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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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“By contrast, four studies (7,27,33,34) found procurement to be the largest hotspot”
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“with three (7,33,34) specifically identifying single-use items to be largest contributors, responsible for up to 78% of the carbon footprint”
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“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)”
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“and b) procurement of consumables, (27,34)”
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“Allocation methods were explicitly stated by four studies.(7,31,33,34)”
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“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)”
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“and two (7,34) reported limited numerical data, with some sub-process results presented as descriptive or graphical data.”
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“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)”
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“Three studies performed scenario uncertainty tests to model the uncertainty due to methodological assumptions”
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“two (31,34) finding this affected results minimally”
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“whilst Thiel et al. estimated this to be 6kg CO2e in India.(34)”
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Metadata
- 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
- 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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