The impact of climate change is unparalleled in magnitude, ranging from changing weather patterns that endanger food production to rising sea levels that raise the likelihood of catastrophic flooding. Future adaptation to these effects will be easier and more affordable with immediate action. An often-overlooked aspect is the eye health effects of climate change. It is likely to increase the incidence of cataracts, severe allergic eye disease, glaucoma, age-related macular degeneration, trachoma infections, vitamin A deficiency, and eye injuries. Eye care can produce its own climate effects, with hospitals, surgical procedures, and different kinds of diagnosis and treatment leaving carbon footprints.
An IVI-VisionPlus discussion, ‘Climate Change and Eye Health,’ highlighted the eye health risks associated with climate change and explored possibilities of environmentally sustainable eye care. The discussion was chaired by Shekhar Nambiar, General Manager, of Education and Communications, IVI, comprised of Dr. R. Venkatesh, Chief Medical Officer, Chief – Glaucoma Services, Aravind Eye Hospital, Prof. Kovin Naidoo, Global Head, Advocacy and Partnerships, OneSight Essilor Luxottica Foundation, and Elise Moo, Global Research Coordinator, The Fred Hollows Foundation.
Low rainfall and high temperatures are expected to increase the prevalence of trachoma infections, making the human eye particularly sensitive to small environmental changes. As food instability is likely to increase, vitamin A deficiencies are expected to worsen. By 2050, increased cataract cases might total up to 200,000. UV exposure is on the rise. Glaucoma and age-related macular degeneration are linked to traffic-related air pollution and severe allergy eye conditions. The delivery of eye health services will be disrupted, and acute long-lasting eye injuries will rise due to extreme weather conditions and natural catastrophes.
Climate change affects natural systems and produces changes in disease vectors, waterborne diseases, and air pollution. This can lead to consequences for human health through mismanaged human systems, such as labor impacts, malnutrition, and mental stress, which, in turn, are factors that impact eye health. Environmental conditions have a bearing on eye disease burden. For example, UV radiation is associated with cataracts, pterygium, photo-conjunctivitis, photokeratitis, macular degeneration, and infectious uveitis. Warmer temperatures may also generate conditions for allergic conjunctivitis.
Shekhar Nambiar drew the panel’s attention to research in the climate change and eye health field and asked the panelists if there were research gaps in the domain. “One area that requires attention is the need to know what component of the ocular disease burden change that occurs is connected with climate change,” noted Kovin Naidoo. “To do that, we will have to collaborate with people who have a good understanding of climate change, its environmental effects, and its impact on society. We understand the diseases well but need to do more to link them with climate change. Randomized control trials bring much more rigor to research. We will have to collect different types of data in terms of climate change.”
Eye care has a carbon footprint. For example, the sheer volume of surgeries and consumables used for surgeries can increase the carbon footprint of an eye hospital. Low-carbon eye care should be the way of the future. Eye care needs to be both financially and environmentally sustainable and resilient, according to Dr. R. Venkatesh, who said eye hospitals could make their infrastructure sustainable and resilient by introducing a range of measures such as using energy-efficient appliances and gadgets, leveraging natural ventilation and lighting and minimizing maintenance with the right choice of material. “It is possible to reduce, reuse and recycle in eye care to make the entire process environmentally sustainable,” he argued.
Using alternative energy sources such as wind and solar, minimizing patient visits to the hospital through outreach programs, and housing staff within the campus are policy interventions eye hospitals can make to reduce their carbon footprint. Efficient surgical protocols, minimizing the use of single-use instruments, and the reuse of instruments with strict sterilization protocols will also help reduce the environmental impact of eye care.
Patient education is a means of creating awareness of vision-threatening conditions. It also has a role to play in lowering our carbon footprint. Answering Mr. Nambiar’s question on patient education, panelists affirmed the value of having aware patients. Some conditions, such as Glaucoma and Retinopathy, can be particularly threatening if not diagnosed early. Diabetic Retinopathy, for example, can be managed well at the early stage with less resource-intensive treatment. However, at an advanced stage, the condition demands expensive and resource-intensive treatment, which, in turn, produces environmental effects.
Slowly but surely, the world is beginning to recognize the relationship between healthcare and climate change. COP 26, held in October and November, marked the first time healthcare found mention in the agenda of the world’s most prominent intergovernmental mechanism to address climate change. Shekhar Nambiar asked Elise Moo about the significance of the new focus on eye health in our climate change discourse. According to her, it is a positive sign that policymakers at the highest level have started to recognize that climate change is a healthcare threat and that there is a role in healthcare policies, plans, and infrastructure for climate change mitigation and adaptation efforts. “This is something we can leverage in our advocacy and engagement. We know that in Australia, for example, the national government has recognized a need for a climate change and health strategy. It’s very early days, but hopefully, it can lead to proactive action and resources to support research, education, and resilience measures in healthcare facilities,” she noted.
There is a need to seize the opportunity generated by COP26 and build toward greater emphasis on healthcare within the climate change mitigation and resilience framework. Governments and leaders worldwide must produce clear policy commitments and resources to meet the challenge.
