CATARACT EWAP MARCH 2023 21 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 Contact information Dhaliwal: dhaliwaldk@upmc.edu Marx: jeffrey.l.marx@lahey.org Rubenstein: jonathan_rubenstein@rush.edu Snyder: msnyder@cvphealth.com The importance of ergonomics in the clinic and OR by Ellen Stodola Editorial Co-Director This article originally appeared in the December 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Four surgeons discussed the importance of ergonomics in ophthalmology, including 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 microscope, Dr. Snyder said. The surgeon can sit with an upright spine rather than leaning forward. 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 advantage 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
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