Cataract Surgery And Environmental Sustainability: Models And Strategies For A Greener High‑Volume Procedure

To review and synthesize current evidence on the environmental impact of cataract surgery and to describe practical strategies—including high‑volume, low‑waste models—that can reduce carbon footprint and waste generation while maintaining or improving surgical outcomes.

The abstract draws on data from life‑cycle assessments and sustainability initiatives in high‑income settings (e.g., United Kingdom teaching hospitals) and from high‑volume eye‑care systems in low‑ and middle‑income countries, notably the Aravind Eye Care System in India, which has been widely studied as a benchmark for efficient and environmentally sustainable cataract services.

A narrative review of peer‑reviewed studies and reports was conducted focusing on: (1) carbon footprint and waste audits of cataract surgery pathways; (2) comparative analyses of resource‑intensive, single‑use models versus reusable, high‑volume systems; and (3) intervention studies using quality‑improvement or Delphi processes to co‑design “green” cataract packs and theater workflows. Key outcomes included per‑case greenhouse gas emissions (kg CO_2‑equivalent), solid waste (kg), and any reported effects on cost or clinical outcomes such as endophthalmitis rates.

A UK hospital life‑cycle assessment estimated that one phacoemulsification cataract operation generated approximately 181–182 kg CO_2‑equivalent, with procurement (disposables and pharmaceuticals) contributing over half of emissions. By contrast, environmental audits at the Aravind Eye Care System reported roughly 250 g of solid waste and about 5.9–6 kg CO_2‑equivalent per case—around 3–5% of the footprint reported in the UK—while achieving equal or lower endophthalmitis rates (0.01% vs 0.04% in a large US registry). High‑volume, standardized surgery with systematic reuse of gowns, drapes, instruments, and multi‑dose pharmaceuticals under strict sterilization protocols accounted for much of this reduction.