Sustainability In Cataract Surgery: Current Practices And Perceptions From The First Nationwide Moroccan Survey

Environmental sustainability is increasingly shaping modern cataract surgery, with initiatives led by scientific societies promoting evidence-based strategies to reduce waste and carbon emissions while maintaining patient safety. Studies from lower- and middle-income settings have demonstrated that resource-optimized models can significantly reduce environmental impact without compromising outcomes. Despite this global momentum, no national data were available from Morocco. This study aimed to provide the first nationwide assessment of current practices, perceptions, and potential implementation pathways within the Moroccan context.

Nationwide survey including ophthalmologists and ophthalmology residents practicing in public and private sectors across Morocco.

A descriptive cross-sectional study was conducted using an anonymous online questionnaire distributed to ophthalmologists and residents practicing in Morocco. The survey explored anesthetic approaches, instrumentation use, consumable management, postoperative care protocols, awareness of environmental impact, perceived barriers to sustainable implementation, and realistic locally adapted solutions. Data were analyzed descriptively, and open-ended responses underwent qualitative synthesis.

A total of 123 participants completed the survey. Reusable instrumentation was reported by 80.5%, and 74.6% reported reusing phacoemulsification cassettes. More than three postoperative eye drops and follow-up visits were reported by 67.8% and 71.2% of respondents, respectively. Ventilation systems varied, and 37.7% were unaware of their operating room system type. Regarding environmental perception, 30.5% agreed that cataract surgery generates excessive waste. The main barriers identified were lack of training (42.5%) and concerns regarding infection (47.5%). Overall, 93.3% supported the development of national sustainability guidelines.

This first national survey highlights substantial interest among Moroccan ophthalmologists and trainees in advancing sustainable cataract surgery. These findings suggest opportunities to optimize postoperative regimens as part of future sustainability strategies. Structured education and context-adapted national guidelines, supported by local societies and international sustainability initiatives, are essential to enable a safe and progressive environmental transition.Trainee engagement may serve as a catalyst for embedding context-adapted environmental recommendations within national practice and positioning Morocco as a regional contributor to sustainable ophthalmic surgery.