Comparative Environmental And Cost Impact Of Cataract Surgery Across Four European Centres

Cataract surgery is the most frequently performed surgical procedure worldwide. While clinical outcomes in the Western world are highly homogenous, the environmental and economic impact of surgical practice varies significantly depending on pack composition, instrument choice, and waste management pathways. Many parties have advocated for more sustainable practice for over a decade; however, real-world implementation remains heterogeneous.

This study aims to investigate the environmental costs and financial cost variation of routine cataract surgery across four European centres, identifying the primary drivers of carbon emissions and cost differences.

Prospective multicentre observational study conducted in four European cataract centres.

NHS Royal Free  (United Kingdom)

Fernando Fonseca Hospital (Portugal)

Flevoziekenhuis (Netherlands)

Fondation Rotschild (France)

For each centre, five comparable components of the standard cataract pack were quantified. Seven surgical instruments were analysed (capsulorhexis forceps, toothed forceps, manipulator/chopper, iris-, Vannas-, Wescott scissors, and tying forceps. For each item, single-use versus reusable status, material, weight, waste pathway (incineration or recycling) and unit cost was assessed. The environmental cost per case (kg CO₂eq) was calculated using the online SIDICS calculator for the components of the cataract pack, and material emission factors plus waste treatment factors for the surgical instruments. For the financial cost, instruments were modelled using standardised average weights and market prices to ensure cross-centre comparability.

A total of 13,100 surgeries were analysed over a 52-week period. The cumulative carbon footprint  was 46,036 kg CO₂e. Cataract pack-related consumables accounted for 97.7% of total emissions, whereas surgical instruments contributed 2.3%.

Among single-use instruments, recyclable models demonstrated a 5% reduction in CO₂ emissions compared with non-recyclable equivalents.

The total procedural cost across 13,100 surgeries was €396,950. Cataract surgical pack-related consumables represented 79.3% of total expenditure, while additional instruments accounted for 20.7%.

Centres implementing recycling as waste pathway for single-use instruments demonstrated a 10% relative cost improvement compared with centres disposing via conventional incineration.

Substantial inter-centre variation exists in both environmental and financial costs of routine cataract surgery. The overwhelming majority of carbon emissions originate from cataract surgical pack-related consumables, while instrument strategy and waste-management pathway influence both carbon footprint and cost efficiency.

Optimisation of the surgical pack composition and adoption of recyclable single-use instruments represent immediately actionable strategies to reduce emissions and improve cost performance without altering clinical outcomes. Standardised environmental metrics should be incorporated into cataract surgery quality frameworks to support more sustainable ophthalmic practice.