Eyeworld

DECEMBER 2022 | EYEWORLD | 37 C one arm down as I was trying to resist, demon- strating a definite loss of strength." As an oph- thalmologist, you cannot risk motor problems affecting your arms and hands, he said. Dr. Rubenstein started using the 3D heads- up microscope, which he thinks helped lessen his neck strain, but he also acknowledged that even heads-up microscopes have issues. They present other issues with posture, he said, be- cause you tend to sit back like you're in an easy chair, and although you're relaxed, you might not have good posture. It's not perfect, but he thinks it's considerably less stress on the back and neck than a traditional microscope. He not- ed that there are a couple of options available in this space, the NGENUITY (Alcon) and the ARTEVO 800 (Carl Zeiss Meditec). The heads-up technology provides a great intraocular view, Dr. Rubenstein said, and it's good for teaching. "Everything the surgeons sees, everyone else in the operating room can see," he said. The disadvantages, however, are that there is more equipment that needs positioning in the operating room. The setup can be clumsy initially, and there is a learning curve for the potential downsides that hopefully technology can overcome. These include the footprint and fixed positioning of the screen, the tower of the microscope sitting right in front of the eye (the surgeon has to look around the stack of the microscope, which requires them to either tilt their spine or turn their head), latency delays in the display system, and the dynamic range of the camera not being quite as good as the human eye. Dr. Snyder mentioned Beyeonics, which pairs virtual reality glasses that are partially transparent with a microscope system. The Beyeonics technology avoids the issue of having to look around the stack of the microscope because the stack could be right in front of you and you can still see fine since the image is in the goggles-based headset, he said. Jonathan Rubenstein, MD Dr. Rubenstein has experienced firsthand the necessity of making changes due to progressive neck problems, which began more than a de- cade ago. He eventually developed a herniated cervical disc and needed a cervical discectomy and cervical fusion in 2008. Ergonomics, he said, is an issue that's get- ting more attention now than it has in the past. The slit lamp is one problem because you're often in a position where you're putting tension on your neck, he said. Additionally, the use of the microscope in the OR has the potential to cause neck and back issues. It is common for ophthalmologists to develop these neck and back issues, he said. Dr. Rubenstein said his neck issues likely built up over time during his more than 30 years in practice. "I remember when I went to phys- ical therapy, I thought I had good posture," he said, adding that the physical therapist showed him the correct posture to realign his back and neck. "Therapy did not obviate the need for sur- gery, but it taught me [what to do] after surgery and how to maintain proper posture," he said. "I knew I had pain, but I didn't think it was a big deal," Dr. Rubenstein said. "I saw a neurosurgeon, and he tested the strength in my arms. I lifted my arms up, and he said, 'Don't let me pull your arm away.' He then easily pulled continued on page 38 Dr. Rubenstein teaches a resident with the NGENUITY system. Source: Jonathan Rubenstein, MD

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