Quantification of the cost and potential environmental effects of unused pharmaceutical products in cataract surgery
Open accessAbstract
IMPORTANCE: Pharmaceutical products, including unused portions, may contribute to financial and environmental costs in the United States. Because cataract surgery is performed millions of times each year in the United States and throughout the rest of the world, understanding these financial and environmental costs associated with cataract surgery is warranted. OBJECTIVE: To investigate the financial and environmental costs of unused pharmaceutical products after phacoemulsification surgery. DESIGN, SETTING, AND PARTICIPANTS: This descriptive qualitative study included 4 surgical sites in the northeastern United States (a private ambulatory care center, private tertiary care center, private outpatient center, and federally run medical center for veterans). Prices and data for use of services and pharmaceuticals were obtained for the tertiary care and outpatient centers from January 1 through April 30, 2016; for the ambulatory care center from June 1, 2017, through March 31, 2018; and the federal medical center from November 1, 2017, through February 28, 2018. Data were collected from routine phacoemulsification surgical procedures without vitreous loss or other complications. Volume or weight of medications remaining after surgery was measured. Total and mean costs of medications per case and month were calculated. Environmental effects were estimated using economic input-output life cycle assessment methods. Data were analyzed from December 1, 2017, through June 30, 2018. MAIN OUTCOMES AND MEASURES: Cost of unused pharmaceutical products (in US dollars) and kilogram equivalents of carbon emissions (carbon dioxide [CO2-e]), air pollution (fine particulate matter emissions of ≤10 μm in diameter [PM10-e]), and eutrophication potential (nitrogen [N-e]). RESULTS: A total of 116 unique drugs were surveyed among the 4 centers. Assuming unmeasured medications had no materials left unused, a cumulative mean 83 070 of 183 304 mL per month (45.3%) of pharmaceuticals were unused by weight or volume across all sites. Annual unused product cost estimates reached approximately $195 200 per site. A larger percentage of eyedrops (65.7% by volume) were unused compared with injections (24.8%) or systemic medications (59.9%). Monthly unused quantities at the ambulatory care center (65.9% by volume [54 971 of 83 440 mL]), tertiary care center (21.3% [17 143 of 80 344 mL]), federal medical center (38.5% [265 of 689 mL]), and outpatient center (56.8% [10 691 of 18 832 mL]) resulted in unnecessary potential emissions at each center of 2135, 2498, 418, and 711 kg CO2-e/mo, respectively. Unnecessary potential air pollution between sites varied from 0.8 to 4.5 kg PM10-e/mo, and unnecessary eutrophication potential between sites varied from 0.07 to 0.42 kg N-e/mo. CONCLUSIONS AND RELEVANCE: This study suggests that unused pharmaceutical products during phacoemulsification result in relatively high financial and environmental costs. If these findings can be substantiated and shown to be generalizable in the United States or elsewhere, reducing these costs may be of value.
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In more developed countries, unused items and partially used items are thrown away with greater frequency.
“In more developed countries, unused items and partially used items are thrown away with greater frequency.”
From Improving productivity, costs and environmental impact in International Eye Health Services: using the ‘Eyefficiency’ cataract surgical services auditing tool to assess the value of cataract surgical services (2021) · cites this paper as [25]
The Discussion (page not provided) reports that partially used antibiotic eyedrop bottles were discarded at four US cataract-surgery sites. The paper does not establish that unused or partially used items are thrown away more frequently in more developed countries than elsewhere; its findings concern pharmaceuticals at US sites. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSingle-dose eye drops in preoperative and postoperative settings create substantial physical and financial waste and environmental pollution.
“Single-dose eye drops in preoperative and postoperative settings have been found to create substantial physical and financial waste and environmental pollution.31”
From How Ophthalmologists Can Decarbonize Eye Care (2023) · cites this paper as [31]
The Discussion (page unavailable) reports substantial unused eyedrops and drug costs at four cataract-surgery centers; it also discusses potential environmental effects. But the studied drops were generally 5–15 mL bottles opened for one patient, not packaged single-dose drops. The paper suggests that smaller single-dose containers could reduce unused solution, so its findings do not establish that single-dose drops create the claimed waste and pollution. (LLM, conf=0.87)
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Cites
International Organization for Standardization
(2011) · Springer eBooks · doi:10.1007/springerreference_16847 · Cited by 12,502 · see citing works
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
Service, I., & Shirazi, M. A. (2005) · Proceedings of the Water Environment Federation · doi:10.2175/193864705783867675 · Cited by 6,674 · see citing works
Nonpoint Pollution of Surface Waters with Phosphorus and Nitrogen
Carpenter, S. R., Caraco, N. F., Correll, D. L., Howarth, R. W., Sharpley, A. N., & Smith, V. H. (1998) · Ecological Applications · doi:10.1890/1051-0761(1998)008[0559:nposww]2.0.co;2 · Cited by 6,099 · see citing works
Climate change and human health: present and future risks
McMichael, A. J., Woodruff, R. E., & Hales, S. (2006) · The Lancet · doi:10.1016/s0140-6736(06)68079-3 · Cited by 2,585 · see citing works
Bartram, J., & Chorus, I. (1999) · CRC Press eBooks · doi:10.1201/9781482295061 · Cited by 2,581 · see citing works
Health and climate change: policy responses to protect public health
Watts, N., Adger, W. N., Agnolucci, P., Blackstock, J., Byass, P., Cai, W., Chaytor, S., Colbourn, T., Collins, M., Cooper, A., et al. (2015) · The Lancet · doi:10.1016/s0140-6736(15)60854-6 · Cited by 2,055 · see citing works
(1999) · Taylor & Francis eBooks · doi:10.4324/9780203478073 · Cited by 1,556 · see citing works
Environmental impacts of the U.S. health care system and effects on public health
Eckelman, M. J., & Sherman, J. (2016) · PLOS ONE · doi:10.1371/journal.pone.0157014 · Cited by 1,017 · see citing works
The Imperative for Climate Action to Protect Health
Haines, A., & Ebi, K. L. (2019) · New England Journal of Medicine · doi:10.1056/nejmra1807873 · Cited by 939 · see citing works
Short term exposure to air pollution and stroke: systematic review and meta-analysis
Shah, A. S. V., Lee, K. K., McAllister, D. A., Hunter, A., Nair, H., Whiteley, W., Langrish, J. P., Newby, D. E., & Mills, N. L. (2015) · BMJ · doi:10.1136/bmj.h1295 · Cited by 870 · see citing works
Cardiovascular effects of air pollution.
Bourdrel, T., Bind, M.-A., Béjot, Y., Morel, O., & Argacha, J.-F. (2017) · Archives of Cardiovascular Diseases · doi:10.1016/j.acvd.2017.05.003 · Cited by 783 · see citing works
Yang, B., Qian, Z. M., Howard, S. W., Vaughn, M. G., Fan, S.-J., Liu, K.-K., & Dong, G. (2018) · Environmental Pollution · doi:10.1016/j.envpol.2018.01.001 · Cited by 597 · see citing works
(2020) · Clinical ophthalmology · doi:10.2147/opth · Cited by 590 · see citing works
Prevalence of Cataract and Pseudophakia/Aphakia Among Adults in theUnited States
Congdon, N. G., Vingerling, J. R., Klein, R., West, S. K., Friedman, D. S., Kempen, J. H., O'Colmain, B. J., Wu, S., & Taylor, H. R. (2004) · Archives of Ophthalmology · doi:10.1001/archopht.122.4.487 · Cited by 581 · see citing works
Zheng, X.-Y., Ding, H., Jiang, L.-N., Chen, S.-W., Zheng, J.-P., Qiu, M. R., Zhou, Y.-X., Chen, Q., & Guan, W. (2015) · PLoS ONE · doi:10.1371/journal.pone.0138146 · Cited by 438 · see citing works
Thiel, C. L., Eckelman, M., Guido, R., Huddleston, M., Landis, A. E., Sherman, J., Shrake, S. O., Copley-Woods, N., & Bilec, M. M. (2015) · Environmental Science & Technology · doi:10.1021/es504719g · Cited by 416 · see citing works
Self-citationEstimate of the carbon footprint of the US health care sector
Chung, J. W., & Meltzer, D. O. (2009) · JAMA · doi:10.1001/jama.2009.1610 · Cited by 415 · see citing works
Aeroparticles, Composition, and Lung Diseases
Falcón-Rodríguez, C. I., Osornio-Vargas, Á. R., Sada‐Ovalle, I., & Segura-Medina, P. (2016) · Frontiers in Immunology · doi:10.3389/fimmu.2016.00003 · Cited by 388 · see citing works
Associations of Short-Term and Long-Term Exposure to Ambient Air Pollutants With Hypertension
Cai, Y., Zhang, B., Ke, W., Feng, B., Lin, H., Xiao, J., Zeng, W., Li, X., Tao, J., Yang, Z., et al. (2016) · Hypertension · doi:10.1161/hypertensionaha.116.07218 · Cited by 348 · see citing works
Ambient Air Pollution and Pregnancy-Induced Hypertensive Disorders
Pedersen, M., Stayner, L. T., Slama, R., Sørensen, M., Figueras, F., Nieuwenhuijsen, M. J., Raaschou‐Nielsen, O., & Dadvand, P. (2014) · Hypertension · doi:10.1161/hypertensionaha.114.03545 · Cited by 328 · see citing works
Nhung, N. T. T., Amini, H., Schindler, C., Joss, M. K., Điền, T. M., Probst-Hensch, N. M., Pérez, L., & Künzli, N. (2017) · Environmental Pollution · doi:10.1016/j.envpol.2017.07.063 · Cited by 291 · see citing works
Thiel, C. L., Schehlein, E., Ravilla, T., Ravindran, R. D., Robin, A. L., Saeedi, O. J., Schuman, J. S., & Venkatesh, R. (2017) · Journal of Cataract and Refractive Surgery · doi:10.1016/j.jcrs.2017.08.017 · Cited by 265 · see citing works
Self-citationEstimated Global Disease Burden From US Health Care Sector Greenhouse Gas Emissions
Eckelman, M. J., & Sherman, J. D. (2017) · American Journal of Public Health · doi:10.2105/ajph.2017.303846 · Cited by 260 · see citing works
The carbon footprint of cataract surgery
Morris, D. S., Wright, T., Somner, J. E. A., & Connor, A. (2013) · Eye · doi:10.1038/eye.2013.9 · Cited by 238 · see citing works
A meta-analysis of exposure to particulate matter and adverse birth outcomes
Lamichhane, D. K., Leem, J.-H., Lee, J.-Y., & Kim, H.-C. (2015) · Environmental Health and Toxicology · doi:10.5620/eht.e2015011 · Cited by 228 · see citing works
Calderón‐Garcidueñas, L., Leray, E., Heydarpour, P., Torres‐Jardón, R., & Reis, J. J. (2015) · Revue Neurologique · doi:10.1016/j.neurol.2015.10.008 · Cited by 226 · see citing works
Strategies to reduce greenhouse gas emissions from laparoscopic surgery
Thiel, C. L., Woods, N. C., & Bilec, M. M. (2018) · American Journal of Public Health · doi:10.2105/ajph.2018.304397 · Cited by 222 · see citing works
Self-citationIncreasing incidence of cataract surgery: Population-based study
Gollogly, H., Hodge, D. O., Sauver, J. L. S., & Erie, J. C. (2013) · Journal of Cataract & Refractive Surgery · doi:10.1016/j.jcrs.2013.03.027 · Cited by 210 · see citing works
Hehua, Z., Qing, C., Shanyan, G., Qijun, W., & Yuhong, Z. (2017) · Environmental Research · doi:10.1016/j.envres.2017.08.038 · Cited by 201 · see citing works
Hilborn, E. D., & Beasley, V. R. (2015) · Toxins · doi:10.3390/toxins7041374 · Cited by 181 · see citing works
Endophthalmitis Reduction with Intracameral Moxifloxacin Prophylaxis
Haripriya, A., Chang, D. F., & Ravindran, R. D. (2017) · Ophthalmology · doi:10.1016/j.ophtha.2017.01.026 · Cited by 179 · see citing works
Beelen, R. M. J., Hoek, G., Raaschou‐Nielsen, O., Stafoggia, M., Andersen, Z. J., Weinmayr, G., Hoffmann, B. H., Wolf, K., Samoli, E., Fischer, P. H., et al. (2015) · Environmental Health Perspectives · doi:10.1289/ehp.1408095 · Cited by 165 · see citing works
Climate Change — A Health Emergency
Solomon, C. G., & LaRocque, R. C. (2019) · New England Journal of Medicine · doi:10.1056/nejmp1817067 · Cited by 162 · see citing works
Siddika, N., Balogun, H. A., Amegah, A. K., & Jaakkola, J. J. K. (2016) · Occupational and Environmental Medicine · doi:10.1136/oemed-2015-103086 · Cited by 115 · see citing works
Short-Term Exposure to Air Pollution and Cardiac Arrhythmia: A Meta-Analysis and Systematic Review
Song, X., Liu, Y., Hu, Y., Zhao, X., Tian, J., Ding, G., & Wang, S. (2016) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph13070642 · Cited by 78 · see citing works
Luo, C.-M., Zhu, X., Yao, C., Hou, L., Zhang, J., Cao, J., & Wang, A. (2015) · Environmental Science and Pollution Research · doi:10.1007/s11356-015-5188-x · Cited by 77 · see citing works
Carbon footprint and cost–effectiveness of cataract surgery
Venkatesh, R., van Landingham, S. W., Khodifad, A. M., Haripriya, A., Thiel, C. L., Ramulu, P., & Robin, A. L. (2016) · Current Opinion in Ophthalmology · doi:10.1097/icu.0000000000000228 · Cited by 76 · see citing works
Self-citationHospital Supply Expenses: An Important Ingredient in Health Services Research
Abdulsalam, Y., & Schneller, E. S. (2017) · Medical Care Research and Review · doi:10.1177/1077558717719928 · Cited by 65 · see citing works
(2022) · Clinics · doi:10.6061/clinics · Cited by 55 · see citing works
Kowalska, M., & Kocot, K. (2016) · Postępy Higieny i Medycyny Doświadczalnej · doi:10.5604/17322693.1220389 · Cited by 43 · see citing works
A systematic review of arterial stiffness, wave reflection and air pollution
Zanoli, L., Lentini, P. L. M., Granata, A. R. M., Gaudio, A., Fatuzzo, P. M., Serafino, L., Rastelli, S., Fiore, V., D’anca, A., Signorelli, S. S., et al. (2017) · Molecular Medicine Reports · doi:10.3892/mmr.2017.6392 · Cited by 43 · see citing works
Ophthalmology carbon footprint: Something to be considered?
Somner, J., Scott, K. M., Morris, D. S., Gaskell, A., & Shepherd, I. (2008) · Journal of Cataract & Refractive Surgery · doi:10.1016/j.jcrs.2008.09.026 · Cited by 41 · see citing works
Li, C., Fang, D., Xu, D., Wang, B., Zhao, S., Yan, S., & Wang, Y. (2014) · European Journal of Endocrinology · doi:10.1530/eje-14-0287 · Cited by 41 · see citing works
Fine particle‐induced birth defects: Impacts of size, payload, and beyond
Teng, C., Wang, Z., & Yan, B. (2016) · Birth Defects Research Part C Embryo Today Reviews · doi:10.1002/bdrc.21136 · Cited by 38 · see citing works
Morris, J. G. (1999) · Annual Review of Energy and the Environment · doi:10.1146/annurev.energy.24.1.367 · Cited by 37 · see citing works
The profound effect of harmful cyanobacterial blooms: From food-web and management perspectives
Šulčius, S., Montvydienė, D., Mazur‐Marzec, H., Kasperovičienė, J., Rulevičius, R., & Jurgelėnė, Ž. (2017) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2017.07.253 · Cited by 35 · see citing works
Potvin, R. J., & Fisher, B. L. (2016) · Clinical ophthalmology · doi:10.2147/opth.s112080 · Cited by 31 · see citing works
Mehta, S., Armstrong, B. K., Kim, S. J., Toma, H. S., West, J. N., Yin, H., Lu, P., Wayman, L. L., Recchia, F. M., & Sternberg, P. (2011) · Retina · doi:10.1097/iae.0b013e31820039af · Cited by 28 · see citing works
Figgatt, M. C., Hyde, J. B., Dziewulski, D. M., Wiegert, E. J., Kishbaugh, S., Zelin, G., & Wilson, L. R. (2017) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6643a5 · Cited by 22 · see citing works
Jensen, M. K., Nahoopii, R., & Johnson, B. (2014) · JAMA Ophthalmology · doi:10.1001/jamaophthalmol.2014.3248 · Cited by 21 · see citing works
Freitas, L. L., Soriano, E. S., Muccioli, C., Höfling-Lima, A. L., & Belfort, R. (2007) · Current Medical Research and Opinion · doi:10.1185/030079907x242629 · Cited by 21 · see citing works
da Cunha, P. A. F., Shinzato, F. A., Tecchio, G. T., Weber, S. L. P., Brasil, A. A., & Avakian, A. (2013) · Clinics · doi:10.6061/clinics/2013(06)18 · Cited by 18 · see citing works
[THE EFFECT OF AIR POLLUTION ON CARDIOVASCULAR DISEASES].
Solomonica, A. (2017) · PubMed · Cited by 3 · see citing works
Flagged first, then by citations
1 of the 54 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [41]41. Morris JGJ. Harmful algal blooms: an emerging public health problem with possible links to human stress on the environment. Annu Rev Energy Environ. 1999;24(1):367-390. doi:10.1146/annurev.energy.24. 1.367 · DOI
Cited by
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Sherman, J. D., Thiel, C., MacNeill, A., Eckelman, M. J., Dubrow, R., Hopf, H., Lagasse, R., Bialowitz, J., Costello, A., Forbes, M., et al. (2020) · Resources, Conservation and Recycling · doi:10.1016/j.resconrec.2020.104882 · Cited by 327 · see citing works
Self-citationde Santiago, E. R., Dinis-Ribeiro, M. J., Pohl, H., Agrawal, D., Arvanitakis, M., Baddeley, R., Bak, E., Bhandari, P., Bretthauer, M., Burga, P., et al. (2022) · Endoscopy · doi:10.1055/a-1859-3726 · Cited by 229 · see citing works
Drew, J., Christie, S. D., Tyedmers, P., Smith-Forrester, J., & Rainham, D. (2021) · Environmental Health Perspectives · doi:10.1289/ehp8666 · Cited by 191 · see citing works
Environmental footprint of regular and intensive inpatient care in a large US hospital
Prasad, P. A., Joshi, D. K., Lighter, J., Agins, J., Allen, R., Collins, M., Pena, F., Velletri, J., & Thiel, C. L. (2021) · The International Journal of Life Cycle Assessment · doi:10.1007/s11367-021-01998-8 · Cited by 152 · see citing works
Self-citationThe role of the health sector in tackling climate change: A narrative review
Or, Z., & Seppänen, A. (2024) · Health Policy · doi:10.1016/j.healthpol.2024.105053 · Cited by 143 · see citing works
HealthcareLCA: an open-access living database of health-care environmental impact assessments
Drew, J., Christie, S., Rainham, D. G. C., & Rizan, C. (2022) · The Lancet Planetary Health · doi:10.1016/s2542-5196(22)00257-1 · Cited by 142 · see citing works
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The carbon footprint of cataract surgery in a French University Hospital
Ferrero, A., Thouvenin, R., Hoogewoud, F., Marcireau, I., Offret, O., Louison, P., Monnet, D., & Brézin, A. P. (2021) · Journal Français d Ophtalmologie · doi:10.1016/j.jfo.2021.08.004 · Cited by 71 · see citing works
Advancing the Sustainable Development Goals through improving eye health: a scoping review
Zhang, J. H., Ramke, J., Jan, C., Bascarán, C., Mwangi, N., Furtado, J. M., Yasmin, S., Ogundo, C., Yoshizaki, M., Marques, A. P., et al. (2022) · The Lancet Planetary Health · doi:10.1016/s2542-5196(21)00351-x · Cited by 66 · see citing works
Addressing the environmental sustainability of eye health-care delivery: a scoping review
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Barloese, M. C. J., & Petersen, C. L. (2023) · Clinical Imaging · doi:10.1016/j.clinimag.2023.110025 · Cited by 13 · see citing works
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Cameron, T. W., Vo, L. V., Emerson, L. K., Emerson, M., & Emerson, G. G. (2021) · Journal of VitreoRetinal Diseases · doi:10.1177/2474126420984657 · Cited by 13 · see citing works
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Taboun, O. S., Orr, S. M. A., Pereira, A., & Choudhry, N. (2023) · Journal of Cataract & Refractive Surgery · doi:10.1097/j.jcrs.0000000000001204 · Cited by 13 · see citing works
What Would It Mean for Health Care Organizations to Justly Manage Their Waste?
Silva, G. S., & Thiel, C. L. (2022) · The AMA Journal of Ethic · doi:10.1001/amajethics.2022.934 · Cited by 12 · see citing works
Self-citationRahemtulla, K. A., Cheema, M. K., Nickonchuk, T., Guirguis, M., Al Hamarneh, Y. N., & Damji, K. F. (2022) · Canadian Journal of Ophthalmology · doi:10.1016/j.jcjo.2021.06.005 · Cited by 11 · see citing works
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Latham, S., Williams, R. L., Grover, L. M., & Rauz, S. (2023) · Eye · doi:10.1038/s41433-023-02814-3 · Cited by 11 · see citing works
Intravitreal Injections: Improving Sustainability by Reducing Clinical Waste
Birtel, J., Hammer, M., Feltgen, N., Pauleikhoff, L. J. B., Ong, A. Y., Geerling, G., Spitzer, M. S., & Issa, P. C. (2024) · Klinische Monatsblätter für Augenheilkunde · doi:10.1055/a-2184-9492 · Cited by 11 · see citing works
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Morris, B. J., Tauber, J., Rai, A., Thiel, C. L., Geringer, T. J., & Mian, U. K. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22010051 · Cited by 11 · see citing works
Self-citationTracing the barriers to decarbonising ophthalmology: A review
Lam, L., Bradbrook, D., & Gale, J. (2024) · Clinical and Experimental Ophthalmology · doi:10.1111/ceo.14349 · Cited by 10 · see citing works
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Pioche, M., Lambin, T., & Rivory, J. (2021) · Endoscopy International Open · doi:10.1055/a-1546-8975 · Cited by 10 · see citing works
Martin, M. F., & Maturen, K. E. (2020) · Academic Radiology · doi:10.1016/j.acra.2020.04.017 · Cited by 9 · see citing works
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Syah, A. F., & Satato, Y. R. (2024) · Kompak Jurnal Ilmiah Komputerisasi Akuntansi · doi:10.51903/kompak.v17i2.1897 · Cited by 8 · see citing works
Bhatter, P., Cypen, S. G., Carter, S. L., & Tao, J. (2020) · Ophthalmic Plastic and Reconstructive Surgery · doi:10.1097/iop.0000000000001891 · Cited by 8 · see citing works
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Palmer, D. J., Volpe, N. J., & Hackett, N. (2020) · Journal of Cataract & Refractive Surgery · doi:10.1097/j.jcrs.0000000000000184 · Cited by 8 · see citing works
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Winklmair, N., Chang, D. F., & Findl, O. (2024) · Wiener Medizinische Wochenschrift · doi:10.1007/s10354-024-01063-7 · Cited by 7 · see citing works
Alhilali, S. M., Helayel, H. B., & Al-Swailem, S. A. (2025) · Clinical ophthalmology · doi:10.2147/opth.s511472 · Cited by 6 · see citing works
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West, E. (2021) · Veterinary Record · doi:10.1002/vetr.1147 · Cited by 6 · see citing works
Kıyat, P., & Palamar, M. (2025) · International Ophthalmology · doi:10.1007/s10792-025-03604-4 · Cited by 5 · see citing works
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Huang, A., Rao, N., & Armenti, S. T. (2025) · International Ophthalmology Clinics · doi:10.1097/iio.0000000000000560 · Cited by 4 · see citing works
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Oliveira, A. P., & Martínez-Pérez, C. (2025) · Ophthalmology · doi:10.1016/j.ophtha.2025.08.005 · Cited by 4 · see citing works
Kohnen, T. (2022) · Journal of Cataract & Refractive Surgery · doi:10.1097/j.jcrs.0000000000001011 · Cited by 4 · see citing works
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Latham, S., Boddy, L., McClay, T., Airaldi, M., Borgia, A., Cordos, A., Madden, A., Undan, A., Hoffman, J. J. S. L., Sibley, D., et al. (2025) · Eye · doi:10.1038/s41433-025-03747-9 · Cited by 3 · see citing works
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Chang, D. F., & See, W. Y. N. (2025) · Asia-Pacific Journal of Ophthalmology · doi:10.1016/j.apjo.2025.100243 · Cited by 3 · see citing works
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Lee, P. P. (2019) · JAMA Ophthalmology · doi:10.1001/jamaophthalmol.2019.2936 · Cited by 3 · see citing works
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Lam, L., Bacchi, S., Casson, R. J., Pho, A., Vu, Q., & Chan, W. O. (2023) · Clinical and Experimental Ophthalmology · doi:10.1111/ceo.14223 · Cited by 3 · see citing works
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Sukhija, J. S., Kaur, S., Kumari, K., Gupta, K., & Gupta, P. C. (2024) · Indian Journal of Ophthalmology · doi:10.4103/ijo.ijo_2628_23 · Cited by 3 · see citing works
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Nanegrungsunk, O., & Kunavisarut, P. (2025) · Asia-Pacific Journal of Ophthalmology · doi:10.1016/j.apjo.2025.100182 · Cited by 2 · see citing works
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Majmudar, I. P., Kaul, H. R., Aneja, A., McCoy, J. E., Aggarwal, S., Gill, N. P., Mussman, J., Winter, H., Baker, R. O., Palmer, D. J., et al. (2025) · Journal of Cataract & Refractive Surgery · doi:10.1097/j.jcrs.0000000000001670 · Cited by 2 · see citing works
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Yzet, C., Benech, N., Lafeuille, P., Lambin, T., Rivory, J., & Pioche, M. (2022) · Endoscopy · doi:10.1055/a-1774-4589 · Cited by 2 · see citing works
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Buchan, J. C., Thiel, C. L., & Thomas, P. B. M. (2021) · Springer eBooks · doi:10.1007/978-3-030-38234-6_14 · Cited by 2 · see citing works
Self-citationRevue systématique du bilan carbone des interventions chirurgicales
de’Angelis, N., Conso, C., Bianchi, G., Rodríguez, A. G. B., Marchegiani, F., Carra, M. C., Lafont, C., Canouï‐Poitrine, F., Slim, K., & Pessaux, P. (2023) · Journal de Chirurgie Viscérale · doi:10.1016/j.jchirv.2023.02.002 · Cited by 1 · see citing works
Practical strategies for environmentally sustainable practices in gynecologic oncology
Kahramanoğlu, İ., Kacperczyk-Bartnik, J. P., Nout, R. A., Planchamp, F., Sieńko, J., Tanderup, K., Zach, D., & Amant, F. C. (2025) · International Journal of Gynecological Cancer · doi:10.1016/j.ijgc.2025.102648 · Cited by 1 · see citing works
Assessing carbon emissions in oculoplastics: blepharoplasty practices in diverse surgical settings
Lee, M. J., Hu, D. J., Migliori, M. M., & Rizzuto, P. R. (2025) · Orbit · doi:10.1080/01676830.2025.2549093 · Cited by 1 · see citing works
Patient Perspectives on Handling Single-Dose versus Multi-Dose Eye Drops: A Cross-Over Study
Dias, J. A., Silva, J. F., Lopes, N., Cruz, M., & Margarido, P. (2025) · Clinical ophthalmology · doi:10.2147/opth.s521148 · Cited by 1 · see citing works
Kıyat, P., Degirmenci, C., Nalçacı, S., & Palamar, M. (2026) · International Ophthalmology · doi:10.1007/s10792-026-03954-7 · Cited by 1 · see citing works
Kaplan, R. I., Rosen, R. B., & Gentile, R. C. (2020) · Ophthalmology Retina · doi:10.1016/j.oret.2020.03.004 · Cited by 1 · see citing works
Considering the Carbon Footprint of Ophthalmology Conferences
Tauber, J. (2023) · JAMA Ophthalmology · doi:10.1001/jamaophthalmol.2023.3582 · Cited by 1 · see citing works
Self-citationCentro terziario a Bridgeport, Connecticut
Meier, R. (1989) · Zodiac
Surgical waste generated in phacoemulsification versus manual small-incision cataract surgeryPreprint
Zhu, C. Q., & LaMattina, K. C. (2022) · Research Square · doi:10.21203/rs.3.rs-1913337/v1
Positionspapier und Handlungsempfehlungen für eine ökologisch nachhaltige Augenheilkunde
(DOG), D. O. G., & (BVA), B. D. A. D. E. V. (2023) · Klinische Monatsblätter für Augenheilkunde · doi:10.1055/a-2015-1562
Khan, T. A., Rauf, A., Bhatti, S. H., Janjua, T. A., Shahid, M. A. R., & Mukhtar, M. A. (2023) · Pakistan Armed Forces Medical Journal · doi:10.51253/pafmj.v73isuppl-2.9355
Développement durable et écoconception des soins en ophtalmologie : revue de la littérature
Roth, Q., Cuglietta, L., & Sauer, A. (2025) · Journal Français d Ophtalmologie · doi:10.1016/j.jfo.2025.104476
Sustainability and Cataract Surgery
Rao, N. T., & Armenti, S. T. (2025) · Advances in Ophthalmology and Optometry · doi:10.1016/j.yaoo.2025.03.007
Goldburg, S. R., Li, L., Schehlein, E. M., Shukla, A. G., & Qiu, M. (2025) · Journal of Ophthalmology · doi:10.1155/joph/7188835
Godfrey, A. A., Menon, S., Takla, P., Lu, J., Chen, T. A., Bass, O., Brown, M., Indaram, M., & Oatts, J. T. (2025) · Journal of American Association for Pediatric Ophthalmology and Strabismus · doi:10.1016/j.jaapos.2026.105212
EyeSustain: Pioneering specialty-specific sustainability
Rachapudi, S. S., Desai, S., Song, A., & Erny, B. C. (2026) · The Journal of Climate Change and Health · doi:10.1016/j.joclim.2025.100631
Martín-Moro, J. G., Altares-Mateos, V. J., Zarallo-Gallardo, J., & Pascual-Prieto, J. (2026) · Archivos de la Sociedad Española de Oftalmología · doi:10.1016/j.oftal.2026.502550
Martín-Moro, J. G., Altares-Mateos, V. J., Zarallo-Gallardo, J., & Pascual-Prieto, J. (2026) · Archivos de la Sociedad Española de Oftalmología (English Edition) · doi:10.1016/j.oftale.2026.502550
Real and perceived barriers to effective use of cataract surgical supplies
Davie, C., Cloud, L. K., Burris, S., Shiwdin, S., Sherry, B., Prescott, C. R., Schuman, J. S., Palmer, D. J., Chang, D., Parra, D., et al. (2026) · The Journal of Climate Change and Health · doi:10.1016/j.joclim.2026.100664
Self-citationEnvironmental Impact of Cataract Surgery
Zaluski, S. (2026) · Springer eBooks · doi:10.1007/978-3-031-98572-0_120
Hu, D. J., Lee, M. J., Wang, E., Duker, J., Janigian, R., Ducharme, J., Migliori, M., & Rizzuto, P. R. (2026) · Journal Français d Ophtalmologie · doi:10.1016/j.jfo.2026.104932
Nachhaltige medikamentöse Versorgung
Schilcher, A. V., & Geerling, G. (2026) · SDG - Forschung, Konzepte, Lösungsansätze zur Nachhaltigkeit · doi:10.1007/978-3-662-71322-8_8
Scoping review of cataract surgery sterility: data gaps linking sustainability and clinical impact
Vujadinovic, Z., Al-Ani, A., Rawlyk, B., Moore, R. T., Kryshtalskyj, M. T., Klassen, T., McClurg, C., Gooi, P., Roy, M., & Huang, P. (2026) · Journal of Cataract & Refractive Surgery · doi:10.1097/j.jcrs.0000000000002058
- Authors
- Tauber, J., Chinwuba, I., Kleyn, D., Rothschild, M., Kahn, J., & Thiel, C. L.
- Affiliations
- NYU Langone Health (US)
- City University of New York (US)
- Corresponding author
- Thiel, Cassandra L.
- Venue
- JAMA Ophthalmology
- Publisher
- American Medical Association (AMA)
- Published
- 2019-10-01
- Volume
- 137
- Issue
- 10
- Pages
- 1156
- ISSN
- 2168-6165 (ISSN-L)
- PMC
- PMC6681547
- OpenAlex
- W2966685989
- Cited by
- 83
- References
- 54
- Citations by year
- 2026: 8 · 2025: 15 · 2024: 7 · 2023: 16 · 2022: 14 · 2021: 12 · 2020: 9 · 2019: 1
- FWCI
- 3.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Ophthalmology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Environmental Science › Environmental Engineering › Environmental Impact and Sustainability
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare and Environmental Waste Management
- Keywords
- cataract surgery, phacoemulsification, pharmaceutical waste, drug costs, environmental impact of pharmaceuticals, CO2 emissions, PM2.5, eutrophication, life cycle assessment, eye drops, outpatient care, tertiary care hospital
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