SIDICS for a More Sustainable OR

Twenty to thirty million lens extraction surgeries are performed worldwide annually, with up to 5 kg of waste and 130 kg of carbon dioxide equivalents per single phacoemulsification. In the global effort to respond to climate change, reducing the environmental impact of cataract surgery has become a more urgent concern.

For Nicolas Winklmair MD, optimisation of cataract packages (cat packs) can be an effective and helpful way to reduce waste and carbon footprints in cataract surgery—an objective easier to achieve thanks to the efforts of the European Society of Cataract and Refractive Surgeons.

“If all departments were to reduce the product volumes and drape sizes to the average lower third already in use in the country, we’d be able to reduce cat pack-associated waste by about 37% and the associated carbon emissions by about 34%,” Dr Winklmair said, referencing a study he and others published in the Journal of Cataract & Refractive Surgery that analysed and compared 55 different custom package sets used in Austria in 2021.¹

“Starting from this study, we brought the analysis up to the European level, sending emails to all ESCRS members, asking them for their cat pack product lists and data on the number of surgeries performed annually,” he said.

“Thanks to the Young Ophthalmologists for Sustainability group (YOFS), we were able to collect data from 44 different surgical centres from 12 different countries and 9 different suppliers.”

The main goal of this research was to find the lowest common denominator of cat packs used in Europe and remove all reusable and unnecessary instruments from the package. “What we ended up with is now the suggested ESCRS sustainable cat pack,” Dr Winklmair said. “Compared to the standard package currently used at the Hanusch Hospital in Vienna, this cat pack is not only lighter and environmentally more friendly but 19% cheaper.”

With the sustainable cat pack as a benchmark, ESCRS and YOFS created the new Sustainability Index for Cataract Surgery (SIDICS), a calculator easily accessible on the ESCRS website. Using SIDICS, surgeons can obtain valuable information on the environmental burden of their surgical activity.

“Once filled with all the required information, you will end up with the product list page, giving the summary and an estimate of the annual carbon footprint and water demand of the cat pack you entered, along with some suggestions for the optimisation potential,” Dr Winklmair said. “For example, the standard package generates 74 tonnes of carbon equivalent per year compared to the 50 tonnes of the benchmark pack. After reassessing all these products, you can download your product list to talk to your peers and your supplier about reimbursing.”

This new tool is one of many steps to reduce the environmental burden in ophthalmology. “With further iterations, we will conduct more detailed assessments of the product’s life cycle, further helping to advocate for policy changes and collaborating with suppliers for more sustainable production,” Dr Winklmair concluded.

Dr Winklmair presented at the 2023 ESCRS Congress in Vienna.

Nicolas Winklmair MD is a researcher at the Vienna Institute for Research in Ocular Surgery Medizinische Universität Wien and Hanusch Hospital of Wien, Austria. nickwinklmair@gmail.com

1.    Winklmair N, et al., JCRS. 49(6): 628–634, June 2023.

How does your cat pack stack up?

You can find out at sidics.escrs.org/