Utilizing off-the-shelf LCA methods to develop a ‘triple bottom line’ auditing tool for global cataract surgical services

Cataract surgery is the most commonly performed medical procedure in the world but there continues to be a large, unmet requirement for more surgery, with cataract still accounting for one third of all global blindness. A great deal of progress has been made in increasing cataract surgical rates or productivity, and associated cost containment. However, there is currently no audit tool which facilitates capture of routine cataract surgical productivity, solid waste, carbon, and cost-related data which could be used for global benchmarking, learning, and improvement. The Eyefficiency tool, discussed here, develops a universal Life Cycle Assessment (LCA) methodology for cataract surgery to identify opportunities for sites to minimize the footprint of cataract surgical services and increase access to cataract surgery for patients worldwide. Here, we describe the LCA approaches tested for use in Eyefficiency, with the goals of creating an easy-to-use, open source tool that is also easy to maintain and update. Given those goals, the development team chose to use a hybrid LCA approach with UK-based process and environmental extended input–output inventories. The carbon results of the Eyefficiency tool are compared to previous studies at two of Eyefficiency's pilot test sites. Though Eyefficiency's carbon calculator may only provide order of magnitude accuracy, it offers cataract surgical providers everywhere in the world an opportunity to benchmark their costs, throughput, waste generation, and carbon emissions. Eyefficiency enables ground level ownership in sustainable pathways for the most common medical procedure worldwide.