Impact of Climate Change on Eye Diseases and Associated Economical Costs

The impact of air pollution and climate change on eye health: a global review

Climate change has important implications on human health, affecting almost every system in the body. Multiple studies have raised the possibility of climate change impacting eye health. In this review, we aimed to summarize current literature on the impact of air pollution and climate change on eye health. We performed a search in four different databases, including Medline, Scopus, Cochrane, and Web of Sciences databases. The search strategy combined terms regarding eye health and environmental/climate changes. The outcome of interest included all eye conditions. The search yielded 2,051 unique articles. After applying inclusion and exclusion criteria, 61 articles were included in this systematic review with data covering 2,620,030 participants. Most studies originated from China, India, South Korea, and USA. Climate change adversely affected different eye conditions, with ocular surface diseases (e.g., conjunctivitis and dry eye) being most affected. Moreover, higher particulate matter (PM) was the most widely assessed pollutant and was adversely associated with the majority of eye conditions, increasing the burden on patients and healthcare providers. We found a low frequency of publications related to the delivery of eye care and its impact on climate change in countries with high air pollution and climate change burden.

Association Between Area Temperature and Severe Vision Impairment in a Nationally Representative Sample of Older Americans

PURPOSE

Several small studies have associated exposure to elevated average temperature with specific vision problems. However, no large-scale studies have examined the relationship between vision impairment and average area temperature in the general population. We conducted a cross-sectional analysis of a large nationally representative sample of older adults to further explore this relationship.

METHODS

Secondary analysis of the American Community Survey (ACS). The survey was conducted through mail, telephone and in-person interviews. Data from six consecutive years of the cross-sectional survey were analysed (2012-2017). The subsample analysed included community-dwelling and institutionalized older adults aged 65 and older in the coterminous US who lived in the same state in which they were born (n = 1,707,333). The question on severe vision impairment was "Is this person blind or does he/she have serious difficulty seeing even when wearing glasses?". Average annual temperature data from the National Oceanic and Atmospheric Administration was combined into a 100-year average and mapped to corresponding US Census Bureau's public use microdata areas from the ACS.

RESULTS

Higher average temperature is consistently associated with increased odds of severe vision impairment across all cohorts (i.e. age, sex, race, income, and educational attainment cohorts) with the exception of Hispanic older adults. Compared to those who lived in counties with average temperature of < 50 °F (< 10 °C) , the odds of severe vision impairment were 44% higher in counties with average temperature of 60 °F (15.5 °C) or above (OR 1.44; 95% CI 1.42-1.46).

CONCLUSION

If the association is found to be causal, the predicted rise in global temperatures could impact the number of older Americans affected by severe vision impairment and the associated health and economic burden.

Tracing the barriers to decarbonising ophthalmology: A review

As climate change demands increasingly urgent mitigation of greenhouse gas emissions, the health sector needs to do its part to decarbonise. Ophthalmologists share concerns about climate change and seek opportunities to reduce their environmental impact. When measuring the footprint of ophthalmology, major contributions are from patient travel to clinics, and from the large amounts of single-use disposable materials that are consumed during surgeries and sterile procedures. Ophthalmic services in India have already demonstrated systems that consume far fewer of these products through efficient throughput of patients and the safe reuse of many items, while maintaining equivalent safety and quality outcomes. Choosing these low-cost low-emission options would seem obvious, but many ophthalmologists experience barriers that prevent them operating as Indian surgeons do. Understanding these barriers to change is a crucial step in the decarbonisation of ophthalmology and the health sector more broadly.

Toxic External Exposure Leading to Ocular Surface Injury

The surface of the eye is directly exposed to the external environment, protected only by a thin tear film, and may therefore be damaged by contact with ambient particulate matter, liquids, aerosols, or vapors. In the workplace or home, the eye is subject to accidental or incidental exposure to cleaning products and pesticides. Organic matter may enter the eye and cause infection. Ocular surface damage can trigger a range of symptoms such as itch, discharge, hyperemia, photophobia, blurred vision, and foreign body sensation. Toxin exposure can be assessed clinically in multiple ways, including via measurement of tear production, slit-lamp examination, corneal staining, and conjunctival staining. At the cellular level, environmental toxins can cause oxidative damage, apoptosis of corneal and conjunctival cells, cell senescence, and impaired motility. Outcomes range from transient and reversible with complete healing to severe and sight-compromising structural changes. Classically, evaluation of tolerance and safety was carried out using live animal testing; however, new in vitro and computer-based, in silico modes are superseding the gold standard Draize test. This review examines how environmental features such as pollutants, temperature, and seasonality affect the ocular surface. Chemical burns to the eye are considered, and approaches to protect the ocular surface are detailed.

Ethnopharmacological survey of endemic plants used in ethnomedicinal knowledge of Soqotra Island

ETHNOPHARMACOLOGICAL RELEVANCE

Due to the long biogeographical isolation since ancient times, Soqotra Island (southern Yemen) is rich in medicinal endemic plants. However, information on their traditional therapeutic knowledge is scarce in scientific literature and still not completely documented.

AIM OF THE STUDY

(1) Documentation and search the native traditional therapeutic knowledge focusing on the medicinal plants which are endemic to Soqotra (2) Identification of the important endemic plants treating diseases by quantitative analysis of the collected data.

MATERIALS AND METHODS

Ethnobotanical data were collected from 105 local informants through open interviews, semi-structured questionnaires and field survey in February 1990 to document the traditional medicinal plants in Soqotra Island. Of them we reported in this study the data of the endemic species, due to their wide biodiversity in the island. The quantitative data were analyzed for use reports (URs) and the informant consensus factor (ICF). The reported diseases were classified according to the International Classification of Primary Care-2 (ICPC-2). New reported medicinal plants in this study were identified compared to literature review. The level of traditional Soqotri knowledge among Islanders was observed during 1990-2003.

RESULTS

In the study, 86 medicinal endemic plants with 7654 therapeutic URs were explored for 69 ailments types belongs to 11 (ICPC-2) groups. The highest ICF value (0.99) were calculated for both eye and ear diseases categories, followed by general and unspecified ailments (0.98), digestive and skin (0.97 for each), and musculoskeletal ailments (0.96) among all diseases categories. While the highest URs (2276) were identified for skin diseases, followed by digestive diseases (URs = 2146). All the 86 recorded medicinal plant species were endemic to Soqotra, belonging to 57 genera and 29 families. Euphorbiaceae and Burseraceae were the dominant families, followed by Apocynaceae, Fabaceae and Asteraceae. Shrubs were the dominant growth form (41 species, 47.67%), followed by herbs (27; 31.4%), and trees (14; 16.28%). Leaves (45 species; 31.25%) were the most frequently used parts, followed by stems (34 species; 23.61%) and barks (species 23; 15.97%). The most cited preparation method was paste for 51 species followed by liquid exudates (48 species) and powder (26 species). Based on the comparative literature review, we recorded 36 new endemic medicinal plants and reported new traditional therapeutic uses for the remaining 50 endemic plants for the first time. On the other hand, all the reported endemic medicinal plants have been enlisted in the IUCN Red List of Threatened Species, of them 21 endemic species enlisted as highest threatened species.

CONCLUSION

According to the quantitative data analyzed, Soqotra Island has a valuable traditional knowledge in several medicinal endemic plants that used by local people in the primary health care until the study time at 1990. This study emphasizes the importance of early time in documenting traditional indigenous knowledge before losing and to protect and conserve the endemic plants against highly endangered. Consequently, these ethnomedicinal data could be used in the future as guide for pharmacological and phytochemical studies to discover new therapeutic drugs.

How Ophthalmologists Can Decarbonize Eye Care: A Review of Existing Sustainability Strategies and Steps Ophthalmologists Can Take

TOPIC

Understanding approaches to sustainability in cataract surgery and their risks and benefits CLINICAL RELEVANCE: In the United States, healthcare is responsible for approximately 8.5% of greenhouse gas (GHG), and cataract surgery is one of the most commonly performed surgical procedures. Ophthalmologists can contribute to reducing GHG emissions, which lead to a steadily increasing list of health concerns ranging from trauma to food instability.

METHODS

We conducted a literature review to identify the benefits and risks of sustainability interventions. We then organized these interventions into a decision tree for use by individual surgeons.

RESULTS

Identified sustainability interventions fall into the domains of advocacy and education, pharmaceuticals, process, and supplies and waste. Existing literature shows certain interventions may be safe, cost-effective, and environmentally friendly. These include dispensing medications home to patients after surgery, multi-dosing appropriate medications, training staff to properly sort medical waste, reducing the number of supplies used during surgery, and implementing immediate sequential bilateral cataract surgery where clinically appropriate. The literature was lacking on the benefits or risks for some interventions, such as switching specific single use supplies to reusables or implementing a hub-and-spoke style theatre setup. Many of the advocacy and education interventions have inadequate literature specific to ophthalmology but are likely to have minimal risks.

CONCLUSIONS

Ophthalmologists can engage in a variety of safe and effective approaches to reduce or eliminate dangerous GHG emissions associated with cataract surgery.

[Current and future effects of climate change on ophthalmology]

BACKGROUND AND OBJECTIVES

Climate change is also an increasingly important issue in the healthcare system. Due to its anatomical and physiological nature, the eye is directly exposed to environmental influences and changes in a special way.

METHODS

The current literature is used to illustrate the effects of climate-induced changes and the respective influences on the eye. A PubMed search (cut-off date 3 October 2021) using the search terms "climate change" or "planetary health" or "global health" and in each case "ophthalmology" or "eye" or "ocular" was used to determine the development of the number of publications between 2011 and 2021.

RESULTS

Measurable effects of climate change are already evident in a wide variety of ophthalmological fields. The significance of this topic, for instance, is reflected in a relatively constant increase in the number of publications and an almost tenfold increase in the number of publications per year from 2011 to 2021.

CONCLUSION

The impact of climate change on eye diseases and on the field of ophthalmology is multifaceted and could be expected to intensify in the coming years. Therefore, the interrelationships need to be further investigated in future studies, preferably on a large scale.