Small Changes for a Necessary Shift

The paradigm shift towards a sustainable practice can happen incidentally just by optimizing resources with small, thoughtful adjustments, according to Pei-Fen Lin MD.

Sustainability in healthcare has become an increasingly important concept, particularly in cataract surgery. Many practical ideas to reduce waste and costs have been designed and put in place to make ophthalmic practice greener. However, implementing sustainable practices has financial and human costs, including changes in management and research efforts.

According to Dr Lin, it is a matter of balancing sustainability with affordability, and sometimes this can happen by accident.

“We became sustainable warriors just by implementing a digital solution to our practice,” Dr Lin said. 

Change began with the COVID-19 pandemic and the challenges it posed to ophthalmic practice, she explained. Cataract services were the first to be shut down and the last to be restarted. Especially in densely populated areas like Croydon in South London, it was particularly difficult to provide cataract services.

In the absence of sufficient funds and by using existing resources and digital technologies for consultation and imaging, her team reduced patient visits from five to one, especially for follow-up visits. This significantly reduced travel, face-to-face appointments, and carbon emissions. They calculated that by switching to a more extensive use of a digital solution, they saved more than 6,000 trees over five years.

Sometimes sustainability is not very high on the agenda of hospital management, so part of the challenge is to convince them that sustainable solutions are efficient, particularly from a financial standpoint, Dr Lin emphasized.

The period immediately after the pandemic saw a steady increase in cataract referrals and attendance. Venues such as public hospitals shifted to using digital technology in the cataract pathway to help process more patients without building new rooms or hiring new staff to accommodate increases in in-person appointments, leading to greater time and cost savings.

Digital tools and strategies are therefore extremely useful and cost effective because they help practitioners streamline existing resources to reduce environmental impact without incurring additional costs. For example, a clinic could stop printing patient leaflets that often get thrown away and switch to electronic instructions, an app, or short videos.

Finally, Dr Lin said the sustainability shift is not exclusive to patient resources, as surgeon training appears to have an environmental impact. A trainee surgeon generates a greater carbon footprint (almost 60% more) than a senior surgeon for cataract surgery since they take more time, are more likely to break equipment, and require extra material. Reviewing existing digital simulation programmes for training can help tackle such carbon waste.

Even the smallest change is useful, Dr Lin added, as it helps shift the existing paradigm, finding the minimum viable product to step into sustainability.

“What can you do to start reducing carbon footprint? Just finish work on time! You switch the lights of your office off, and you have started reducing waste already,” she concluded.

Dr Lin spoke at the 2025 ESCRS Annual Congress in Copenhagen.

Pei-Fen Lin MD is a leading consultant ophthalmic surgeon at Moorfields Eye Hospital, London, UK. p.lin@nhs.net