title: Carbon footprint and cost-effectiveness of cataract surgery.
abstract: OBJECTIVE
  This article raises awareness about the cost-effectiveness and carbon footprint of various cataract surgery techniques, comparing their relative carbon emissions and expenses: manual small-incision cataract surgery (MSICS), phacoemulsification, and femtosecond laser-assisted cataract surgery.
  
  
  RESULTS
  As the most commonly performed surgical procedure worldwide, cataract surgery contributes significantly to global climate change. The carbon footprint of a single phacoemulsification cataract surgery is estimated to be comparable to that of a typical person's life for 1 week. Phacoemulsification has been estimated to be between 1.4 and 4.7 times more expensive than MSICS; however, given the lower degree of postoperative astigmatism and other potential complications, phacoemulsification may still be preferable to MSICS in relatively resource-rich settings requiring high levels of visual function. Limited data are currently available regarding the environmental and financial impact of femtosecond laser-assisted cataract surgery; however, in its current form, it appears to be the least cost-effective option.
  
  
  CONCLUSIONS
  Cataract surgery has a high value to patients. The relative environmental impact and cost of different types of cataract surgery should be considered as this treatment becomes even more broadly available globally and as new technologies are developed and implemented.
authors.affiliation: aAravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Pondicherry, Tamil Nadu, IndiabWilmer Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USAcAravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, IndiadDepartment of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, PennsylvaniaeDepartment of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MichiganfDepartment of Ophthalmology, University of MarylandgDepartment of International Health, Bloomberg School of Public Health, Johns Hopkins, University, Baltimore, Maryland, USA*Rengaraj Venkatesh and Aravind Haripriya contributed equally to the writing of this article.
authors.forename: Rengaraj
authors.initials: R
authors.lastname: Venkatesh
authors.forename: Suzanne W
authors.initials: SW
authors.lastname: van Landingham
authors.forename: Ashish M
authors.initials: AM
authors.lastname: Khodifad
authors.forename: Aravind
authors.initials: A
authors.lastname: Haripriya
authors.forename: Cassandra L
authors.initials: CL
authors.lastname: Thiel
authors.forename: Pradeep
authors.initials: P
authors.lastname: Ramulu
authors.forename: Alan L
authors.initials: AL
authors.lastname: Robin
mesh_terms: D001251:Astigmatism; D058572:Carbon Footprint; D002386:Cataract / Q000191:economics*; D002387:Cataract Extraction / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D006801:Humans; D018918:Phacoemulsification / Q000379:methods; D011184:Postoperative Period