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Comment on: ‘The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 19, a comparative study of the cost and carbon footprint of local anaesthesia techniques for cataract surgery’

Eye volume 39, pages 2318–2319 (2025)Cite this article

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We were interested to see an analysis of the carbon footprint of different local anaesthesia techniques for cataract surgery [1]. We agree that topical anaesthesia should be cheaper and more environmentally-friendly than sub-Tenon’s anaesthesia (STA). However, we believe that, in extrapolating data from just three STA’s in Leeds, the authors’ assumptions may not all apply at a national level.

In our unit, STA is almost never used for cataract surgery [2], though we do use STA for vitreo-retinal surgery, and some corneal and glaucoma procedures. With approval from our local clinical audit department, we recently audited our colleagues’ usage of STA. Costs were obtained from our theatre procurement team, though we were unable to assess disposal costs for disposal of non-reuseable equipment. Assumptions for the ‘lifetime’ of reusable equipment are in Table 1.

Table 1 Analysis of costs for various techniques of sub-Tenon’s anaesthesia (STA) in 2025.
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References

  1. Malcolm J, Gruszka-Goh M, Donachie PH, Buchan JC. The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 19, a comparative study of the cost and carbon footprint of local anaesthesia techniques for cataract surgery. Eye. 2024;39:779–84. Available from: https://doi.org/10.1038/s41433-024-03494-3.

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  4. Allman KG, Theron AD, Byles DB. A new technique of incisionless minimally invasive sub-Tenon’s anaesthesia. Anaesthesia. 2008;63:782–3. Available from: https://doi.org/10.1111/j.1365-2044.2008.05592.x.

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Authors and Affiliations

  1. University of East Anglia, Norwich, UK

    Goodness Daniel

  2. Department of Ophthalmology, Norfolk & Norwich University Hospital, Norwich, UK

    Tom Eke

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  1. Goodness Daniel
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  2. Tom Eke
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Contributions

GD: applied for consent, carried out data collection and analysis, contributed to drafts and references, and submitted correspondence for publication. TE: had the idea for the study, is the project supervisor, wrote the first draft and is the study guarantor.

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Correspondence to Goodness Daniel.

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Daniel, G., Eke, T. Comment on: ‘The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 19, a comparative study of the cost and carbon footprint of local anaesthesia techniques for cataract surgery’. Eye 39, 2318–2319 (2025). https://doi.org/10.1038/s41433-025-03860-9

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  • DOI: https://doi.org/10.1038/s41433-025-03860-9

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