Eyeworld

36 | EYEWORLD | DECEMBER 2022 HOT TOPICS IN OPHTHALMOLOGY ATARACT C by Ellen Stodola Editorial Co-Director About the physicians Deepinder Dhaliwal, MD Professor of Ophthalmology University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Jeffrey Marx, MD Lahey Hospital & Medical Center Burlington, Massachusetts Jonathan Rubenstein, MD Chairman Department of Ophthalmology Rush University Medical Center Chicago, Illinois Michael Snyder, MD Professor of Ophthalmology University of Cincinnati Cincinnati, Ohio This also elevates the patient's head relative to the floor, allowing the surgeon's hands to be a little higher and their elbows to drop down. "When our elbows fall toward our sides, we're not using any of the neck muscles to lift our shoulders," he said. That's more comfortable and puts less strain on the cervical spine. Dr. Snyder said he learned these initial tips from Dr. Wallace's lecture; they are fundamental and cost nothing to implement. Dr. Snyder also began tilting his foot pedals. Some prototypes have been created for this, but pedal tilt can be achieved by taping something to the bottom side of the far end of the foot pedal. "The ad- vantage of tilting the foot pedals is that now the feet, rather than being in full extension of the ankles, are in the midpoint of the joint's range of motion, the most sensitive position for any joint. When the feet are not in full extension, it also puts less stress on the lumbar spine." Next, Dr. Snyder turned his attention to the OR chair. Most surgical chairs don't have great lumbar support, and the backs of the chair are often too wide, so they end up bumping the elbows of the sterile gown and contaminating the elbows. Dr. Snyder has been working with Haag-Streit to design a new surgical chair that has center back support that follows the con- tours of the lumbar spine and goes up into the thoracic spine. Chair height is also important. "The sur- geon should set their own chair height … and take the extra 3 seconds to raise or lower the patient so the bed in the OR and the slit lamp in the clinic are at a comfortable height," he said. "Most ophthalmologists either lean down a little or lean up a little." While this might be fine for a few minutes, Dr. Snyder said it becomes a problem when you're doing it 50–100 times a day several days a week, decade after decade. Some operative microscopes and slit lamps have attachments that allow the surgeon to change either the angle of viewing or the distance the oculars extend laterally. When it comes to the slit lamp, Dr. Snyder said its basic design has been around for 150 years and it's time for an update. When considering heads-up microscope technology, Dr. Snyder mentioned several The importance of ergonomics in the clinic and OR Note the tilt of both the microscope and the patient's head so that they are coaxial with each other but allow Dr. Snyder to sit upright with a straight spine, without leaning forward. Source: Michael Snyder, MD F our surgeons discussed the importance of ergonomics in ophthalmology, includ- ing their personal experiences and how they arrange their clinics and ORs for better ergonomics. Michael Snyder, MD Dr. Snyder's attention to ergonomics began more than 25 years ago when he heard a lecture from Bruce Wallace, MD. "He gave a talk on ergonomics and how young people should pay attention so we didn't run into issues with back and spine disease," Dr. Snyder said. At that time, he was advocating for tilting the microscope and the patient's head about 30 degrees. The oculars are then farther lateral to the eye, so the surgeon does not have to lean into the micro- scope, Dr. Snyder said. The surgeon can sit with an upright spine rather than leaning forward.

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