Environmental Impact of Cataract Surgery Packs: Benchmarking Real-World Practice Through the ESCRS SIDICS Platform

PURPOSE: To assess the carbon footprint of cataract surgery pack-lists entered into the Sustainability Index for Disposables in Cataract Surgery (SIDICS) online platform of the European Society of Cataract and Refractive Surgeons (ESCRS), compare real-world configurations with the ESCRS Benchmark Pack, and identify components contributing most to disposable-related emissions. SETTING: International, web-based ESCRS SIDICS platform. DESIGN: Retrospective observational study. METHODS: User-entered cataract surgical pack configurations recorded in SIDICS between November 2023 and April 2025 were screened according to inclusion criteria. Carbon emissions were estimated using conservative, material-specific life-cycle assessment data from Ecoinvent v3.7.1 via Ansys Granta EduPack. Pack-level emissions were compared with the ESCRS Benchmark Pack (3.91 kg CO2 equivalent), and product-category contributions were assessed. Submission to SIDICS was voluntary; therefore, the analyzed packs represent a convenience cohort. RESULTS: A total of 609 cataract packs were included. The median carbon footprint was 5.59 kg CO2 equivalent (interquartile range 4.88-6.70 kg). The carbon footprint of 93.3% of submitted packs exceeded that of the ESCRS Benchmark Pack (3.91 kg CO2 equivalent), whereas 6.7% met or fell below it. The median excess over the ESCRS Benchmark Pack was 1.68 kg CO2e (p < 0.001). Drapes and covers accounted for 60.3% of emissions and surgical gowns for 23.7%. CONCLUSION: The carbon footprint of most cataract surgery packs submitted to SIDICS exceeded that of the ESCRS Benchmark Pack, with drapes and gowns accounting for most pack-related emissions. Standardization and selective optimization of these high-impact components may reduce emissions, while still considering patient safety. SIDICS provides a practical tool for benchmarking pack-related emissions and quantifying measurable sustainability improvements.