Identification Of Action Areas To Make Routine Cataract Surgery More Carbon Neutral

To identify the streams of waste generated from a single cataract surgery in a UK National Health Service district hospital and identify easy actionable items to help reduce it. The secondary aim is to generate awareness, build consensus and encourage dialogue among stake-holders (surgeons, nursing and administrative staff).

This study was undertaken at the ophthalmology thetres at Epsom and St Helier NHS Trust (a UK NHS district hospital) during a routine consultant led cataract theatre list. Patient data was accessed using the electronic medical records (EMR) software Medisoft®.

All waste generated from a single, uncomplicated, consultant operated cataract procedure was segregated. Physical data was obtained by separating paper, plastic and metals and then photographed. Single-use metal instruments (capsulorhexis forceps, phaco-chopper, phacoemulsification tip and fine-tooth forceps) were weighed on a sensitive scale. Items were catalogued by manufacturer and place of manufacturing where possible. The study included data from medical equipment used. It excluded the theatre’s running cost of building energy use and travel sector contributions. A discussion with the trust’s sustainability lead ensued to identify immediate, short and long-term steps to lower the impact of cataract surgeries on the environment.

Single use vs autoclaved metal instruments weighed 28 and 453 grams respectively. ‘Clean’ paper and plastic waste weighed 58 and 85 grams respectively. Domestic waste went to a landfill. Clinical waste was incinerated. 3 primary action points were identified: Firstly, patient hats in theatre currently made from virgin plastic can be replaced with cloth caps. Secondly, the paper card in intra-ocular lens boxes are not given to patients. All data is available on Medisoft^®. Each patient is given a letter. We will initiate discussions with the lens manufacturers. Thirdly, waste recycling was not undertaken. Following discussions within the trust, we will have access to more waste streams due to a change in the external waste disposal supplier.

The increasing numbers of cataract surgery worldwide provides a unique opportunity to reduce the environmental impact. The approach to more sustainable cataract surgery will require identifying easy actionable items at each hospital as well as involving trust sustainability leads. Partnership with the pharmaceutical and medical equipment industry will be essential in achieving carbon neutrality in cataract surgery.