Cataract surgery and environmental sustainability: waste and lifecycle assessment of phacoemulsification at a private healthcare facility
Open accessAbstract
PURPOSE: To measure the waste generation and lifecycle environmental emissions from cataract surgery via phacoemulsification in a recognized resource-efficient setting. SETTING: Two tertiary care centers of the Aravind Eye Care System in southern India. DESIGN: Observational case series. METHODS: Manual waste audits, purchasing data, and interviews with Aravind staff were used in a hybrid environmental lifecycle assessment framework to quantify the environmental emissions associated with cataract surgery. Kilograms of solid waste generated and midpoint emissions in a variety of impact categories (eg, kilograms of carbon dioxide equivalents). RESULTS: Aravind generates 250 grams of waste per phacoemulsification and nearly 6 kilograms of carbon dioxide-equivalents in greenhouse gases. This is approximately 5% of the United Kingdom's phaco carbon footprint with comparable outcomes. A majority of Aravind's lifecycle environmental emissions occur in the sterilization process of reusable instruments because their surgical system uses largely reusable instruments and materials. Electricity use in the operating room and the Central Sterile Services Department (CSSD) accounts for 10% to 25% of most environmental emissions. CONCLUSIONS: Surgical systems in most developed countries and, in particular their use of materials, are unsustainable. Results show that ophthalmologists and other medical specialists can reduce material use and emissions in medical procedures using the system described here.
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Four studies found procurement to be the largest hotspot.
“By contrast, four studies (7,27,33,34) found procurement to be the largest hotspot”
From The Carbon Footprint of Surgical Operations (2020) · cites this paper as [34]
The Results (Lifecycle Assessment Results; page not available in our copy) identify sterilization of reusable instruments—not procurement—as the dominant source of emissions in this study. The Discussion says procurement accounts for over 50% of the UK cataract-surgery carbon footprint, but distinguishes that comparison from the study’s Aravind findings. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredThree studies specifically identified single-use items as the largest contributors, responsible for up to 78% of the carbon footprint, with two of these studies referring to the same dataset.
“with three (7,33,34) specifically identifying single-use items to be largest contributors, responsible for up to 78% of the carbon footprint”
From The Carbon Footprint of Surgical Operations (2020) · cites this paper as [34]
The Results (Lifecycle Assessment Results; page unavailable) identify reusable instruments and their sterilization—not single-use items—as responsible for more than half of emissions in most impact categories. Single-use materials contribute the largest share only to ozone depletion. The paper does not report that they account for up to 78% of the carbon footprint. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredFive included studies used a hybrid approach using both EEIO and process-based methodologies; three termed this EIOLCA and one a component analysis study.
“Five studies used a hybrid approach, using both EEIO and process-based methodologies, of which three termed this an 'economic-' or 'environment input-output life cycle assessment (EIOLCA)' (7,33,34) and one a 'component analysis study'.(27)”
From The Carbon Footprint of Surgical Operations (2020) · cites this paper as [34]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThis review found that procurement of consumables is a major carbon hotspot within operating theatres.
“and b) procurement of consumables, (27,34)”
From The Carbon Footprint of Surgical Operations (2020) · cites this paper as [34]
The Discussion reports that procurement of supplies accounts for over 50% of the UK phacoemulsification carbon footprint, supporting its importance in that setting. But the Results identify sterilization of reusable instruments—not consumables—as the largest emissions source at the facility studied, so the paper does not establish procurement as a major carbon hotspot across operating theatres generally. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAllocation methods were explicitly stated by four included studies.
“Allocation methods were explicitly stated by four studies.(7,31,33,34)”
From The Carbon Footprint of Surgical Operations (2020) · cites this paper as [34]
Three included studies used primary process activity data only, one used secondary financial activity data only, and all others used a mixture of data types.
“Three studies used primary process activity data only, (26,31,35) one used secondary financial activity data only (32) and all others used a mixture of data types (Supplementary Table 3).(7,27,33,34)”
From The Carbon Footprint of Surgical Operations (2020) · cites this paper as [34]
Two studies reported limited numerical data, with some sub-process results presented as descriptive or graphical data.
“and two (7,34) reported limited numerical data, with some sub-process results presented as descriptive or graphical data.”
From The Carbon Footprint of Surgical Operations (2020) · cites this paper as [34]
This review found that the carbon footprint of a single operation ranged from 6 kg CO2e for cataract surgery in India to 814 kg CO2e for a robotic hysterectomy in the US.
“This review found that the carbon footprint of a single operation ranged from 6 (for cataract surgery in India) (34) to 814 kg CO2e, (for a robotic hysterectomy in the US),( 7)”
From The Carbon Footprint of Surgical Operations (2020) · cites this paper as [34]
Three studies performed scenario uncertainty tests to model uncertainty due to methodological assumptions.
“Three studies performed scenario uncertainty tests to model the uncertainty due to methodological assumptions”
From The Carbon Footprint of Surgical Operations (2020) · cites this paper as [34]
Two studies found scenario uncertainty affected results minimally.
“two (31,34) finding this affected results minimally”
From The Carbon Footprint of Surgical Operations (2020) · cites this paper as [34]
Thiel et al. estimated the carbon footprint of a cataract operation in India at 6 kg CO2e.
“whilst Thiel et al. estimated this to be 6kg CO2e in India.(34)”
From The Carbon Footprint of Surgical Operations (2020) · cites this paper as [34]
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- Authors
- Thiel, C. L., Schehlein, E., Ravilla, T., Ravindran, R. D., Robin, A. L., Saeedi, O. J., Schuman, J. S., & Venkatesh, R.
- Affiliations
- University of Maryland, Baltimore (US)
- Corresponding author
- Thiel, Cassandra L.
- ORCID
- Venue
- Journal of Cataract and Refractive Surgery
- Published
- 2017-11
- Volume
- 43
- Issue
- 11
- Pages
- 1391-1398
- ISSN
- 0146-2776 (ISSN-L)
- 0886-3350
- PMC
- PMC5728421
- OpenAlex
- W2772246762
- Cited by
- 265
- References
- 23
- Citations by year
- 2026: 29 · 2025: 53 · 2024: 40 · 2023: 39 · 2022: 41 · 2021: 28 · 2020: 18 · 2019: 5 · 2018: 11 · 2016: 1
- FWCI
- 5.21
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of Cataract & Refractive Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Eye Institute (K23EY025014)
- Topics
- Physical Sciences › Environmental Science › Environmental Engineering › Environmental Impact and Sustainability
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare and Environmental Waste Management
- Life Sciences › Immunology and Microbiology › Microbiology › Medical Device Sterilization and Disinfection
- Keywords
- cataract surgery, phacoemulsification, surgical waste, environmental sustainability, carbon footprint, greenhouse gas emissions, sterilization, reusable surgical instruments, resource efficiency
- MeSH terms
- Greenhouse Gases, Cataract, Cataract Extraction, United Kingdom, Humans, Lens, Crystalline, Ophthalmology, Phacoemulsification, Carbon Footprint
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