An Indian Hospital Could Revolutionise Cataract Surgery Models

Tej Kohli & Ruit Foundation
5 min readJan 11, 2023


Cataract surgery is one of the most common surgeries with around 400,000 performed per year in England alone. Just like with any surgery, or frankly any activity, there are bound to be emissions emitted. But how large are these emissions and does every method of surgery emit the same amount? And should global health policy makers be investing in greener options if they’re available?

A Sizeable Environmental Cost

Cataract surgery emits 180 kg of carbon dioxide (CO2) per eye in the U.K. To put it in more understandable terms, just one cataract surgery using the U.K.’s current method is the equivalent of driving a car by 700km. The same surgery in India emits just 6 kg of CO2. Over half of the emissions in the U.K. are down to the procurement of materials and equipment, which overall are single use. Comparatively, in India most of the emissions come from the sterilising of instruments as the eye care system tends to opt to reusable equipment.

In most, if not all, of developed countries there are many single-use materials and equipment used in medical settings. This creates a considerable amount of waste which in-turn results in emissions that directly and in-directly affect public health.

Though the majority’s opinion would be the societal benefits of healthcare outweigh negatives from emissions, it’s still interesting to explore the sustainability of healthcare and in this case, eye care.

In the UK, the NHS is responsible for 3% of the countries greenhouse gases. Also, in the U.S. the healthcare sector produces 10% of greenhouse gases and 9% of air pollutants. Research has shown that in the UK, half of NHS emissions are due to waste meaning that 1.5% of all the U.K.’s greenhouse gases come from the acquiring and disposal of single-use medical equipment.

In recent years, in-direct effects of the emissions from the waste produced by countries with strong economies like the U.K., the U.S and China have been proven to have catastrophic effects on less developed countries. Every country is at risk of the effects of climate change, whether that be volatile weather, mass migration, floods, droughts, and a host of other consequences, at the moment it is less advantaged areas that are being hit.

The Aravind Eye Care System

India, the location of the 2018 ‘Cataract surgery and environmental sustainability’ study, is considered a developing country. Economic and environmental conditions such as high population numbers and air and water pollution make it challenging to mitigate the effects of climate change, even the effects that are caused by other nations.

Though climate change due to the behaviour of other countries can’t be controlled, some institutions in the Indian eye health industry are taking matters into their own hands and leading the way for sustainable practices. One case in particular is the Aravind Eye Hospital.

The hospital, based in the southern state of Tamil Nadu, has a mission akin to that of the Tej Kohli & Ruit Foundation — to eliminate needless blindness. Teams have developed an effective and sustainable model to deliver excellent eye care that never discriminates based on economic status and ensures that resources are used in the most efficient way.

The hospital performs an average of 5000 surgeries a week, or 450,000 a year, making it the largest eye care provider in the world. Since it opened its doors time, the Aravind has handled more than 6.5 million patients and performed over 7.8 million surgeries. 60% of these operations are at no cost to the patient.

On top of the high volume and minimal cost, the outcomes of the surgeries have significantly lower complication rates than the U.K. and the equipment used isn’t single use. Most of the carbon footprint that the Aravind does emit comes from the sterilising of instruments and equipment, an amount that is just a fraction of the carbon footprint emitted by the current U.K. surgery model.

The Aravind model is not anything new and still the U.K. has not adopted similar methods and continues to use materials just once. In Aravind’s model, these items are disposed of after one use:

· face drape

· patient cap and booties

· some needles and blades

· intraocular lens packaging.

The stainless-steel instruments, syringes and tools that come into contact with a patient are washed and sterilised after every surgery. Gloves are sterilised between cases and discarded after every ten surgeries.

These items are laundered of at the end of the day:

· surgical teams’ caps, masks, gowns, sandals

· patients blanket.

All pharmaceuticals, aesthetic and solutions are used from the same bottle of multiple patients until the bottle is empty. Waste auditors show that per surgery, an average of 250 grams of waste is produced used the Aravind model. If every medical item was single-use and disposed of after surgery, just one surgery would be the equivalent of 40 surgeries.

It was said in 2018 that India needed to double its cataract surgical rates (CSR) to eliminate needless blindness by 2020. Even if this was achieved, the emissions from doubling surgical rates whilst using the Aravind method would still have caused less emissions than the U.K.’s method.

Climate change is something that is creeping up to all sectors of the world and it is inevitable that changes are going to occur. Countries like the U.K.’s should follow in the footsteps of countries like India and adopt sustainable practices if we want to see a world without excessive waste and emissions that affect public health.

For more information on our co-founder Tej Kohli as a philanthropist visit and to read more of his views go to his personal blog.

To read about Tej Kohli as an investor and technologist visit Kohli Ventures.

Find out more about Tej Kohli: Tej Kohli the technologist investing in human triumph, Tej Kohli the philanthropist trying to cure the developing world of cataracts and Tej Kohli the London tycoon with a generous streak.

| Follow: Twitter | Instagram | LinkedIn | Facebook | YouTube |



Tej Kohli & Ruit Foundation

The Tej Kohli & Ruit Foundation is advancing the UN Sustainable Development Goal to end poverty everywhere by making grassroots interventions to cure blindness.