Sustainability in the OR

New Guidance on Sustainable Cataract Surgery by The Royal College of Ophthalmologists

Recommendations That Can Be Implemented Now

  1. Immediate Sequential Bilateral Cataract Surgery (ISBCS): Reduces patient travel, costs, and emissions with comparable safety and outcomes.
  2. Reduce Theater Ventilation: Run ventilation only when necessary; turn off overnight.
  3. Use Reusable Gowns and Hats: Cuts carbon emissions and waste significantly without increasing infection risk.
  4. Use Alcohol-Based Hand Rub After First Wash: Saves millions of liters of water while maintaining infection control.
  5. Rationalize Surgical Packs: Open only essential instruments; use smaller drapes and reusable handles.
  6. Avoid Routine Oxygen, Adrenaline, and Postoperative Antibiotics: Evidence shows no benefit in uncomplicated cases.
  7. Use Topical Anaesthesia When Suitable: Reduces consumables and waste.
  8. Avoid Non-Sterile Single-Use Gloves Unless Necessary; Recycle Waste: Prevents unnecessary plastic and incineration emissions.

🔬 Recommendations Requiring Further Work

  1. Multi-Use Eye Drop Bottles: Safe internationally with strict protocols, but require UK regulatory review.
  2. Multi-Use Intracameral Antibiotic Vials: Used in high-volume settings abroad (e.g., Aravind, India),but not yet licensed for UK practice.

Future UK guidelines (e.g., dropless cataract surgery) may expand options.

🏥 Case Study: Leeds Teaching Hospitals

Leeds implemented a Delphi process to identify and act on sustainable ideas. Their “Eco-packs” reduced landfill waste by 650 kg per year across 5,000 operations — a model for national replication.

Steps in their approach:

  1. Gather staff ideas.
  2. Collate and rank suggestions.
  3. Implement top actions.
  4. Quantify environmental and cost savings.