Carbon Footprint of Cataract Surgery

Case study submitted as part of Lancet Commission call for case studies.

Team members / location: Oumaima Elouali / Barcelona, Spain.

Issue:

The field of ophthalmology, particularly cataract surgery, has a significant carbon
footprint due to its high procedural volume, supply procurement, and operating room waste.

The UK estimates 130 to 181.8 kg CO2-eq per one cataract surgery, largely due to procurement of supply and consumables.

Intervention: 

• Increasing  awareness about the environmental impact of cataract procedures and waste management in operating rooms ( SusQI calculator, ESCRS Framework, EyeSustain, Healthcare without Harm guidelines and tools… )
• The Aravind Hospital model based on the 5 R’s approach, offers a valuable framework for operating more eco-consciously.
• Prioritising reusable and recyclable instruments aiming to reduce carbon footprint generated by surgical procedures. Innovations like HASA OPTIX recyclable single-use surgical instruments are transforming ophthalmic surgery, while ensuring patient safety and environmental sustainability in the field of ophthalmology.

Outcomes:

• Clinical
  • Eye surgeons in Europe compared to the green Aravind hospital model had both a lower postoperative endophthalmitis rate which validates the safety of the reuse approach.
  • Existing regulations, risk of postoperative infections, and the lack of studies on the safety of reusing supplies and medications create challenges for implementing more sustainable practices. Furthermore, the bilateral cataract surgery technique, which has emerged as an eco-friendly approach, has also faced some regulatory challenges and other limitations.
     
• Environmental
  • The carbon footprint of a cataract surgery in the Aravind Eye Hospital was estimated at 6 kg CO2-equivalent.
  • In contrast, the UK estimates the carbon emission coming from a single procedure at 180 kg CO2 -eq.

  • This comparison shows that Aravind Eye Hospital's model has a significantly lower carbon footprint - approximately 95% less - than a typical cataract surgery in the UK.
     

• Social

  • Improving public health by minimising emissions and waste, leading to cleaner air and a reduced risk of respiratory and cardiovascular diseases.
  • Sustainable practices lower surgical costs by reducing the use of disposable materials, making healthcare more affordable and accessible in low-income settings.
  • Community engagement by cultivating a shared commitment to protecting our planet and human health.
  • Following a green healthcare model can create job opportunities, as new roles are needed to manage sustainability initiatives and training programs.
  • Educating patients, staff, and communities on sustainability can inspire environmentally friendly behaviours.
     
• Financial
  • Cost effectiveness and energy savings.

Key learning point:

As we look toward the future, the call to action is clear. The challenges faced by ophthalmologists and ophthalmic manufacturers require collaborative efforts to navigate regulatory barriers and implement sustainable practices without compromising patient safety.