CATARACT 22 EWAP MARCH 2023 surgical chair that has center back support that follows the contours of the lumbar spine and goes up into the thoracic spine. Chair height is also important. “The surgeon should set their own chair height … and take the extra 3 seconds to raise or lower the patient so the bed in the OR and the slit lamp in the clinic are at a comfortable height,” he said. “Most ophthalmologists either lean down a little or lean up a little.” While this might be fine for a few minutes, Dr. Snyder said it becomes a problem when you’re doing it 50–100 times a day several days a week, decade after decade. Some operative microscopes and slit lamps have attachments that allow the surgeon to change either the angle of viewing or the distance the oculars extend laterally. When it comes to the slit lamp, Dr. Snyder said its basic design has been around for 150 years and it’s time for an update. When considering heads-up microscope technology, Dr. Snyder mentioned several potential downsides that hopefully technology can overcome. These include the footprint and fixed positioning of the screen, the tower of the microscope sitting right in front of the eye (the surgeon has to look around the stack of the microscope, which requires them to either tilt their spine or turn their head), latency delays in the display system, and the dynamic range of the camera not being quite as good as the human eye. Dr. Snyder mentioned Beyeonics, which pairs virtual reality glasses that are partially transparent with a microscope system. The Beyeonics technology avoids the issue of having to look around the stack of the microscope because the stack could be right in front of you and you can still see fine since the image is in the goggles-based headset, he said. Jonathan Rubenstein, MD Dr. Rubenstein has experienced firsthand the necessity of making changes due to progressive neck problems, which began more than a decade ago. He eventually developed a herniated cervical disc and needed a cervical discectomy and cervical fusion in 2008. Ergonomics, he said, is an issue that’s getting more attention now than it has in the past. The slit lamp is one problem because you’re often in a position where you’re putting tension on your neck, he said. Additionally, the use of the microscope in the OR has the potential to cause neck and back issues. It is common for ophthalmologists to develop these neck and back issues, he said. Dr. Rubenstein said his neck issues likely built up over time during his more than 30 years in practice. “I remember when I went to physical therapy, I thought I had good posture,” he said, adding that the physical therapist showed him the correct posture to realign his back and neck. “Therapy did not obviate the need for surgery, but it taught me [what to do] after surgery and how to maintain proper posture,” he said. “I knew I had pain, but I didn’t think it was a big deal,” Dr. Rubenstein said. “I saw a neurosurgeon, and he tested the strength in my arms. I lifted my arms up, and he said, ‘Don’t let me pull your arm away.’ He then easily pulled one arm down as I was trying to resist, demonstrating a definite loss of strength.” As an ophthalmologist, you cannot risk motor problems affecting your arms and hands, he said. Dr. Rubenstein started using the 3D heads-up microscope, which he thinks helped lessen his neck strain, but he also acknowledged that even heads-up microscopes have issues. They present other issues with posture, he said, because you tend to sit back like you’re in an easy chair, and although you’re relaxed, you might not have good posture. It’s not perfect, but he thinks it’s considerably less stress on the back and neck than a traditional microscope. He noted that there are a couple of options available in this space, the NGENUITY (Alcon) and the ARTEVO 800 (Carl Zeiss Meditec). The heads-up technology provides a great intraocular view, Dr. Rubenstein said, and it’s good for teaching. “Everything the surgeons sees, everyone else in the operating room can see,” he said. The disadvantages, however, are that there is more equipment that needs positioning in the Dr. Rubenstein teaches a resident with the NGENUITY system. Source: Jonathan Rubenstein, MD
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