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  • Reducing the Carbon Footprint of Cataract Surgery

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
    Cataract/Anterior Segment
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    Journal Highlights

    Ophthalmology, July 2023

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    Cataract surgery, the most commonly performed ophthalmic operation, is a contributor to carbon emissions and overall waste. Sherry et al. reviewed published literature to explore the ben­efits and risks of sustainability methods used in health care, from which they created decision trees for surgeons. They found some strategies to be safe, cost-effective, and environmentally friendly and noted that others lacked risk-benefit data.

    The authors began by generating a list of interventions relevant to cataract surgery—based on published literature and field observations. They applied the “rethink, reduce, reuse, recycle” frame­work to organize the potential inter­ventions. Categories included advocacy, education, pharmaceuticals, supplies, waste, and process changes. They fo­cused on environmental sustainability tactics that could be enacted by sur­geons, nurses, pharmacists, and other clinical personnel. For each interven­tion, the authors reviewed published findings to ascertain any known impact on emissions, costs, safety, and clini­cal outcomes; they also documented gaps in the literature. In addition, they sought to capture health-system websites and reports that specified benefits or challenges of adopting a particular intervention.

    The analyses showed evidence of the safety, cost-effectiveness, and/or environmental viability of various interventions. These include multi-patient dosing of applicable intra- and perioperative medications; allowing post-op patients to take home their unfinished medicines; training staff to properly sort medical waste; re­ducing the amount of supplies used during surgery; and perform­ing immediate sequential bilateral cataract surgery in appropriate patients. Benefits or risks were not stated for some strategies, such as switching single-use supplies to reusable materials or implementing a hub-and-spoke surgical model. Ophthalmology-spe­cific details were unavailable for many advocacy and education strategies, but the risks of these should be minimal, said the authors.

    “Which interventions will work best must be determined by the individual stakeholders at each hospital or health system,” noted the authors. They affirmed that, despite the literature limitations, there is ample evidence of the feasibility and cost-effectiveness of reducing emissions in the OR.

    The original article can be found here.