Hi Inger, you are a cataract and refractive surgeon in Hamburg, Germany, and at the same time also a mother of a child. Last weekend I heard an exciting lecture from you about sustainability in eye surgery and the digital transformation of ophthalmology. What moves you about this and why is this topic important to you?

Hi Sebastian, thank you so much for your interest and the possibility to speak about ecological sustainability with you on this great platform.

I grew up in an environment in which ecological sustainability has always been a topic. From the moment I have decided to become an ophthalmologist my primary goal has been to become a good doctor and surgeon. However, my eye for the beauty of the world is still here and I have realized that ecological sustainability is not defined as a goal in the German Health Care System. In 2021 the 125. Deutsche Ärztetag has argued for CO2-neutrality until 2030. The Time Window for substantial reduction of greenhouse gas emissions gets tighter and tighter. I feel a huge motivation to talk about this fact and to come into action.

Our platform is called Digital-Ophthalmology.net and we always present exciting digital projects. Digital ultimately also means a consumption of resources. How do you assess the sustainability potential of new, digital technologies in ophthalmology?

That is a good question. You are right, digitalization itself is a driver for greenhouse gas emissions. In my opinion it is important to see digitalization not as an end in itself but as a tool to reach our goals. Therefore I think it is mandatory to define these goals for the Health Care System also from the political side.

The UN has published data that 70% of sustainability goals can be positively affected using digital technology. They are referring to the 17 Sustainable Developmental Goals by the UN.

From the ecological point of view, first, digitalization has the potential to reduce mobility. In ophthalmology there is a high amount of doctor-patient contacts. Smart devices for self-monitoring and telemedicine are promising tools. Mobility amounts to 10% of the German Health Care Emissions.

Second, an international survey by the Commonwealth Fund 2017 found out that 43% of German patients with high supply needs have experienced loss of data and documents or have got double examinations. By improving intersectoral communication and monitoring of chronic diseases, digitalization has a high potential to reduce oversupply. Subsequently, Energy-resources and hospitalization could be decreased.

Third, digitalization apart from specific technologies in ophthalmology can help protecting the environment. Digitally available information about Life cycle assessments for ophthalmic instruments would be helpful. Digital tools can also help improving the energy management.

We often discuss the "big" changes, on which we as individual campaigners usually have no influence, but which are rather supported by politics or the economy (e.g. electromobility, phasing out fossil fuels, etc.). Are there also concrete things that each individual can implement and that, if implemented by many, will also have a major impact on sustainability and climate change?

Thank you for this question. I see both approaches, the political action and the individual action as two sides of the same medal. One side is not imaginable without the other side.

There are a lot of good and also sometimes cheap approaches for everyone. A plant-based nutrition and reduction of food waste seem to have the biggest impact. Investing into green shares is a low-threshold approach or becoming part of green energy projects in form of public participation is possible. I love the idea of taking the problem seriously while being creative in the transformation process. So why not implementing a mobility challenge for the team?

There is also always the discussion whether we should use disposable or reusable instruments. Are there any studies at all that prove that the environmental friendliness of one product or another outweighs the other?

In 2019, the NGO Healthcare without harm has published that over 70% of the emissions in the health care system derive from the health care supply chain. These emissions come from production, transportation and disposal of instruments, hospital equipment and pharmaceuticals. McGain et al  have compared the CO2-emissions of single-use vs reusable anesthetic instruments depending on the country in which they are used. They have shown that switching from single-use to reusable equipment in Australia has increased the emissions by 9%. On the other hand, the same adjustment has shown a significant reduction by 84% in Europe. Therefore the results are depending on the energy-mix that is used. The water consumption seems to be higher for reusable instruments. (McGain et al, 2017)

At last week's symposium, the concept of sustainability was very broad. Does sustainability only mean saving greenhouse emissions, or is there more to it?

You are absolutely right, sustainability is a very broad concept. The UN has established 17 sustainable development goals and it is worth to have a look at these. I love the idea of choosing 2-3 goals and referring to these. For example goal 3, Good Health and Wellbeing, and 13, Climate Action. At last week’s symposium, sustainability was seen even broader. Sustainable patient experience as well as sustainable education for surgeons and in your case combined with digital transformation have been interesting and relevant topics.

What would you like to see that could be implemented right now?

At the moment, I see a high potential for savings in the daily practice. For example, every patient who has entered the operation theatre in our clinic had to wear plastic shoe covers. We have stopped this now. A lot of things are done because they always have done and it is worth having a critical look at the own processes.

Thank you so much for the great interview, Inger!