Eyeworld

EW CATARACT 62 February 2018 Cataract editor's corner of the world by Rich Daly EyeWorld Contributing Writer Surgeons discuss ways to avoid repetitive stress injuries in the operating room and the office setting A mid a growing body of evidence that the work of ophthalmic surgeons carries the risk of repet- itive stress injuries with potentially serious consequences, some surgeons suggest focusing on the little things. Among findings indicating the extent of the ergonomics challenge for ophthalmologists was a 2005 survey of U.S. ophthalmologists that revealed 52% of the 697 respon- dents had neck, upper body, or low- er back pain, and 15% had to curtail their work as a result. Specifically, low back pain was present in 39% of respondents, followed by upper ex- tremity symptoms (33%) and neck pain (33%).¹ Richard Lindstrom, MD, founder and attending surgeon, Minnesota Eye Consultants, suggest- ed surgeons sit tall at the operating microscope, in the clinic, and at the slit lamp to minimize repetitive stress injuries. Additionally, performing exercises at home that stretch and Dr. Lindstrom pairs that ap- proach with daily back and neck exercises developed by Pete Egoscue, a physical therapist and author. Helpful equipment Helpful equipment that Dr. Berdahl underscored for fellow surgeons is a high quality surgical chair. "We have a surgical chair that is comfortable, although we have explored a number of different ones and I haven't found one that's per- fect yet," he said. Dr. Lindstrom makes sure his operating chair includes an elbow rest, and he uses a wrist rest on the OR table. Dr. Berdahl highlighted the addition of longer oculars on his operating microscope as helpful for maintaining a healthy posture. Complicating the benefits of such OR equipment is the common necessity of sharing the OR with other surgeons. "When I operate with the fellow and we need to switch chairs, it's tempting to not readjust ev- erything," Dr. Berdahl said. "It's important to readjust everything because often these are challenging cases that can take awhile; better surgery occurs when the surgeon is comfortable, and it's better for our bodies." Dr. Berdahl gained some ergo- nomics insights from a consult's assessment of his operating posi- tioning. "She wanted to make sure that my knees were at a 90-degree angle so that my feet were flat on the floor," Dr. Berdahl said. "She also ensured that I didn't ride sidesaddle and twist my body while I was look- ing at the operating microscope. Make sure as a surgeon that you are square to the work in front of you." Prioritizing ergonomics in the OR H ow many times have we arrived home after a long day examining patients at the office or doing surgery in the OR and realized that we had a bad headache, our necks were stiff and sore, or our lower backs were throbbing? That is most likely due to poorly optimized ergonomics. Although many things in life can prove to be a pain in the neck, doing what we love to do as ophthalmologists shouldn't be one of them. In this article, Dr. Lindstrom and Dr. Berdahl share their pearls on how to best optimize ergonomics in the OR to minimize muscle strain and in- juries. It is an insightful article and will help many of us make our day less stressful on our bodies. Rosa Braga-Mele, MD, Cataract editor Dr. Berdahl adjusting the scope for a procedure Source: John Berdahl, MD continued on page 65 strengthen back and neck muscles helps, he said. John Berdahl, MD, Vance Thompson Vision, Sioux Falls, South Dakota, has aimed to avoid repeti- tive stress injuries by aligning all the technologies in the operating room (OR) to him. "The bed height, microscope, foot pedals, and surgical chair are all aligned to my comfort, and I don't adjust my body to them," Dr. Berdahl said. Another OR ergonomics pearl from Dr. Berdahl was to zoom in the microscope all the way and find a proper focal point, then zoom out. "That ensures that you're right in the middle of the depth of focus," Dr. Berdahl said. Dr. Lindstrom agreed with the use of maximum magnification at the beginning of a case, while focusing on the eye."Then at lower magnifications you will stay in focus as you zoom up and down," he said.

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