Sustainability In Cataract Surgery - Surveying National Health Service Theatre Staff On The Impact, Barriers And Opportunities For Environmental Improvement

Cataract surgery is a high-volume procedure in the National Health Service (NHS), presenting a significant opportunity to address the environmental implications of surgical practice. This survey aims to evaluate current attitudes and engagement among theatre staff regarding sustainability practices in cataract surgery. We also aim to identify organizational barriers to sustainability improvements so as to inform targeted interventions.

Single centre study conducted at a large tertiary NHS teaching hospital in London, United Kingdom. The average volume of cataract surgeries conducted per year at this hospital is about ~2500 eyes.

This was a cross-sectional survey circulated amongst consultant ophthalmic surgeons, resident surgeons and theatre nursing staff actively involved in cataract surgery. They were invited to complete an online 19-question, multiple-choice qualitative survey in February 2025. The questionnaire design was based on previous validated surveys with input from the American-European Congress of Ophthalmic Surgery (AECOS) Green Working Group and adaptations made to reflect current practices in the NHS. The survey was circulated electronically. Responses were collected anonymously, using a Likert scale, with each email address only permitting one submission. Data was analyzed using descriptive statistics and presented as proportions.

A total of 32 responses were collected: 12 consultants, 8 scrub nurses, and 12 resident doctors. Awareness of cataract surgery’s environmental impact was high (88%). Surgical waste was perceived as excessive by 88%, while fewer than 16% felt current disposal practices were environmentally responsible. Most (88%) believed sustainable changes would have positive environmental effects, and 88% felt sustainability could improve without compromising patient care. All respondents agreed on optimizing packaging for sustainability. Support for change was strong, with 94% open to modifying practice. Suggestions included multi-use bottles (75%), reusable instruments (97%), reduced packaging waste (91%), and digitized records (84%).

This study highlights a strong awareness amongst NHS cataract surgery teams regarding the environmental impact of current practices, with an overwhelming majority recognizing excessive surgical waste and the inadequacy of existing disposal methods. Importantly, there was a clear consensus that sustainable changes can be implemented without compromising patient care. Given that 93% of respondents are willing to adapt to more sustainable practices, there is a significant opportunity for systemic change. The results underscore widespread support for the implementation of feasibility, cost-effectiveness and digital transformation studies along with research of lifecycle analysis of surgical materials in the near future.