Eyeworld

92 | EYEWORLD | DECEMBER 2021 by Ellen Stodola Editorial Co-Director About the physicians Xavier Campos-Möller, MD Head of Glaucoma and Advanced Anterior Segment Surgery Western Health Eye Care Center Corner Brook, Newfoundland, Canada Manjool Shah, MD Clinical Assistant Professor Kellogg Eye Center University of Michigan Ann Arbor, Michigan W hen it comes to ophthalmic surgery, ergonomics play an important role. Manjool Shah, MD, and Xavier Campos-Möller, MD, discussed how they consid- er ergonomics in everyday practice, equipment and strategies to help, and its role in glaucoma surgery. Improving ergonomics daily According to Dr. Campos-Möller, the most important thing to understand is the alignment of the entire spine and the alignment of the shoulders and hips. He described it as a verti- cal line, which represents the spine, and two horizontal lines, which represent the shoulders and hips. "What's important is making sure that the vertical line is always vertical and the two horizontal lines are always horizontal," he said. If you drop your shoulder, this will cause one of the lines to be diagonal and would immediately put stress on the spine. When you sit down for surgery, make sure your feet are level on the ground or level on the pedals, Dr. Campos-Möller said. Another important consideration is the pro- cess of tilting the microscope toward you. This allows you to sit more upright because you don't have to lean forward in order for your eyes to match the oculars, and you're not leaning over the patient. Make sure that your operating chair or stool is not too high, Dr. Campos-Möller said. One issue with the chair being too high is the feet are dangling, and you are no longer supporting yourself like a tripod. If you're not properly sup- porting yourself, you're compensating with core muscles to make sure you don't fall off. When you lower the chair in conjunction with tilting the microscope toward you, Dr. Campos-Möller said you end up in an upright position that allows for your elbows to be below the patient's eye level. This allows the elbows to be comfort- ably hanging by the side, relaxing the shoulders and neck and reducing the risk of tremors when operating. "One of the most common errors in young- er, less experienced surgeons is pushing the eye down when operating," Dr. Campos-Möller said. Another key consideration with the operat- ing room chair is the positioning of your pelvis. The ideal position is to not hyperextend your spine; keep your back straight and make sure you don't tuck your tailbone in when you're sitting on the chair, Dr. Campos-Möller said. Seat height and microscope adjustments should be made when different surgeons oper- ate, such as trainees or fellows. In clinic, Dr. Shah said he tries to remind himself to avoid leaning or hunching forward and compensating with neck extension. "Try to keep the shoulders back and chest up," he said. He will also try to encourage patients to come toward him, so he doesn't have to hunch forward. He raises the patient's chair as well as the slit lamp to facilitate an upright posture. In the OR, he will tilt the operating room microscope about 10–15 degrees toward him- self like Dr. Campos-Moller suggested and tilt the patient's head toward him the same amount so a coaxial view is maintained. "I think [ergonomics] has always been an issue; numerous studies have shown that ophthalmologists suffer chronic back or neck pain," Dr. Shah said. "With increased volumes and efficiency, we are seeing more patients and doing more surgery, so the toll on our spines is that much more. The hope is increased atten- tion to this problem will promote better habits and maybe even better designs for surgical and clinical tools." Recommended equipment Dr. Shah said that a comfortable surgical chair with elbow and lumbar support is key. Dr. Campos-Möller mentioned techniques he employs to improve ergonomics. Specifically, he tries to improve flexibility and body strength. He uses foam rollers to develop range of mo- tion and weights and elastic bands to improve strength. "There's no way you can perform at a high level unless you understand the mechanics of the motions you're putting your body through and train your body to have flexibility, range of motion, and strength to be able to do what you need to do," he said. G UCOMA The role of ergonomics in glaucoma surgery

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