CATARACT EWAP MARCH 2023 23 operating room. The setup can be clumsy initially, and there is a learning curve for the surgeon and the OR staff. The extra HD monitor also tends to restrict access for anesthesia. Dr. Rubenstein said there will likely be a number of advances in the future to improve heads-up microscope technology, including smaller monitors that can be mounted on the microscope stand. He also said there will be more components visible on the 3D screen and potentially virtual reality goggles that may obviate the need for the monitor. Deepinder Dhaliwal, MD Dr. Dhaliwal also has firsthand experience with posture problems from years of practicing ophthalmology. In 2015, she developed a disc herniation and a ruptured disc in her back. “I was actually in the OR and slipped on some water, and that was the final blow,” she said. “Two neurosurgeons and an orthopedic surgery were ready to do my discectomy.” However, Dr. Dhaliwal decided to take a more conservative approach after she was told by a radiologist that results after a year with conservative treatment versus surgery are the same. “I started doing physical therapy, acupuncture, meditation, and I had to stop working because I was getting weakness in my right leg,” she said. “It was scary because I thought I was going to be disabled. This made me stop being a doctor, so it was a total wakeup call.” After doing therapy and other modifications, Dr. Dhaliwal said her symptoms gradually started to dissipate. Dr. Dhaliwal still does physical therapy, and she said she wishes someone had taught her these things when she was a first-year resident. “The bottom line is that we all need to be mindful about our posture, about our instrumentation, about what we’re doing as we deliver care,” she said. “We’re so concerned about patients’ comfort and health, and over the years and decades, the toll that it takes on our necks and backs adds up.” The critical thing is to do an overhaul of the office, in terms of how you see patients, how you do surgery, and how you use certain instruments, she said. One of the most important things, she said, is to work on having the neck over the shoulders over the hips and having a straight spine. In the office, when Dr. Dhaliwal is at the slit lamp, she has the patient move to the edge of their seat so she can keep her back straight. She then raises the exam chair and rolls her stool under the platform for their feet. Sitting can get you into trouble with bad posture, Dr. Dhaliwal said. When sitting, you’re putting 200 times more pressure on the discs than when lying down; standing only puts 100 times more pressure on them. Dr. Dhaliwal said she tries to take “micro breaks” between every case. This involves extending her arms and shoulders back to reverse the posture she was in during surgery. Dr. Dhaliwal emphasized the need for a good chair with lumbar support. She noted that she brings a lumbar support pillow everywhere she goes. Dr. Dhaliwal has also tried the heads-up microscope technology but said she used an older version that was not comfortable for her neck. She said that she’s not as comfortable wearing the glasses needed for the heads-up microscope technology and prefers to make the chair and microscope modifications. However, she plans to try the technology again in the future. She noted the focus in training on ergonomics. “I think people realize that you don’t want to stop practicing due to a disability.” Jeffrey Marx, MD While Dr. Marx has not had neck or back issues himself, he factored ergonomics into his career early. “My journey with ergonomics started when I was a junior faculty member at Lahey Hospital & Medical Center, and I was one of two Dr. Dhaliwal raises the patient’s chair so that her neck does not have to flex during a retinal exam. Source: Deepinder Dhaliwal, MD
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