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  • Cataract/Anterior Segment, Comprehensive Ophthalmology

    Review of: Potential environmental effect of reducing the variation of disposable materials used for cataract surgery

    Winklmair N, Kieselbach G, Bopp J, et al. Journal of Cataract & Refractive Surgery, June 2023

    The healthcare sector is thought to be responsible for approximately 5%–10% of greenhouse gas emissions worldwide. Austrian investigators sought to ascertain the amount and type of waste generated by disposable materials used during cataract surgery.

    Study design

    This cross-sectional study examined cataract package components from 3 different Austrian hospitals. Disposable components (e.g., surgical gowns, swabs, cannulas, phaco knives) were separated out and weighed. This information, combined with sales figures from the main cataract package suppliers in Austria (reflecting 94% of the trade), was used to estimate the carbon footprint of all cataract packages sold in Austria in 2021.


    The average weight of the disposable materials per package was 0.74 kg, translating to 2.3 kg of CO2 equivalent. Fifty-two percent of the weight came from drapes and covers, and approximately 30% came from surgical gowns. The full cataract packages themselves weighed between 0.5 kg and 1.2 kg, indicating variability in package composition.


    The carbon footprint was extrapolated by measuring only the disposables in the cataract package, and therefore may not be completely accurate regarding the true carbon footprint. A larger sample taken from outside the 3 hospitals may show that the components of the packages are more consistent than those analyzed in this study.

    Clinical significance

    The environmental impact of cataract surgery varies greatly from country to country due to the use of disposable vs nondisposable materials. Even in the 3 Austrian hospitals in the study, the weight of the cataract packages varied greatly, with the lightest package being 57% lighter than the heaviest package, and the drape size varied by 71%. While the use of nondisposable instruments and gowns has been shown to be safe for patients, a simple change to standardize drape size could have an immediate impact on the CO2 emissions caused by cataract surgery in just one country. Given the number of cataract surgeries done worldwide each year, these smaller changes could not only reduce the environmental effects but also provide cost savings.

    Financial disclosures: Dr. Leela Raju discloses financial relationships with RPS Diagnostics (Equity/Stock Holder - Private).