CATARACT 24 EWAP MARCH 2023 retina specialists,” he said. “My partner, the other retina specialist, was out for a month for his first carpal tunnel surgery and a couple months later for a second surgery.” This prompted Dr. Marx to talk to his partner’s physical therapist about how he could avoid injuries, and he started working with physical therapists and other specialists to reduce his risk for problems. Dr. Marx said equipment is important and noted that one challenge is the size of the operating rooms and clinics and how much equipment needs to be positioned. In terms of necessities, he always uses an elbow support. “It’s important to support the upper extremities when using lenses,” he said. Dr. Marx is also very aware of the “competition” between the patient and the physician. “The patient wants us to move everything forward to them so that they don’t have to lean forward, and we want the patient to sit on the edge of the chair and lean forward so we can maintain upright posture,” he said. The back support of the chair is incredibly important, Dr. Marx added. “I look at all my chairs before I start the day and make sure that they’re for me,” he said, adding that he likes a certain chair for his laser procedures that many other colleagues don’t prefer. While Dr. Marx said his practice hasn’t bought much new equipment, he did insist on ergonomic arms for the computer monitors. In the OR, Dr. Marx said he has access to the NGENUITY system, but he prefers to use the traditional microscope. “I haven’t had neck pain in years after operating, and after a few times operating with the NGENUITY as the assistant, I didn’t like it,” he said. “I think it’s great and there are ergonomic benefits, but I personally don’t use it,” he said. Dr. Marx uses a microscope from Carl Zeiss Meditec with extended oculars, which help him maintain a neutral posture with back support. It comes down to neutral posture, back support, and positioning yourself appropriately, he said. Pain is the warning sign that something in your daily life is causing you to potentially have problems down the road. Decreasing that risk at work is incredibly important, and the flip side of that is taking care of yourself outside of work as well. This includes factors like exercise, diet, good sleep, reducing stress, and building strength in various muscles so you can withstand the rigors of a long day. EWAP Editors’ note: Dr. Dhaliwal is Professor of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and has interests with Haag-Streit. Dr. Marx practices at Lahey Hospital & Medical Center, Burlington, Massachusetts, and declared no relevant financial interests. Dr. Rubenstein is Chairman, Department of Ifully agree with the observations and suggestions made by surgeons regarding the posture and ergonomics of ophthalmic surgery. While we all concentrate our energies on acquiring clinical and surgical skills, one aspect that is often not emphasized enough in training is to pay attention to the ergonomics of the workplace. Unfortunately, many of us realize the importance of this aspect later in life, when we may be riddled with back/spine issues, largely due to the nature of our work. One of the very important aspects in maintaining good ergonomics is the operating chair. In my experience, most operating room chairs do not have supports to rest the hand. Even if they do, they may not be adjustable in angle and height. If the surgeon’s elbows are supported, the muscles will be more relaxed, and there will be minimal to no transmission of strain to the shoulder and neck. As has been pointed out by Dr. Snyder in his article, it is important that the surgeons’ hands are placed such that the elbows are at a lower level than the wrists so that there is free movement at the wrists and fingers. Another very important aspect in maintaining good ergonomics is the support to the entire back, particularly the lumbar region and upper back. Therefore, it is best to use a chair, as opposed to stools, and have a chair height that is adjustable. In this aspect, forming a partnership with the industry is very useful, as surgeons can give their input, and can help customize or individualize modifiable features for their ergonomic comfort. Another crucial aspect is to make adjustments in the patient chairs and tables. Since a lot of ophthalmic patients are geriatric and may have other comorbidities, paying special attention to lumbar support, below knee support, and elbow support during surgery will go a long way in ensuring both comfort and cooperation of patients. It is time we, as ophthalmologists, start paying attention to our ergonomics, and ensure our professional and personal well-being. An integral part of this is also to engage in regular exercises, particularly for the back and neck, as well as strength building exercises. Editors’ note: Dr. Samaresh Srivastava declared no relevant financial interests. Samaresh Srivastava, MD Consultant, Raghudeep Eye Hospital, A-16 Tilak Nagar, Jaipur, India samaresh@raghudeepeyeclinic.com ASIA-PACIFIC PERSPECTIVES Ophthalmology, Rush University Medical Center, Chicago, Illinois, and has interest with Alcon. Dr. Snyder is Professor of Ophthalmology, University of Cincinnati, Cincinnati, Ohio, and has interest with Beyeonics and Haag-Streit.
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