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Cited by 47Environmental Impact and SustainabilityHealthcare Facilities Design and SustainabilityHealthcare and Environmental Waste Management

How Ophthalmologists Can Decarbonize Eye Care

Open access
Sherry, Brooke, Lee, Samuel, Ramos Cadena, Maria De Los Angeles, Laynor, Gregory, Patel, Sheel R., Simon, Maxine dellaBadia, Romanowski, Eric G., Hochman, Sarah E. +3 more·2023·Ophthalmology
DOI 10.1016/j.ophtha.2023.02.028PMC PMC10293062
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Abstract

Literature review of sustainability interventions in cataract surgery, organized into advocacy and education, pharmaceuticals, process, and supplies and waste.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review maps sustainability interventions for cataract surgery into advocacy/education, pharmaceuticals, process, and supplies/waste domains, and offers decision trees for individual surgeons. It concludes that several interventions are safe, cost-effective, and emissions-reducing, while flagging that evidence is thin or absent for others.

Key findings

  • Health care accounts for roughly 5% of global greenhouse gas emissions and about 8.5% of US emissions; in high-income countries most cataract-surgery emissions come from manufacturing and distributing single-use supplies.
  • Pharmaceutical waste is large: with 3.8 million US cataract procedures annually, medications worth about $560 million are discarded. Multi-dose protocols saved roughly $240,000 per institution over 5 years and cut disposed bottles by 97%; single-use dilating drops cost about 4 times more per milliliter, and single-use drops up to 3 times more overall.
  • Waste-sorting education produced a 10.3% saving in sharps disposal costs at Mayo Clinic (where 57% of surveyed clinicians did not know what was recyclable), and another program raised recycling participation by 409%. Reusable gown systems showed 28% less energy use, 30% fewer GHG emissions, 41% less blue water consumption, and 93% less solid waste than disposables; Marysville Surgical Center saved $32,000 annually by trimming custom packs.
  • Immediate sequential bilateral cataract surgery cut the time for two procedures by an average of 16% and reduces travel-related emissions (average health-care travel time 34 minutes); infection risk is considered low with intracameral antibiotics.

Methods

  • Literature review searching PubMed, SCOPUS, and Cochrane Library for articles on specific sustainability interventions, supplemented by hospital/health-system websites and reports; titles and abstracts were screened and full texts evaluated.
  • Interventions were generated from prior literature and field observation and organized using a "rethink, reduce, reuse, recycle" framework into advocacy, education, pharmaceuticals, process, supplies, and waste domains, restricted to actions clinical personnel could take.
  • Each intervention was qualitatively rated on a 3-point scale (generally positive, neutral, or negative) for GHG impact, hospital effort, and financial impact; decision-support charts were built for supply and pharmaceutical choices, prioritizing reduction first. No IRB approval or consent was needed for this review.

Limitations

  • Stated: the literature was lacking on benefits/risks for some interventions (e.g., switching single-use supplies to reusables, hub-and-spoke operating room models); many advocacy and education interventions have inadequate ophthalmology-specific evidence; contamination studies come from international settings and may not represent US practice; no prospective randomized trials compare reusable with single-use gowns, and evidence on reusable draping and infection is limited; no literature was found on emissions from ophthalmic anesthesia or on full-body versus face drapes.
  • Evident from the text: the impact/effort/financial ratings are the authors' qualitative judgments rather than measured outcomes, and the review reports no primary data or life-cycle assessment of its own.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.ophtha.2023.02.028

Cites

106 of 106 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

17 of 59 cited sources checked · 6 supported · 2 flagged · accuracy not yet measured

  • Findingcitation

    Wu et al showed through video recordings and bacterial cultures the efficacy and safety of multi-dose preoperative eye drops administered by properly trained ophthalmic technicians.

    “Wu et al 35 showed through video recordings and bacterial cultures the efficacy and safety of multi-dose preoperative eye drops administered by properly trained ophthalmic technicians.85”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [35] Wu, 2021, A videographic evaluation of eyedrop administration by ophthalmic technicians, Ophthalmology source
    • cites [85] Daehn, 2021, Contamination of multi dose eyedrops in the intra and perioperative context, Sci Rep source

      The Methods (Ophthalmic medications; page unavailable) describe intraoperative drops administered by trained nurses or surgeons, not preoperative drops administered by ophthalmic technicians. The Discussion (page unavailable) reports contamination despite professional use and recommends single-dose drops, contrary to the claimed demonstration of multi-dose safety. The paper does not describe video recordings. (LLM, conf=0.89)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Interpretationcitation

    Endophthalmitis studies at Aravind Eye Care System raise the possibility that many costly and wasteful infection control protocols used by operating rooms in the United States could be unnecessary.

    “Endophthalmitis studies at Aravind Eye Care System raise the possibility that many of the costly and wasteful infection control protocols used by operating rooms in the United States could be unnecessary.39”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [39] Haripriya, 2017, Endophthalmitis reduction with intracameral moxifloxacin prophylaxis: analysis of 600 000 surgeries, Ophthalmology source

      The discussion of cost-saving practices (page not provided) reports a low endophthalmitis rate at Aravind despite reuse of supplies that would not be allowed in North America. That raises the possibility behind the claim, but the paper does not assess US operating-room protocols or establish that many are costly, wasteful, or unnecessary. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
  • Findingcitation

    Literature increasingly supports the use of immediate sequential bilateral cataract surgery for its benefits in providing faster patient rehabilitation and cost and time savings.

    “Although this practice has been widely debated, literature increasingly supports the use of ISBCS for its benefits in providing faster patient rehabilitation and cost and time savings.105”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [105] Bhalla, 2021, Immediate sequential bilateral cataract surgery and its relevance in COVID-19 era, Indian J Ophthalmol source
  • Findingcitation

    With 3.8 million cataract procedures performed every year in the United States, medications potentially totaling $560 million are needlessly discarded.

    “With 3.8 million cataract procedures performed every year in the United States, medications potentially totaling $560 million are needlessly discarded.76,77”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [76] Palmer, 2022, for the Ophthalmic Instrument Cleaning and Sterilization Task Force. Reducing Topical Drug Waste in Ophthalmic Surgery Multi-society Position Paper, Journal of Cataract & Refractive Surgery source
    • cites [77] Kauh, 2016, Geographic variation in the rate and timing of cataract surgery among US communities, JAMA Ophthalmol source

      The Results report cataract surgeries among enrollees in a managed-care network, not an annual US total. Searches for 3.8 million procedures and $560 million in discarded medications found no passage addressing either figure or medication waste; the cited paper cannot verify this claim. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
  • Findingcitation

    Shah et al demonstrated that with immediate sequential bilateral cataract surgery, it is possible to achieve an average 16% reduction in the time taken to perform 2 cataract surgeries.

    “Shah et al 109 demonstrated that with ISBCS, it is possible to achieve an average 16% reduction in the time taken to perform 2 cataract surgeries.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [109] Shah, 2020, Acceptability of immediate sequential bilateral cataract surgery (ISBCS) in a public health care setting before and after COVID-19: a prospective patient questionnaire survey, BMJ Open Ophthalmol source

      The Introduction (page unavailable) says ISBCS has the potential to increase surgical efficiency by reducing operating-room transfer and preparation times. It does not report an average 16% reduction in the time to perform two surgeries, nor demonstrate that reduction in this questionnaire survey. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 7
  • May combine two claims. 26
  • The quote only partly states this claim. 3

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the United States, approximately 9% of toxic air pollutants come from health care.

    “including 9% of the toxic air pollutants in the United States.21”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [21] Eckelman, 2016, Environmental impacts of the U.S. health care system and effects on public health, PLoS One source

      The Results (Non-GHG Emissions, Table 2) attribute about 9% of the national total to particulate matter, not toxic air pollutants. They report 1.0% for carcinogenic and 2.2% for non-carcinogenic air toxics. (LLM, conf=0.94)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    There is substantial variability in waste generation and emissions from cataract surgery in different countries, suggesting improvements are possible.

    “There is substantial variability in waste generation and emissions from cataract surgery in different countries, suggesting improvements are possible.29,33,39”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [29] Goel, 2021, 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, BMJ Open Ophthalmol source
    • cites [33] Venkatesh, 2016, Carbon footprint and cost–effectiveness of cataract surgery, Curr Opin Ophthalmol source
    • cites [39] Haripriya, 2017, Endophthalmitis reduction with intracameral moxifloxacin prophylaxis: analysis of 600 000 surgeries, Ophthalmology source

      The discussion (section labeled “z”; page unavailable) says that disposable supplies are reused at the Indian hospitals and that some cost-saving practices would not be allowed in North America or Western Europe. It does not compare cataract-surgery waste generation or emissions across countries. Searches for waste, emissions, and carbon footprint found no passage addressing that claim. (LLM, conf=0.74)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    For eye care, climate change will likely increase ocular trauma, vector-borne diseases such as trachoma and onchocerciasis, and diseases affected by exposure to heat, ultraviolet radiation, ozone, and other environmental pollutants.

    “For eye care, climate change will likely increase ocular trauma (from extreme weather events), vector-borne diseases, such as trachoma 4e6 and onchocerciasis 7,8 ; and diseases affected by exposure to heat, ultraviolet radiation, ozone, and other environmental pollutants.9e17”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites 4e6

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [7] Cheke, 2015, Potential effects of warmer worms and vectors on onchocerciasis transmission in West Africa, Philos Trans R Soc B Biol Sci source

      The transmission-model section (page unavailable) projects increasing onchocerciasis transmission potential and worm loads as temperature rises in a Ghanaian savannah-vector scenario. But the Discussion (page unavailable) calls the paper’s results inconclusive and conflicting, so it does not establish that climate change will likely increase onchocerciasis generally. The other conditions in the citing sentence have separate citations and are not assessed against this source. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [8] Kalkstein, 1993, The impact of climate change on human health: Some international implications, Experientia source
    • cites 9e17

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    Compared with the disposable gown system, the reusable gown system showed a 28% reduction in energy consumption, a 30% reduction in greenhouse gas emissions, a 41% reduction in blue water consumption, and a 93% reduction in solid waste generation.

    “Compared with the disposable gown system, the reusable gown system showed a 28% reduction in energy consumption, a 30% reduction in GHG emissions, a 41% reduction in blue water consumption, and a 93% reduction in solid waste generation.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [112] Vozzola, 2018, Environmental considerations in the selection of isolation gowns: a life cycle assessment of reusable and disposable alternatives, Am J Infect Control source

  • May combine two claims.

    Findingcitation

    Tsegaw et al reported a contamination rate of 11%, all of it being from the dropper's tip and none from the residual solution of the dropper.

    “Tsegaw et al 93 reported a contamination rate of 11%, all of it being from the dropper's tip and none from the residual solution of the dropper.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [93] Tsegaw, 2017, Bacterial contamination of multi-dose eye drops at ophthalmology department, University of Gondar, Northwest Ethiopia, Middle East Afr J Ophthalmol source

  • May combine two claims.

    Premisecitation

    Single-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”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [31] Tauber, 2019, Quantification of the cost and potential environmental effects of unused pharmaceutical products in cataract surgery, JAMA Ophthalmol source

      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)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Numerous studies have proven immediate sequential bilateral cataract surgery to be more cost-effective and efficient.

    “Numerous studies have proven ISBCS to be more cost-effective and efficient.105,107,108”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [105] Bhalla, 2021, Immediate sequential bilateral cataract surgery and its relevance in COVID-19 era, Indian J Ophthalmol source
    • cites [107] Leivo, 2011, Simultaneous bilateral cataract surgery: economic analysis; Helsinki Simultaneous Bilateral Cataract Surgery Study Report 2, J Cataract Refract Surg source
    • cites [108] Alio, 2022, Immediate bilateral sequential cataract surgery, Arch Soc Esp Oftalmol (Engl Ed) source

  • May combine two claims.

    Findingcitation

    Improper use appears to be the main cause of contamination, with increased risks when the application time period is increased, untrained staff handle the drops, and the eye drops are used on a larger number of patients.

    “Improper use appears to be the main cause of contamination, with increased risks when the application time period is increased, untrained staff handle the drops, and the eye drops are used on a larger number of patients.85”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [85] Daehn, 2021, Contamination of multi dose eyedrops in the intra and perioperative context, Sci Rep source

      The Introduction and Discussion (page numbers unavailable) attribute contamination chiefly to improper use and say contamination increases with time of use. The paper does not establish increased risk from untrained staff or use on more patients: the Methods say only trained personnel applied the drops, and the Discussion says the number of patients was not recorded. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims. The quote only partly states this claim.

    Findingreasoning

    Reducing the number of supplies used during surgery is a safe, cost-effective, and environmentally friendly intervention.

    “These include dispensing medications at home to patients after surgery, multi-dosing appropriate medications, training staff to properly sort medical waste, reducing the number of supplies used during surgery, and implementing immediate sequential bilateral cataract surgery where clinically appropriate.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Proper waste sorting and recycling in operating rooms can have a positive environmental and financial impact, but several barriers to operating room recycling exist.

    “Proper waste sorting and recycling in operating rooms can have a positive environmental and financial impact, but several barriers to operating room recycling exist.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Training staff to properly sort medical waste is a safe, cost-effective, and environmentally friendly intervention.

    “These include dispensing medications at home to patients after surgery, multi-dosing appropriate medications, training staff to properly sort medical waste, reducing the number of supplies used during surgery, and implementing immediate sequential bilateral cataract surgery where clinically appropriate.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Existing literature shows certain sustainability interventions may be safe, cost-effective, and environmentally friendly.

    “Existing literature shows certain interventions may be safe, costeffective, and environmentally friendly.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingreasoning

    Multi-dosing appropriate medications is a safe, cost-effective, and environmentally friendly intervention.

    “These include dispensing medications at home to patients after surgery, multi-dosing appropriate medications, training staff to properly sort medical waste, reducing the number of supplies used during surgery, and implementing immediate sequential bilateral cataract surgery where clinically appropriate.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Implementing immediate sequential bilateral cataract surgery where clinically appropriate is a safe, cost-effective, and environmentally friendly intervention.

    “These include dispensing medications at home to patients after surgery, multi-dosing appropriate medications, training staff to properly sort medical waste, reducing the number of supplies used during surgery, and implementing immediate sequential bilateral cataract surgery where clinically appropriate.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingreasoning

    Dispensing medications at home to patients after surgery is a safe, cost-effective, and environmentally friendly intervention.

    “These include dispensing medications at home to patients after surgery, multi-dosing appropriate medications, training staff to properly sort medical waste, reducing the number of supplies used during surgery, and implementing immediate sequential bilateral cataract surgery where clinically appropriate.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Studies have found that the use of reusable surgical gowns reduces greenhouse gas emissions and solid waste generation while also providing superior protection and durability compared with single-use gowns.

    “Studies have found that the use of reusable surgical gowns reduces GHG emissions and solid waste generation while also providing superior protection and durability compared with single-use gowns.111”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [111] Wyssusek, 2019, Operating room greening initiatives – the old, the new, and the way forward: a narrative review, Waste Manage Res source

  • May combine two claims.

    Findingcitation

    Patients at Aravind Eye Hospital wear their own clothes for cataract surgery with no significant difference in rates of endophthalmitis, and the lack of gowning is practiced already in some US facilities.

    “Patients at Aravind Eye Hospital wear their own clothes for cataract surgery with no significant difference in rates of endophthalmitis, and the lack of gowning is practiced already in some US facilities.46”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [46] Thiel, 2022, Differences in reuse of cataract surgical supplies and pharmaceuticals based on type of surgical facility, J Cataract Refract Surg source

  • May combine two claims.

    Findingcitation

    Aravind Eye Hospital uses reusable surgical gowns and other linens along with numerous other sustainable practices with surgical outcomes that are equivalent to Western countries.

    “Aravind Eye Hospital uses reusable surgical gowns and other linens along with numerous other sustainable practices with surgical outcomes that are equivalent to Western countries.46”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] Thiel, 2022, Differences in reuse of cataract surgical supplies and pharmaceuticals based on type of surgical facility, J Cataract Refract Surg source

  • May combine two claims.

    Findingcitation

    A 2022 study found multi-dose preoperative and preinjection eyedrop protocols saved approximately $240,000 per institution over a 5-year period and led to a 97% reduction in the number of bottles disposed.

    “A 2022 study found multi-dose preoperative and preinjection eyedrop protocols saved approximately $240 000 per institution over a 5-year period and led to a 97% reduction in the number of bottles disposed.81”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [81] Berkowitz, 2022, Potential cost savings associated with a multiuse preoperative and preinjection eyedrop protocol, Ophthalmology source

  • May combine two claims.

    Findingcitation

    Virani et al collected multi-dose eyedrops used long term (37 days to 54 days), and none of the eye drop solutions had any growth on any culture media after 14 days.

    “Virani et al 92 collected multi-dose eyedrops used long term (37 days to 54 days), and the eye drop solution was cultured for assessment of microbial contamination.They showed that none of the eye drop solutions had any growth on any culture media after 14 days.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [92] Virani, 2016, microbiological safety of using eye drops after one month: contamination is a rule or mere regulation?, Delhi J Ophthalmol source

  • May combine two claims.

    Findingreasoning

    Although the financial benefit of preference card standardization has been clearly demonstrated, the environmental impact remains more nebulous.

    “Although the financial benefit of preference card standardization has been clearly demonstrated, the environmental impact remains more nebulous.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Many advocacy and education interventions have inadequate literature specific to ophthalmology but are likely to have minimal risks.

    “Many of the advocacy and education interventions have inadequate literature specific to ophthalmology but are likely to have minimal risks.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Globally, health care emits approximately 5% of greenhouse gases.

    “Globally, health care emits approximately 5% of GHGs.18”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Karliner, 2019

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the United States, health care is responsible for approximately 8.5% of greenhouse gas emissions.

    “In the United States, health care is responsible for approximately 8.5% of greenhouse gas (GHG)”
    • Also stated in: § Abstract · plain
      “approximately 8.5% of the total GHG emissions come from the health sector.19e21”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 19e21

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Climate change is causing an increase in immediate health threats from drought and fire, flooding and storms, and tick- and mosquito-borne diseases.

    “Climate change is causing an increase in immediate health threats from drought and fire, flooding and storms, and tick-and mosquito-borne diseases.1e3”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 1e3

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    This literature comes from other international settings and may not be representative of a US case.

    “However, this literature comes from other international settings and may not be representative of a US case.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In June 2022, the Centers for Medicare & Medicaid Services clarified that only injectable vials are subject to the 28-day expiration date, unless otherwise noted by the manufacturer, and that eyedrops can be used multi-dose on multiple patients with aseptic application techniques, proper storage, and manufacturer multi-dose labeling.

    “In June 2022, the Centers for Medicare & Medicaid Services clarified that only injectable vials are subject to this expiration date, unless otherwise noted by the manufacturer, and that eyedrops can be used multi-dose on multiple patients with aseptic application techniques, proper storage, and manufacturer multi-dose labeling.91”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [91] Updated Guidance for Ambulatory Surgical Centers - Appendix L of the State Operations Manual (SOM), Memo#QSO-11-16-ASC, 2022. Available at: https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/updated-guidance-ambulatory-surgical-centers-appendix-l-state-operations-manual-som.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    Despite the limitations of existing literature, there is sufficient evidence that reducing environmental emissions in the operating room is achievable and cost-efficient.

    “Despite the limitations of existing literature, there is sufficient evidence that reducing environmental emissions in the operating room is achievable and cost-efficient.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Research suggests that climate action and activism build resilience, helping to stave off climate-related anxiety and depression.

    “Although addressing the climate crisis may still feel overwhelming for the individual clinician, research suggests that climate action and activism build resilience, helping to stave off climate-related anxiety and depression.122e124”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 122e124

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    For surgeons in higher-volume settings, a hub-and-spoke model of surgery could improve operational efficiency and reduce emissions associated with energy consumption.

    “For surgeons in higher-volume settings, a hub-and-spoke model of surgery could improve operational efficiency and reduce emissions associated with energy consumption.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: US regulations require multiple operating rooms for different patients in a hub-and-spoke model.
30 of 30

  • The paper relies on this without support.

    Cataract surgery is one of the most commonly performed operations worldwide, and global need will continue to increase with a growing and aging population.

    “Cataract surgery, for example, is one of the most commonly performed operations worldwide, and the global need will continue to increase with a growing and aging population.”

  • The paper relies on this without support.

    Unused surgical supplies are routinely discarded in operating rooms, which significantly contributes to waste and the overall carbon footprint.

    “Unused surgical supplies are routinely discarded in operating rooms, which significantly contributes to waste and the overall carbon footprint.”

  • The paper relies on this without support.

    In the United States, both surgeries in immediate sequential bilateral cataract surgery are treated as separate cases for infection control purposes.

    “However, there is typically a limited reduction in supplies used because, in the United States, both surgeries are treated as separate cases for infection control purposes.”

  • The paper relies on this without support.

    US regulations require multiple operating rooms for different patients in a hub-and-spoke model.

    “Aravind has patients within the same operating room on 2 separate tables, but regulations in the United States would require multiple operating rooms for different patients.”
4 of 4

Cites

Flagged first, then by citations

10 of the 116 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Morris, 2013, The carbon footprint of cataract surgery, Eye (Lond), 27, 495, 10.1038/eye.2013.9 · DOI · Paper page
  2. Larsson C, Orvehed M. Carbon offsetting, a new form of CO2lonialism?: Local implications of tree-planting projects in East Africa. Student thesis. 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-45657. Accessed 11/06/2021.
  3. Daehn, 2021, Contamination of multi dose eyedrops in the intra and perioperative context, Sci Rep, 11, 1, 10.1038/s41598-021-99892-8 · DOI · Paper page

Cited by

Sorted by citations

Related

Authors
Sherry, B., Lee, S., Ramos Cadena, M. D. L. A., Laynor, G., Patel, S. R., Simon, M. D., Romanowski, E. G., Hochman, S. E., Schuman, J. S., Prescott, C., & Thiel, C. L.
Affiliations
  • NYU Langone Health (US)
  • University of Pittsburgh (US)
Corresponding author
Thiel, Cassandra L.
ORCID
Venue
Ophthalmology
Publisher
Elsevier BV
Published
2023-07
Volume
130
Issue
7
Pages
702-714
ISSN
0161-6420 (ISSN-L)
DOI
10.1016/j.ophtha.2023.02.028
PMC
PMC10293062
OpenAlex
W4323308919
Cited by
47
References
116
Citations by year
2026: 12 · 2025: 22 · 2024: 9 · 2023: 4
FWCI
1.07
Type
journal article
Language
en
Open access
Licence
Locations
  • Ophthalmology (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Science Foundation
  • Patrick and Catherine Weldon Donaghue Medical Research Foundation
  • Massachusetts General Hospital
  • Children's Hospital of Philadelphia
  • Stryker
  • South China University of Technology
  • National Institutes of Health (1r56ey033779-01a1)
  • Leonard N. Stern School of Business, New York University
  • National Eye Institute (R56 EY033779)
Topics
  • Physical Sciences › Environmental Science › Environmental Engineering › Environmental Impact and Sustainability
  • Social Sciences › Urban Studies › Healthcare Facilities Design and Sustainability
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare and Environmental Waste Management
Keywords
cataract surgery, decarbonization, greenhouse gas emissions, sustainability interventions, environmental impact of healthcare, bilateral cataract surgery
MeSH terms
Ophthalmologists, Cataract, Cataract Extraction, Humans, Lens, Crystalline, Ophthalmology

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

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