Background: Ophthalmology is one of the most resource-intensive medical specialties, with frequent outpatient visits, centralized care systems, and widespread use of single-use equipment contributing significantly to healthcare’s environmental footprint. As climate change intensifies, there is an urgent need to embed sustainability into eye care systems without compromising clinical outcomes or access. This study explores how sustainability can be operationalized in eye care through systems-level reforms and clinician-led behavior change. It identifies practical interventions, highlights best practices across Asia-Pacific and beyond, and examines behavior change strategies that enable clinicians to adopt greener practices in their routine work.
Methods: A qualitative synthesis of 30 peer-reviewed and grey literature was conducted from April to May 2025, drawing on case studies from India, Ireland, Singapore and the UK. Behavior changes enablers and barriers were examined using the Capability, Opportunity, Motivation-Behavior (COM-B) model and the Behavior Change Wheel to understand how sustainability practices can be adopted by clinicians in high-volume, time-constrained settings. Emerging insights informed the development of a proposed framework for identifying sustainability touchpoints.
Results: While numerous cost-effective and scalable green interventions exist, according to the COM-B model, clinician uptake is hindered by barriers including lack of awareness, institutional inertia, and resource constraints. Based on these findings, a 5Ps framework—patient, provider, pharmaceutical, procurement, and policy—was proposed to help identify key entry points for greening the eye care ecosystem.
Conclusions: Transitioning to climate-smart eye care requires both system-level reforms and clinician engagement. The 5Ps framework offers a novel, actionable pathway to reimagine eye care in the era of climate change. By aligning systems change with behavioral insights, it can guide institutions across Asia and beyond toward greener, more environmentally sustainable ophthalmology.
