Eyeworld

EW RESIDENTS 45 to halt the surgeon's overactive ac- commodation. Most young surgeons have a large range of accommoda- tion and can readjust the micro- scope so the attending can see, without compromising their view of the operating field. If verbal reassurance is unsuc- cessful, the young surgeon can be encouraged to look away from the case when it is safe. This brief glance to a different focal point can relieve the surgeon's hyperactive accommo- dation. The surgeon can look away while exchanging instruments, and this will frequently stop the accom- modative response. In rare cases, changing the ocu- lars on the surgeon's or the attend- ing's scope to compensate for the excessive accommodation is re- quired. If the accommodation prob- lem persists, the surgeon should have a cycloplegic eye exam to see if a refractive error such as overcor- rected myopia, hyperopia, or astig- matism is accounting for the visual difficulties. In summary, excess accommo- dation is a common problem but one that can be relieved by straight- forward solutions. Robert S. Bailey Jr., M.D., director, Cataract and Primary Eye Care Service, Wills Eye Institute, and clinical associate professor, Thomas Jefferson University, Philadelphia When viewing through a micro- scope, excessive accommodation often occurs even though the instru- ment is designed to render the mag- nified object at optical infinity. This overaccommodation is known as in- strument myopia. It may be linked to myopia development and pro- gression that is seen in micro- scopists. The cause of instrument myopia is not certain but is felt by most to be related to what is known as proximal accommodation due to the awareness of the closeness of the viewed object during microscopy. To the ophthalmology resident learning microsurgery, excessive ac- commodation may lead to headaches and fatigue, especially in the setting of learning new proce- dures with longer case times. Microscope setup is important in avoiding or reducing excessive ac- commodation. Sitting up with a straight back and neck and having your knees flexed 90 degrees to allow your feet to be directly below your knees on the foot pedals are important ergonomic tips that will allow you to be comfortable during the longer case times. Adjust the eyepiece tilt to make sure your head and neck positions are comfortable. This will also maximize the distance between your eyes and the patient, continued on page 46 December 2011

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