Consultant ophthalmologist, John Buchan, outlined how optometrists can serve both their patients and the broader population by making their service more environmentally sustainable at the AOP’s Hospital and Specialty Optometrists Conference (8–9 November 2025, London).
Buchan highlighted that in the UK ophthalmology is the highest volume specialty within the NHS.
He added that one phacoemulsification in the UK creates 20 times the greenhouse gas emissions of the same procedure in India.
“That is despite the fact that the outcomes – such as visual outcomes, refractive outcomes and complications – are just as good in a centre of excellence in India as they are in the UK,” Buchan shared.
He added that as global inequity increases it becomes more incumbent on those delivering healthcare in affluent countries to consider what they can do to minimise over-consumption.
“It just doesn’t work to have some people consuming a disproportionate amount to others,” Buchan emphasised.
“Just because we can consume more and spend more per patient in the UK, it doesn’t make it something that is right,” he added.
Outlining the difference in levels of waste between eye care delivery in the UK and Sierra Leone, Buchan contrasted the protocol he follows when performing cataract surgery.
In the UK, he would dispose of a knife following a single incision – whereas in Sierra Leone the knife would be sterilised and re-used.
Buchan described an approach clinicians can use when attempting to improve the sustainability of their eye care service called the Delphi process.
This involves collecting suggestions from colleagues to compile a list of suggestions for reducing the environmental impact of a service.
As a group, the shortlist of the ideas is then ranked according to how realistic and effective they are.
“You can then have a meeting with all your colleagues to say ‘These are the ideas that you created and these are the rankings you gave them. How are we going to do the top-ranked idea? How will we do the second and third?” Buchan explained.
After carrying out the above process at Leeds Teaching Hospitals NHS Trust, Buchan and his colleagues were able to substantially reduce the number of items in a standard cataract operating set.
This resulted in each of the 5000 cataract operations that the trust carries out annually having a lower environmental impact – as well as costing the trust less.
“Our packs became £20 to £30 cheaper because of the objects we were removing. That cost saving is then redeployed within healthcare,” Buchan shared.
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