The Environmental Sustainability of Dry Eye Disease

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Article initiated by:
Anna March de Ribot, MD, PhD, Francesc March de Ribot, MD, PhD
All contributors:
Anna March de Ribot, MD, PhD, Francesc March de Ribot, MD, PhD, Colleen Halfpenny, M.D.
Assigned editor:
Neha Shaik, MD
Review:
Assigned status Update Pending
.


Introduction

Dry Eye Disease Sustainability is an interesting topic.[1] Globally, the healthcare sector is responsible for 4 to 6% of CO2 emissions.[2] As the healthcare industry expands due to an aging population and improved care, sustainability becomes increasingly important.[3] Ophthalmology, with its high volume of consultations and procedures, has a significant environmental impact, making sustainability efforts crucial.[3]

Dry eye disease (DED) is a common reason for ophthalmology visits, ranking third after refractive errors and cataracts.[4][5] It affects approximately one in 11 people worldwide, with prevalence ranging from 5% to 50% in epidemiological studies.[4] The risk of DED increases with age, with prevalence ranging from 2.7% in individuals aged 18 to 34 to 18.6% in those aged 75 and older.[6] Women and the Asian population have a higher prevalence of DED.[7] Factors such as pollution, low humidity (related to climate change), medications, and eye surgeries contribute to DED.[4][8] Moreover, the increasing use of digital screens has led to a rise in digital eye strain, affecting 26–70% of screen users globally.[8][9]

Estimates suggest that DED affects 350 to 700 million people worldwide.[6][10] Unfortunately, DED is often underdiagnosed and underreported. For example, in the USA, more than 16 million cases have been diagnosed in the past, with an additional 6 million people undiagnosed.[11] Recent estimatIONS suggest that up to 40 million people in the USA have DED.[6][10]

The indirect cost of DED due to reduced productivity in the USA is estimated at US $73.12 billion annually, equating to US $15,596 per person.[12] Treatment costs vary based on DED severity, ranging from US $300 to US $1100 per person in different countries.[13][14][15] The global DED market size was USD 5.22 billion in 2019 and is projected to reach USD 6.54 billion by 2027, with an annual growth rate of 4.7%.[16]

Potential Solutions and Future Directions

Prevention:

The primary approach to DED prevention involves proper diagnosis, risk factor avoidance, and addressing environmental factors, such as pollution, low humidity, medications, and digital device use.[8][17][18][19][20][21][22] Digital eye strain can be reduced by limiting screen time, with smartphones potentially causing fewer dry eye symptoms compared to computers.[8][23][24]

Treatment:

Lubricating eye drops are a common DED treatment but generate significant plastic waste. Recycling rates for these plastics are less than 8.7%, leading to environmental concerns.[25] Promoting preservative-free eye drops is more ecological and avoids the use of harmful preservatives like benzalkonium chloride.[25][26] Eye drops result in an annual CO2 impact of 7 kg per person, mainly due to plastic production and waste processing.[27][28]

Anti-inflammatory drugs and autologous serum are alternatives to lubricating eye drops but also generate plastic waste.[17] Eyelid hygiene, punctal plugs, moisture chamber spectacles, and scleral lenses can reduce the need for eye drops and waste[17][29] [30]. Special retention eyewear can increase humidity and comfort, potentially reducing the use of lubricants.[30]

Conclusions

Dry eye disease presents challenges in economic and environmental sustainability due to its prevalence and resource consumption. Chronic use of eye drops generates significant plastic waste, highlighting the need for preservative-free alternatives. Preventative measures and digital solutions may offer potential benefits for both patient care and sustainability efforts.[1]

References

  1. ↑ 1.0 1.1 March de Ribot F, Benitez Del Castillo JM, Geerling G, Messmer EM, Baudouin C, Alves M. Dry eye disease sustainability. Ocul Surf. 2023 Aug 22;30:104-106. doi: 10.1016/j.jtos.2023.08.006. Epub ahead of print. PMID: 37619668.
  2. ↑ Health care climate footprint report
  3. ↑ 3.0 3.1 Tennison I, Roschnik S, Ashby B, Boyd R, Hamilton I, Oreszczyn T, Owen A, Romanello M, Ruyssevelt P, Sherman JD, Smith AZP, Steele K, Watts N, Eckelman MJ. Health care's response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Health. 2021 Feb;5(2):e84-e92.
  4. ↑ 4.0 4.1 4.2 Stapleton F, Alves M, Bunya VY, Jalbert I, Lekhanont K, Malet F, Na KS, Schaumberg D, Uchino M, Vehof J, Viso E, Vitale S, Jones L. TFOS DEWS II Epidemiology Report. Ocul Surf. 2017 Jul;15(3):334-365.
  5. ↑ Bradley JL, Özer Stillman I, Pivneva I, Guerin A, Evans AM, Dana R. Dry eye disease ranking among common reasons for seeking eye care in a large US claims database. Clin Ophthalmol. 2019 Feb 1;13:225-232.
  6. ↑ 6.0 6.1 6.2 Papas EB. The global prevalence of dry eye disease: A Bayesian view. Ophthalmic Physiol Opt. 2021 Nov;41(6):1254-1266.
  7. ↑ McCann P, Abraham AG, Mukhopadhyay A, Panagiotopoulou K, Chen H, Rittiphairoj T, Gregory DG, Hauswirth SG, Ifantides C, Qureshi R, Liu SH, Saldanha IJ, Li T. Prevalence and Incidence of Dry Eye and Meibomian Gland Dysfunction in the United States: A Systematic Review and Meta-analysis. JAMA Ophthalmol. 2022 Dec 1;140(12):1181-1192.
  8. ↑ 8.0 8.1 8.2 8.3 Wolffsohn JS, Lingham G, Downie LE, Huntjens B, Inomata T, Jivraj S, Kobia-Acquah E, Muntz A, Mohamed-Noriega K, Plainis S, Read M, Sayegh RR, Singh S, Utheim TP, Craig JP. TFOS Lifestyle: Impact of the digital environment on the ocular surface. Ocul Surf. 2023 Apr 14;28:213-252.
  9. ↑ Fjaervoll H, Fjaervoll K, Magno M, Moschowits E, Vehof J, Dartt DA, Utheim TP. The association between visual display terminal use and dry eye: a review. Acta Ophthalmol. 2022 Jun;100(4):357-375.
  10. ↑ 10.0 10.1 https://www.market-scope.com/pages/reports/355/2022-dry-eye-disease-model-december-2022#reports 2022 Dry Eye Disease Model, December, 2022]
  11. ↑ Farrand KF, Fridman M, Stillman IÖ, Schaumberg DA. Prevalence of Diagnosed Dry Eye Disease in the United States Among Adults Aged 18 Years and Older. Am J Ophthalmol 2017; 182:90.
  12. ↑ Yu J, Asche CV, Fairchild CJ. The economic burden of dry eye disease in the United States: a decision tree analysis. Cornea. 2011 Apr;30(4):379-87.
  13. ↑ McDonald M, Patel DA, Keith MS, Snedecor SJ. Economic and Humanistic Burden of Dry Eye Disease in Europe, North America, and Asia: A Systematic Literature Review. Ocul Surf. 2016 Apr;14(2):144-67.
  14. ↑ Uchino M, Uchino Y, Dogru M, Kawashima M, Yokoi N, Komuro A, Sonomura Y, Kato H, Kinoshita S, Schaumberg DA, Tsubota K. Dry eye disease and work productivity loss in visual display users: the Osaka study. Am J Ophthalmol. 2014 Feb;157(2):294-300.
  15. ↑ Clegg JP, Guest JF, Lehman A, Smith AF. The annual cost of dry eye syndrome in France, Germany, Italy, Spain, Sweden and the United Kingdom among patients managed by ophthalmologists. Ophthalmic Epidemiol. 2006 Aug;13(4):263-74.
  16. ↑ Dry Eye Syndrome Market Size, Share & COVID-19 (Anti-inflammatory Impact Analysis, By Product Products {Cyclosporin, Corticosteroids, and Others), Artificial Tears and Lubricants, and Others), By Distribution Channel (Hospital Pharmacies, Retail Pharmacies, and Others), and Regional Forecast, 2023-2030
  17. ↑ 17.0 17.1 17.2 Jones L, Downie LE, Korb D, Benitez-Del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017 Jul;15(3):575-628.
  18. ↑ Alves M, Asbell P, Dogru M, Giannaccare G, Grau A, Gregory D, Kim DH, Marini MC, Ngo W, Nowinska A, Saldanha IJ, Villani E, Wakamatsu TH, Yu M, Stapleton F. TFOS Lifestyle Report: Impact of environmental conditions on the ocular surface. Ocul Surf. 2023 Apr 14;29:1-52.
  19. ↑ Stapleton F, Abad JC, Barabino S, Burnett A, Iyer G, Lekhanont K, Li T, Liu Y, Navas A, Obinwanne CJ, Qureshi R, Roshandel D, Sahin A, Shih K, Tichenor A, Jones L. TFOS lifestyle: Impact of societal challenges on the ocular surface. Ocul Surf. 2023 Apr 14;28:165-199.
  20. ↑ Galor A, Britten-Jones AC, Feng Y, Ferrari G, Goldblum D, Gupta PK, Merayo-Lloves J, Na KS, Naroo SA, Nichols KK, Rocha EM, Tong L, Wang MTM, Craig JP. TFOS Lifestyle: Impact of lifestyle challenges on the ocular surface. Ocul Surf. 2023 Apr 11;28:262-303.
  21. ↑ Gomes JAP, Azar DT, Baudouin C, Bitton E, Chen W, Hafezi F, Hamrah P, Hogg RE, Horwath-Winter J, Kontadakis GA, Mehta JS, Messmer EM, Perez VL, Zadok D, Willcox MDP. TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface. Ocul Surf. 2023 Apr 20:S1542-0124(23)00037-X.
  22. ↑ Sullivan DA, da Costa AX, Del Duca E, Doll T, Grupcheva CN, Lazreg S, Liu SH, McGee SR, Murthy R, Narang P, Ng A, Nistico S, O'Dell L, Roos J, Shen J, Markoulli M. TFOS Lifestyle: Impact of cosmetics on the ocular surface. Ocul Surf. 2023 Apr 13;29:77-130.
  23. ↑ Yee RW, Sperling HG, Kattek A, Paukert MT, Dawson K, Garcia M, Hilsenbeck S. Isolation of the ocular surface to treat dysfunctional tear syndrome associated with computer use. Ocul Surf. 2007 Oct;5(4):308-15.
  24. ↑ Bron AJ, de Paiva CS, Chauhan SK, Bonini S, Gabison EE, Jain S, Knop E, Markoulli M, Ogawa Y, Perez V, Uchino Y, Yokoi N, Zoukhri D, Sullivan DA. TFOS DEWS II pathophysiology report. Ocul Surf. 2017 Jul;15(3):438-510.
  25. ↑ 25.0 25.1 Govindasamy G, Lim C, Riau AK, Tong L. Limiting plastic waste in dry eye practice for environmental sustainability. Ocul Surf. 2022 Jul;25:87-88.
  26. ↑ Kim S, Ji K, Shin H, Park S, Kho Y, Park K, Kim K, Choi K. Occurrences of benzalkonium chloride in streams near a pharmaceutical manufacturing complex in Korea and associated ecological risk. Chemosphere. 2020 Oct;256:127084.
  27. ↑ PharMaAnalyst. 2021 02.06.2023.
  28. ↑ Pre-sustainability (2023). LCA software for informed change-makers.
  29. ↑ Jones L, Efron N, Bandamwar K, Barnett M, Jacobs DS, Jalbert I, Pult H, Rhee MK, Sheardown H, Shovlin JP, Stahl U, Stanila A, Tan J, Tavazzi S, Ucakhan OO, Willcox MDP, Downie LE. TFOS Lifestyle: Impact of contact lenses on the ocular surface. Ocul Surf. 2023 May 4;29:175-219.
  30. ↑ 30.0 30.1 Morgan SL, Morgan PB, Efron N. Environmental impact of three replacement modalities of soft contact lens wear. Cont Lens Anterior Eye. 2003 Mar;26:43-46.

See also

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