Instrument Lifespan Metrics Power Sustainability

A median lifespan of reusable instruments (RUIs) for cataract surgery can be evaluated according to a study by Johnson Yan Ning Neo MD.

“We know there is a strong desire [among] surgeons across Europe and the US for more reusable options, [particularly] for instruments,” he said. However, controversy surrounds the environmental benefits of reusable surgical instruments because of a lack of data on their usage duration and frequency.

Single-use instruments have a higher carbon footprint due to manufacturing and waste disposal processes,^1,2 Dr Neo emphasised. Yet RUIs risk potential fatigue and failure after repeated sterilisation cycles, which may not meet manufactur¬er specifications. Also, while some studies show lower carbon footprints for reusable instruments, the single-use variety may be more cost effective in high-volume sterilisation centres. Previous cost calculations were based on low RUI reuse rates, which may not reflect real-life scenarios, he noted.

To fill this gap in the literature, the ESCRS Young Ophthal¬mologists for Sustainability (YOFS) conducted a simple sur¬vey in 16 European centres examining annual cataract surgery volumes, reusable cataract instrument usage and replacement frequency, and single-use tool use. The evaluation assessed the instruments for median lifespan in years and median lifespan in surgeries.

The study covered a median of 3,000 cataract surgeries, showing that only about 5% of centres avoid single-use instruments while more than 95% use a combination of RUIs and single-use tools. The 5 instruments used most often were the IOL injector, adjustable lid speculum, notched forceps, nu¬cleus chopper, and, surprisingly, capsulorhexis forceps. As Dr Neo highlighted, even the most fragile capsulorhexis forceps last nearly 3 years and undergo approximately 340 surgeries before replacement.

These data are significant, as they show that using reusable forceps at least 20 times instead of single-use equivalents achieves carbon neutrality. The study also indicates RUIs were used far more frequently than expected before getting replaced, demonstrating additional carbon savings. While this information is already helpful, Dr Neo concluded more research is needed to fully optimise RUIs and reduce waste.

“Median lifespan for reusable instruments was potentially underestimated because a lot of these instruments [were] bulk purchased before the start of the calculated lifespan,” Dr Neo said.

Founded in 2022, the Young Ophthalmologists for Sustainability (YOFS) group strives to enhance sustainability within the field of ophthalmology. YOFS initiatives focus on waste reduction, research, education, advocacy, and fostering collaboration. For more information on current projects, please visit https://www.escrs.org/special-interest-groups/yos/yofs

Dr Neo spoke at the 2025 ESCRS Annual Congress in Copenhagen.

Johnson Yan Ning Neo FHEA, FRCOphth, FEBO, CertLRS is a consultant ophthalmic surgeon at Barts Health NHS Trust, London, UK.

1. V Qin, et al. Clin Ophthalmol, 2024 Sept 3; 18: 2481–2485. 
2. E McCance, et al. Eye (Lond), 2025 Jun; 39(8): 1481–1485.