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Sustainable ophthalmology: regulatory constraints and challenges

Eye (2026)Cite this article

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I read with great interest the recent paper by Maheshwari et al. on sustainability in ophthalmology [1]. The review has cleverly paved the way towards understanding the importance of environmental sustainability in eye care by initially describing climate change and its impact worldwide, defining sustainability, and highlighting that meeting the current generation’s needs shouldn’t compromise future generations. Then, the authors linked these issues to current ophthalmic practices and how they may contribute to a high carbon footprint and environmental detriment. Thereafter, they displayed interesting examples of eco-friendly ophthalmic practices that have the potential to reduce carbon emissions significantly. While the prospects of environmentally friendly eye care are exciting, regulatory constraints within the NHS (National Health Service) may hinder such efforts [2]. Although Maheshwari et al. effectively highlighted the evidence behind the re-use of single-use devices and the studies examining the safety of such a strategy, there remains a regulatory constraint regarding adopting such a strategy, even if it is proven not to pose an infection risk. This regulatory constraint is reflected in laws and regulations that put legal liability on the institutions or professionals that or who adopt such recycling of single use items, rendering them contravening national guidance and potentially committing an offence under several laws including the Health and Safety at Work Act 1974, Part 1 of the Consumer Protection Act 1987, The General Product Safety Regulations 2005, and the UK Medical Devices Regulations 2002 (as amended) [3]. Therefore, there appears to be a need to find a centralised national approach to mitigate these challenges and ensure a well-outlined pathway towards sustainable healthcare and sustainable ophthalmology practice [4]. In conclusion, as the pace of ophthalmology advancement is growing fast with the rapid development of its technologies, so is its carbon footprint burden. Therefore, eco-friendly practices must be adopted to ensure its sustainability. Practices that are often faced with regulatory restrictions need centralised, clearly described policies to mitigate any challenges and ensure eye care that envisions the importance of sustainability.

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References

  1. Maheshwari A, Dave VP, March de Ribot F, Romano MR, Arevalo JF, Özdek Ş, et al. Sustainable ophthalmology: an overview of concepts and practices. Eye. 2025;39:2846–51. https://doi.org/10.1038/s41433-025-03999-5.

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  2. Smith M, Bhutta MF, Malone T, Williams SJ. Sustainable procurement in the NHS: barriers and enablers to staff behavioural change. Br J Healthc Manag. 2025;31:113.

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  3. GOV.UK. Single-use medical devices: implications and consequences of re-use. 2021. https://www.gov.uk/government/publications/singleuse-medical-devices-implicationsand-consequences-of-re-use. Accessed 2025 Nov 6.

  4. Rizan C, Bhutta M. Policy brief: reducing the environmental impact of medical devices adopted for use in the NHS. 2024. https://www.bsms.ac.uk/_pdf/about/environmentalimpact-nhs-devices-report-finalv2.pdf. Accessed 2025 Nov 6.

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  1. Kettering General Hospital NHS Foundation Trust, Kettering, Northamptonshire, UK

    Yosif Albrahem

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  1. Yosif Albrahem
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The author (Y Albrahem) wrote, drafted, and approved the final version of this manuscript.

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Correspondence to Yosif Albrahem.

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Albrahem, Y. Sustainable ophthalmology: regulatory constraints and challenges. Eye (2026). https://doi.org/10.1038/s41433-025-04237-8

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