Emma J Kooistra, Laura Golsteijn, Egid M van Bree, Sjoerd Elferink, Evelyn A Brakema, Floris Hermeling, Pleun Hemelaar, Anne Ottenbros, Niels Crama, Rosalie van Zelm, Hugo R Touw, Tim Stobernack
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Abstract
Purpose: The healthcare sector significantly contributes to environmental challenges. Cataract surgery, as one of the most frequently performed procedures worldwide, presents an opportunity to address these challenges. This study identifies the main environmental hotspots of cataract surgery and evaluates strategies to reduce its environmental impact. A secondary objective was to compare process-based and monetary value-based methodologies for environmental assessment.
Setting: Academic hospital in the Netherlands.
Design: Cradle-to-grave Life Cycle Assessment (LCA) following ISO 14040/44 guidelines.
Methods: The environmental impact of phacoemulsification cataract surgery was assessed, including all processes, products, and equipment used in the operating room. Key contributors to human health and ecosystem damage were identified. A monetary value-based analysis was performed using the same inventory data to compare methodological approaches.
Results: Disposables (35%) and patient travel (31%) were the largest contributors to the environmental impact. Immediate sequential bilateral cataract surgery (ISBCS) reduced the impact by 19%, and simplifying surgical kits achieved a 10% reduction. Additional reductions were observed with renewable energy (-12%) and sustainable transportation (-8%). The monetary value-based approach yielded a fourfold higher carbon footprint than the process-based LCA, while identifying similar hotspots.
Conclusions: The main environmental hotspots of cataract surgery were patient travel and disposable products. The most effective mitigation strategy to reduce the carbon footprint is implementing ISBCS. Additional mitigation strategies include reducing the use of disposable products, encouraging sustainable travel options, and switching to renewable energy. These findings highlight opportunities for ophthalmologists to contribute to more sustainable surgical care.
期刊介绍：
The Journal of Cataract & Refractive Surgery (JCRS), a preeminent peer-reviewed monthly ophthalmology publication, is the official journal of the American Society of Cataract and Refractive Surgery (ASCRS) and the European Society of Cataract and Refractive Surgeons (ESCRS).
JCRS publishes high quality articles on all aspects of anterior segment surgery. In addition to original clinical studies, the journal features a consultation section, practical techniques, important cases, and reviews as well as basic science articles.
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