several eye conditions. Cataracts develop more rapidly due to increased UV light exposure and the risks of developing severe allergic eye diseases, glaucoma, age-related macular degeneration; infections such as trachoma, vitamin A deficiencies, dry eye syndromes; and ocular injuries are all expected to rise with an increase in global warming. These conditions affect the quality of life on an individual level and increase the burden on healthcare systems. By embracing eco-friendly practices, ophthalmologists can provide high-quality care while mitigating environmental harm.
Key areas for sustainability in ophthalmology
1. Sustainable surgical practices
Ophthalmology includes a range of surgical procedures, many of which involve the use of disposable instruments and single-use plastics. Cataract surgeries, the most common ophthalmic surgery, rely on disposable surgical tools, drapes, and packaging. While these materials are often necessary to maintain sterile environments and ensure patient safety, they contribute significantly to waste generation. Efforts to reduce surgical waste include:
- Reprocessing medical devices: Some surgical tools, such as certain types of lenses and implants, can be reprocessed and reused safely, provided they meet the regulatory standards.
- Minimising single-use plastics: The ophthalmic community can explore alternatives to single-use plastic devices by opting for reusable surgical instruments and packaging made from biodegradable or recyclable materials.
- Optimising sterilisation practices: Innovations in sterilisation methods can reduce the need for single-use items, especially in environments like operating rooms.
2. Greener diagnostic equipment
Diagnostic equipment, such as fundus cameras, optical coherence tomography, and visual field testers, are energy-intensive and produce significant waste in the form of electronic waste (e-waste) when they are discarded. The carbon footprint of storing and processing data is around 10kg of carbon-dioxide equivalents a year for 1TB of data storage. Steps toward sustainability include:
- Energy-efficient devices: Manufacturers are increasingly designing ophthalmic equipment that consumes less power while maintaining performance. Transitioning to low-energy alternatives can reduce overall carbon emissions.
- Extended equipment lifespan: Ensuring that equipment is well-maintained and repaired rather than prematurely replaced can reduce e-waste and the demand for raw materials used in electronics manufacturing.
3. Eco-friendly pharmaceuticals
Many of the medications used in ophthalmology, such as eye drops, ointments, and injectables, come in single-use packaging that contributes to waste. Additionally, some medications may have a significant environmental impact due to the chemical ingredients they contain. Sustainable approaches can include:
- Reducing packaging waste: Pharmaceutical companies can design smaller, more efficient packaging and eliminate unnecessary layers of plastic. Bulk dispensing or refillable packaging could also be explored as alternatives to single-dose vials.
- Promoting green chemistry: Research into environmentally friendly drugs, formulations, and manufacturing processes can reduce the ecological footprint of pharmaceutical products in the ophthalmic field.
- Disposal practices: Proper disposal of expired or unused medications is crucial in preventing harmful substances from contaminating the environment. Healthcare providers can educate patients on proper disposal methods, such as through take-back programmes or pharmaceutical waste collection.
4. Sustainable patient care and education
Patient education is a critical element in reducing environmental impact. Simple steps that patients can take, such as recycling packaging, opting for reusable eyecare products, and following guidelines for the responsible disposal of medications, can make a difference.
Additionally, telemedicine is increasingly being used in ophthalmology for consultations, follow-ups, and screenings. This not only increases access to eyecare in remote areas but also reduces the carbon footprint associated with travel and in-person visits.
5. Reducing the carbon footprint of ophthalmic conferences and events
Conferences and symposia are essential for advancing knowledge in ophthalmology, but they can also have significant environmental costs due to travel, waste, and energy consumption. Organising more sustainable conferences can help reduce the environmental impact of professional gatherings. Some potential solutions include:
- Virtual and hybrid conferences: By offering virtual participation options, ophthalmologists can attend events without the need for long-distance travel, reducing their carbon footprint.
- Sustainable event practices: Events can be organised with minimal use of disposable materials, promote digital resources over printed materials, and utilise eco-friendly venues and transportation options.
