OSLI Retina

September 2019

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September 2019 · Vol. 50, No. 9 537 Practical Retina Incorporating current trials and technology into clinical practice Ergonomics in Retina by Christina Y. Weng, MD, MBA, and Yannek I. Leiderman, MD, PhD For this column, Christina Y. Weng, MD, MBA, from Houston and Yannek I. Leiderman, MD, PhD, from Chicago were asked to com- ment on how we can apply ergo- nomic principles in day-to-day ret- ina practice. This is a very pertinent "Practical Retina" piece, as retina specialists are par- ticularly prone to musculoskeletal in- juries given the nature of our work. Implementing ergonomic solutions can help prevent strain injuries before they happen. Employing ergonomic principles can decrease cost, increase productivity, increase efficiency, and allow for longevity in our careers. Can our workplace be optimized to improve ergonomics? As you will see in this article, small changes in our workplace can really make a meaning- ful difference in our well-being. Drs. Weng and Leiderman also dis- cuss changes we can make outside of the patient care setting that can de- crease our "aches and pains." Sim- ple adjustments to our driver's seats, changes to where we hold our steering wheels, and use of lumbar support de- vices can benefit our musculoskeletal systems. We really appreciate Drs. Weng and Leiderman generously sharing their extensive knowledge regarding this aspect of our work. I am certain that their insights and practical pearls will prove to be very valuable for our community given the increasing pa- tient volumes we have all witnessed over the past decade. INTRODUCTION If you have ever ended the workday with neck pain, a backache, or a tingling hand, you are not alone. In a survey of American Acade- my of Ophthalmology members, 51.8% of re- spondents reported experiencing symptoms affecting their neck, lower back, or upper body. 1 Not only are ophthalmologists more prone to musculoskeletal disorders com- pared to physicians in other specialties, 2-4 vitreoretinal specialists are particularly sus- ceptible to these disorders due to the nature of the work we do. 5 Repetitive, nonergonom- ic postures stress the muscles, tendons, liga- ments, and joints. 6 In fact, a survey of retina specialists showed that 85% of respondents were affected by neck or back pain. 7 During the span of a career, these symptoms can lead to decreased productivity, permanent disability, and even forced retirement. As is true with other diseases, the best way to approach occu- pational musculoskeletal disorders is with awareness and pre- vention. Many of us may not even realize that our daily activi- ties are causing physical strain. In this article, we will discuss several ways vitreoretinal specialists can improve the ergonom- ics of their work environment. THE OPERATING ROOM Creating an ergonomically sound operating room (OR) starts with patient positioning. Remember to always adjust the patient to facilitate an optimal ergonomic posture for the surgeon, not the other way around. It is common for the patient's head to be slightly flexed and too far down in the bed, causing the surgeon to lean forward. The patient's head should be positioned at the top of the bed with the iris parallel to the ground (Figure 1). Adjust the bed to an appropriate height so that your neck and back are in a neutral position and your legs have sufficient room. The foot pedals should be moved so that your feet are flat on the floor, knees are bent at an angle close to or slightly greater than 90°, and hips are symmetrically elevated to avoid spinal twist- ing 8 (Figure 2). Use of a wrist rest is a personal preference, but either way, the surgeon's hands should always be supported to avoid unnecessary strain on the upper extremities. 9 Exert the least amount of grasping or pinching tension necessary when handling instruments; the delicate micromovements performed during maneuvers like membrane peels are especially taxing on Christina Y. Weng Yannek I. Leiderman doi: 10.3928/23258160-20190905-01 Seenu M. Hariprasad Practical Retina Co-Editor

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