Gowned and gloved, mask in place, surgical technician Savannah Stanford prepares the operating room. She tears open plastic wrapping with a practiced pop and rip. The sound, sharp as a pistol crack, cuts through the silence before the day’s first case. Blue drapes spill over the table; syringes clatter against stainless steel. “A lot of wrappers,” she said. “A lot of plastic. Some things come in multiple plastic wrappers, not just one. So that’s layers and layers of plastic.”
It often only takes about fifteen minutes to fix the most common cause of blindness in the world: cataracts. In that quarter hour, surgeons can replace a cloudy lens and give someone their sight back, a small everyday miracle. But there’s another sight worth noticing: the trash bin. Health care is responsible for an estimated 4.4 percent of global greenhouse gas emissions, and more than 8 percent in the United States. Ophthalmology, a field known for its precision and efficiency, turns out to be a surprising contributor. A recent systematic review in the journal Ophthalmology highlights what we know so far about the growing problem and what surgeons and hospitals can do about it.
I’m one of those surgeons. I’ve spent over a decade performing eye surgery in the U.S. Army, and I can tell you that the trash bin fills up long before the patient arrives. The drapes, tubing, syringes, and disposable instruments are all opened and arranged in a sterile field, and by the time I sit down at the microscope, the packaging alone could fill a 30-gallon bag. In the U.K., a single cataract surgery generates roughly 180 kilograms of carbon dioxide equivalent, comparable to driving over 400 miles in a car. Now multiply that by the more than 20 million cataract surgeries performed globally each year.
Much of the environmental impact comes from single-use items, packaging, medications, and energy-hungry surgical suites. “A lot of our procedures look the same in terms of where the emissions come from,” said Dr. Cassandra Thiel, a sustainability researcher at NYU Grossman School of Medicine who has studied the environmental impact of surgery for more than a decade. “Most of that is upstream. Everything that happens before the instrument comes to your door. We’re mining raw minerals from the earth, extracting those resources and manufacturing them into products, and shipping them all over the world.”
Real physician voices, twice a week
Free, and one click to unsubscribe.
Stanford sees that upstream waste land in her lap every morning. “Normal setup for me is twelve minutes,” she said. “Just opening the stuff itself takes me probably eight of those twelve minutes.” For a single eye surgery, she opens over a dozen disposable items, and sometimes double, depending on the complexity. The surgical packs arrive at the hospital preassembled by manufacturers and labeled as “cataract set,” even though they contain far more than what’s needed for a typical cataract operation. “There’s a bunch of needles we don’t use that come in the pack, a bunch of syringes we don’t use,” she said. “I think the companies that produce the items for us to open could package it better so that we’re not wasting all this plastic and paper.”
She’s right, and as a surgeon, I know exactly which items sit untouched. Every one-size-fits-all cataract set has many instruments and supplies I never touch. But customizing packs means navigating hospital procurement, negotiating with manufacturers, and accepting that any change introduces a new variable into a process where consistency saves sight. That tension between what we know is wasteful and what we’re reluctant to disrupt runs through the entire field.
Thiel and her colleagues found that these inefficiencies are common worldwide. Single-use packaging and instruments dominate in high-income countries like the United States, where infection-control standards and liability concerns have driven a culture of disposability. But there are alternatives. Some hospitals in the U.K. have cut their carbon footprint for instruments by up to 95 percent through eliminating disposable tools and reusing sterilized instruments.
At Aravind Eye Hospital in southern India, surgeons perform high-volume cataract operations using largely reusable items as part of a comprehensive sterilization protocol that extends even to surgical gloves. Their infection rates, as low as 0.02 percent in published studies, match or exceed those in the U.S. and U.K., yet research led by Thiel’s team has shown that the Aravind model generates less than 4 percent of the carbon emissions of the same surgery performed in the U.K. In the United States, I suspect most surgeons and patients would be uneasy with the idea of reused gloves. But the data from Aravind challenges the assumption that more disposable material means safer surgery.
Institutional momentum is slowly building. The U.K.’s National Health Service has launched a “Green Surgery” initiative, and the U.S. Department of Health and Human Services (HHS) began pilot programs under its Health Sector Climate Pledge, though the Trump administration has since closed the HHS climate office, leaving the effort without a federal vanguard.
“For a long time health care has been ignored or given a pass,” Thiel said. “The amount of resources we use on health care, it’s not just about the environment, it’s about access and cost.”
If ophthalmology can standardize so much, from incision size to implant design, it could also standardize sustainability. “Reduce, reuse, recycle. It’s in that order for a reason,” Thiel said. “The further upstream you go to stop some of these activities, the better the impact is going to be.”
Back in the operating room, the drapes, boxes, and tubes overflow from the trash as Stanford continues getting ready for surgery. She gestures across the breadth of the room. “There’s plastic on plastic on plastic.”
Zachary Skurski is a cornea and refractive eye surgeon.
