Updating the Hippocratic Ideal

Small changes could make a big difference in making cataract surgery more environmentally friendly, according to Sjoerd Elferink MD.

“It is always good to kick off with a banana,” he said. “You might think a banana grown across the ocean must have a high environmental footprint. However, when you look closely into its details, a banana does not need a hothouse to grow—and it comes with its own packaging. It is not bad at all.”

By considering similar small details, cataract surgery can have a lower impact on the environment, peeling off waste on the path of a greener surgery.

The total carbon emissions of cataract surgery differ between 39 and 150 kilogrammes, which Dr Elferink said can be reduced and balanced with many different expedients. “There are many ways to make cataract surgery more sustainable, and you can already start next Monday.”

A strategy for sustainability is the core part of the #StartNextMonday campaign promoted by the ESCRS Young Ophthalmologists for Sustainability (YOFS).

“Start with energy use,” Dr Elferink said. “Enabling OR ventilation just 30 minutes prior to the operation will be enough to clean the air. Furthermore, to meet the requirement for a class-2 OR, you will need only 20 air changes per hour.”

Optimising surgical materials is also an essential way to reduce carbon footprint.

“You can replace your full body drape with a face drape only, cover the armrest with your gown, use medical sponges only when your hands are visibly dirty, and use only alcohol-based hand scrub. Re-evaluate the content of your cataract custom pack. You can save an enormous amount of waste and money this way,” Dr Elferink said.

“Finally, we as doctors should advocate for dietary changes,” he said. “The latest IPCC report urged for an accelerated food transition. The mitigation potential is enormous because we could cut yearly carbon equivalent emission by 25% by just eating less meat. Physicians do have an important role in this—a 50% reduction in red meat reduces mortality up to 20% and will benefit both patients and the environment.”

With this level of involvement, Dr Elferink believes it should lead to an ethical re-evaluation of what it means to be a doctor.

“What we need is a new oath of Hippocrates because we as doctors have a really important role. Something similar recently happened in the Netherlands. Our code of conduct was changed with a new bullet point: ‘You are aware of the relationship between health, climate, and environment, you are committed to a sustainable healthcare sector and healthy living environment’. This is really our way to change the vicious circle of climate change,” he concluded. “It is crucial to realise that if everything is at stake, everything is possible.”

For more information on ESCRS Young Ophthalmologists for Sustainability, please visit the website.

Dr Elferink presented at the 2023 ESCRS Congress in Vienna.

Sjoerd Elferink MD is a cataract surgeon at the Flevoziekenhuis Hospital of Almere, Netherlands. sjoerd.elferink@gmail.com