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J Cataract Refract Surg. 2017 Nov;43(11):1391-1398. doi: 10.1016/j.jcrs.2017.08.017.

Cataract surgery and environmental sustainability: Waste and lifecycle assessment of phacoemulsification at a private healthcare facility.

Author information

1
From the Department of Population Health, Langone Medical Center, and Wagner Graduate School of Public Service (Thiel), New York University, and the Department of Ophthalmology (Schuman), New York University School of Medicine, New York, New York; the University of Maryland School of Medicine (Schehlein), the Department of Ophthalmology (Robin), University of Maryland, the Ophthalmology and International Health (Robin), Johns Hopkins University, and the Department of Ophthalmology and Visual Sciences (Saeedi), University of Maryland Medical Center, Baltimore, Maryland; and Department of Ophthalmology (Robin), University of Michigan, Ann Arbor, Michigan, USA; the Aravind Eye Care System (Ravilla, Ravindran), Tamil Nadu and Aravind Eye Hospital (Venkatesh), Pondicherry, India. Electronic address: cassandra.thiel@nyumc.org.
2
From the Department of Population Health, Langone Medical Center, and Wagner Graduate School of Public Service (Thiel), New York University, and the Department of Ophthalmology (Schuman), New York University School of Medicine, New York, New York; the University of Maryland School of Medicine (Schehlein), the Department of Ophthalmology (Robin), University of Maryland, the Ophthalmology and International Health (Robin), Johns Hopkins University, and the Department of Ophthalmology and Visual Sciences (Saeedi), University of Maryland Medical Center, Baltimore, Maryland; and Department of Ophthalmology (Robin), University of Michigan, Ann Arbor, Michigan, USA; the Aravind Eye Care System (Ravilla, Ravindran), Tamil Nadu and Aravind Eye Hospital (Venkatesh), Pondicherry, India.

Abstract

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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