Sustainable Vision: A Comprehensive Environmental Impact Analysis Of Cataract Surgery In A Dutch Tertiary Hospital

The climate crisis presents not only ecological challenges but also significant threats to human health, including ophthalmic health. The healthcare sector accounts for a substantial 4.4% of the global carbon footprint. One major contributor to negative environmental impact is the operating room (OR). Given that more than 90 million people worldwide experience visual impairments due to cataract, cataract surgery (by phacoemulsification) is a commonly performed procedure globally. This study aims to assess the environmental impact of individual cataract surgeries in a tertiary hospital in the Netherlands and identify key areas for mitigation.

A single center observational study was performed from May until November 2022 in the Radboud University Medical Center (Radboudumc) in the Netherlands. Ten adult patients who underwent cataract surgery by phacoemulsification were included.

A cradle-to-grave Life Cycle Assessment (LCA) was conducted, adhering to ISO-14040 LCA guidelines. Through observational data collection and waste audits, we analysed the entire lifecycle of cataract surgery, from raw material extraction to waste disposal, utilizing data from the Ecoinvent 3.9 database. Environmental impact factors, including carbon footprint and 17 others, were evaluated using the ReCiPe 2016 method and aggregated into three endpoints: damage to human health, ecosystems, and resources.

Each cataract surgery procedure contributes to human health loss (5.63E-5 DALYS) and biodiversity decline (1.25E-7 annual species loss) and generates 2.52 kg of waste. Travel movements of both patients and healthcare workers, particularly non-electric car transportation, emerged as the primary contributor to global warming potential (48%).  Next to global warming potential (26.7 [19.1-38.4] kg CO₂ eq.), also fine particulate matter formation (0.027 [0.019-0.040] kg PM2.5 eq.), human carcinogenic toxicity (2.17 [1.43-3.39] kg 1,4-DCB), terrestrial acidification (0.064 [0.046-0.093] kg SO2 eq.), and land use (1.96 [1.45-2.85] annual m¬2 crop eq.) had major environmental impact.

The environmental impact of a single cataract surgery results in the loss of 30 minutes of healthy lifetime globally. This impact primarily stems from patient and healthcare worker travel movements and the use of disposable products. Implementing bilateral surgery on a single day could reduce this impact. Other mitigation measures should focus on sustainable travel options, materials, and prevention.