Environmental impact of cataract surgery and strategies for mitigation: a life cycle assessment in an academic hospital.

PURPOSE: To identify the main environmental hotspots of cataract surgery and evaluates strategies to reduce its environmental impact and to compare process-based and monetary value-based methodologies for environmental assessment.

SETTING

Radboud University Medical Center, Nijmegen, 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.