Paper on the Environmental Impact of Cataract Surgery: Is There a Tradeoff Between Sustainable Practices and Good Safety?

Andriele Madison's picture

The article "Reducing the environmental impact of cataract surgery: Sustainability versus safety: A tradeoff?" published by Dr. Nick Mamalis (University of Utah, USA) discusses the evidence available in terms of the environmental impact of cataract surgery, the need for sustainable practices and the issue of clinical safety that is often raised when changes in practice is discussed. 

The article explains the findings of an experimental study that investigates the safety of using phacoemulsification tips multiple times. The reuse of phacoemulsification tips multiple times has been discussed as a mode for reducing waste in cataract surgery; however, some controversy exists in regards to the safety of multiple use tips when compared to single use tips.

The laboratory study compared eight different types of phacoemulsification tips. The study evaluated changes to the tips through scanning of the structure prior to use and after multiple cycles that mimic the clinical use process these tips undergo during cataract surgery. Unused tips acted as a control group in this study.

Findings of the study showed “no significant structural changes, such as scratches, cracks, or breaks. There was no sign of micro stress fractures or fissuring in any of the tips evaluated. The tips did show areas of precipitated salt, likely from the balanced salt solution used.”

Dr. Nick Mamalis argues that given these results, where no significant differences where detected on the phacoemulsification tips after multiple uses, that “cataract surgeons be allowed discretion in terms of reusing phaco tips based on their best clinical observation and judgment. This would help reduce the higher cost associated with single-use phacoemulsification tips as well as possibly decrease the environmental impact associated with single-use phacoemulsification tips.”



Mamalis, N. (2018). Reducing the environmental impact of cataract surgery: Sustainability versus safety: A tradeoff? Journal of Cataract & Refractive Surgery, 44(1), 1–2.

Tsaousis, K., Chang, D., Werner, L., Perez, J., Guan, J., Reiter, N., … Mamalis, N. (2018). Comparison of different types of phacoemulsification tips. III. Morphological changes induced after multiple uses in an ex vivo model. Journal of Cataract and Refractive Surgery.

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