DO YOU KNOW WHERE YOUR CAT PACK COMES FROM?

The modern cataract pack (“cat pack”) is a case study in the benefits of customisation and efficiency. Everything an eye surgeon might need—gowns, gloves, drapes, cotton-tipped applicators, eye spears, gauze, instrument wipes, label sheets, resealable bags, syringes, cassettes and tubing, phaco needles, disposable blades, syringes, cannulas, and so on—are included, matched to the machines in use and the surgeon’s preferences.

But what the cat pack saves in staff time, it more than wastes in terms of environmental impact. Items that go unused or used just once, heavy packaging materials, plastics that are difficult to recycle—the cat pack has them all.

“We did a study that looked at the cat packs used in Austria because Austria is a small country and has relatively few operating centres, so we know them all,” says Dr Oliver Findl, president of the ESCRS. “Essentially what we’ve seen is that there’s a huge variability in the size of these cat packs. We’ve calculated that if we all were to go down to the average of the lowest third of the packs in Austria, we would reduce the carbon footprint of our packages by about one-third. And it would actually be cheaper, so it’s a win-win from a cost and sustainability point of view.”

Achieving those wins is the goal of the SIDICS (Sustainability Index for Disposables in Cataract Surgery) Project, an ESCRS-led initiative aiming to create metrics to help cataract surgeons evaluate the overall sustainability of cat packs. The project kicked off with a workshop at the 2022 ESCRS Congress in Milan, attended by ophthalmologists with an interest in sustainability as well as representatives of companies that sell cat packs. Leading the workshop (and the SIDICS Project) was SDI*Rating, a firm based in Vienna that developed a scientifically based methodology to capture industry-relevant sustainability indicators and present them in a single number ranging from 0 to 100.

“The SIDICS project is about providing the same quality of medical care with fewer materials and less waste and, therefore, more sustainably,” says Erek Stoisser, co-founder of SDI*Rating. “The first challenge is the speed with which we can initiate this transformation. There’s quite a high number of stakeholders, which makes this process relatively slow. The second challenge is the lack of standardisation of procedures and resources used. For example, the weight of the surgical kit varies by 236%, while the patient care remains the same.”

Over the course of the year, SDI*Rating will work with the ESCRS to develop a sustainability index that will enable cataract surgeons to evaluate their cat packs. Findl hopes to unveil the index at the 2023 ESCRS Congress in Vienna.

“The idea is to have a sustainability index, let’s say from 0 to 100, where 100 would be the most sustainable pack you can imagine, and 0 will be really devastating to the environment,” says Dr Findl. “Part of that index will be a rating of the company as a whole. Do they have photovoltaic panels? Do they have electric cars? What is the mix of their electric power origin?

“The bigger part of the index will be the pack itself,” he adds. “Where is the drape produced, and how is it produced? What is the supply chain like? And at the end of the day, what you get at is, how sustainable is this pack?”

The annual carbon footprint of cataract surgeries in Europe is equivalent to that of 410,000 cars per year. Reducing the size and weight of cat packs and reusing more of their components—as is done in India, for example—can significantly reduce their carbon footprint.

“What we’re doing is looking at how you can benchmark your cat pack,” Dr Findl says. “You could just say, ‘I have a package that works well for me.’ But you might want to see a benchmark and whether your pack is close to that because you want to have a sustainable cat pack or cassette and tubing. So you would ask your producer to fill out the rating form, they would complete it, and you could see where your cat pack rates on the scale.”

When finalised, the sustainability index will represent a significant milestone in the effort to reduce the environmental impact of cataract surgery. The challenge then will be to persuade ophthalmologists to use the index to encourage manufacturers to develop more sustainable cat packs.

“It is important that ESCRS continues this conversation once the index is developed, making sure hospitals use it and the exchange with industry keeps happening,” Stoisser says. “Generating greater awareness of sustainability issues among all stakeholders and highlighting further ways the eye care industry can be improved is the key to ensure long-term systemic change. This way, doctors will become more aware of the impact their purchasing decisions have, and the industry will be encouraged to design more sustainable products.”