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Surgery’s impact on environment

Practice changes needed to address unsustainability of current systems.

Cheryl Guttman Krader

Posted: Friday, May 1, 2020

Although a number of advantages can be listed for using single-use disposable instruments in cataract surgery, their impact on the environment must also be considered, said Juan José Mura MD, MHA, at the 37th Congress of the ESCRS in Paris, France.

“Technology can be evaluated with different views,” said Dr Mura, Centro de la Visión, Clínica Las Condes, Santiago, Chile.

“The word disposable does not mean that the object will disappear. It has to go somewhere else. Therefore, the use of new disposable technology must be associated with a recycling strategy, and that is our responsibility. We and the industry should take care of that need together.”

Putting the problem of waste generation from use of disposable materials in cataract surgery into perspective, Dr Mura discussed the economic costs, impact on marine life and adverse health consequences of plastic pollution. In addition, he cited a published study that analysed waste generation and life cycle environmental emissions from cataract surgery via phacoemulsification at the Aravind Eye Care System in India [Thiel CL, et al. J Cataract Refract Surg. 2017;43(11):1391-1398].

Dr Mura compared the waste generation and carbon emissions from cataract surgery done at centres in Western countries (United States, and the UK) with those from procedures performed in India, where reusable instruments and materials are largely used. Combining several techniques, Aravind Eye Care System emitted 96% less carbon than UK per cataract surgery and considering that the rate of endophthalmitis at Aravind is 0.05% and is reported to be 0.08% internationally, the greater reliance on reusable equipment does not seem to be adversely affecting infection risk.

“The conclusion of this paper has strong words. It states, ‘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’.” quoted Dr Mura.
Action steps
Quoting more statistics, Dr Mura said that the carbon footprint of the global healthcare sector equals 4.4% of all global net emissions; the percentage is 5% in the UK and 10% in the United States.
He proposed that a large portion of the carbon footprint created through cataract surgery could be reduced by changes in practice to incorporate readily available resource efficiency measures. They include optimising the use of reusable instruments and supplies, maximising single-use device reprocessing, promoting minimum waste and recycling practices, using energy efficient appliances and air handling systems, investing in low carbon energy sources, and using flash autoclaving (also known as immediate-use sterile supplies).