Ergonomics Tips for Eye Care Providers

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• Ergonomics Tips for Eye Care Providers
• You might have heard the phrase everyones
  replaceable. That might be true for a lot of
  positions, but if youre an eye care provider,
  its not. As a physician youre not just a part
  of the practiceyou are the practice. If you miss
  clinic or surgery days because of musculoskeletal
  injuries, the whole practice suffers scheduling
  and revenue setbacks. To keep your practice in
  tip-top shape youve got to keep your body in
  tip-top shape.
• You may not realize it, but the activities you
  perform day in and day out cause wear and tear on
  your body for eye care providers, the neck,
  back, shoulders, and wrists are areas of
  particular concern. Left unchecked over the
  years, this wear and tear can eventually lead to
  injury, according to Jeffrey L. Marx, who spoke
  to ophthalmologists about ergonomics at AAO 2017.
• Some of the biggest factors affecting eye care
  providers, according to Marx, are poor postures,
  repetitive motions, and staying in an awkward
  positionsay, head bent forwardfor long
  durations. These factors combined can result in
  problems like musculoskeletal disorders (MSDs),
  cumulative trauma disorders (CTDs), and
  repetitive strain injuries (RSIs). The result is
  pain and discomfort that affects your mood, your
  productivity, and your bedside manner. Your
  overall quality of life will suffer, and even
  your leisure activities could be curtailed.
• We need to heighten awareness and the benefits
  of prevention before people will buy into a
  prevention plan.Scott Olitsky, MD
• The 3 Ps of Prevention
• Luckily, a few small adjustments now can go a
  long way towards preventing problems later. And
  prevention strategies are the key to healing and
  avoiding wear and tear on the bodys soft tissues
  that can lead to an injury. After all, its all
  too easy to ignore inconveniences like a sore
  neck or back until they turn into bigger
  problemslike missed work days and lost income.
  There are three main ideas to keep in mind
  throughout the day, according to Scott E.
  Olitsky, MD, who also spoke about ergonomics at
  AAO 2017 your posture, positioning of yourself
  and the patient, and taking a few minutes to
  practice periodic stretching.
• Ergonomics In the Clinic
• Pay attention to your clinical setup. In many
  practices, treatment rooms are identical. That
  means youre stressing one side of the body Set
  up rooms so that youre not always

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• leaning the same way. It may feel awkward at
  first to use the rooms that make you lean the
  other way, but you can train yourself to vary
  positions.
• Youll be performing many clinic activities
  seated on a stool unsupported sitting. Wehking
  likes models where the seat tilts
• forward and back, but whatever style you choose,
  remember that posture starts at the pelvis.
• Take a few moments to position yourself in front
  of the patient. Try to get your exam stool wheels
  underneath the patients footrest so that you
  dont have to reach forward during the
• examination. Raise the footrest if necessary.
• Tip When performing retinoscopy, try switching
  hands regularly to ease the burden on your
  dominant side.
• The Ergonomics of Medical Equipment
• Many pieces of equipment you use regularly
  werent created with ergonomics in mind.
  Indirect ophthalmoscopy is and ergonomic
  jungle due to the constant bending and leaning,
  Dr. Marx jokes. And forcing your body into
  awkward positions to accommodate equipment can
  eventually cause neck pain, numbness in the hands
  and arms, and even cervical problems. Until
  manufacturers start designing tools with
  ergonomics in mind, here are a few tips for
  coping

Slit Lamp ?

• Shorten or narrow your slit lamp table to
  increase your reach and bring the slit lamp
  closer to you. That way, you can avoid leaning
  forward and extending your neck. Sitting up
  straight can also help you keep your wrist in a
  neutral position (instead of bent) when using the
  controls.
• Many physicians rest their elbow on the slit lamp
  table to
• steady their hand. Over time, the constant
  pressure on the elbowwhich isnt meant to be
  weight-bearingcan cause numbness and tingling.
  Thats nerve damage. Instead, use a gel rest to
  support your elbow, advisees Marx.

Injections Ophthalmologists administer millions
of injections each year. That makes repetitive
motion injuries a top concern. Dont put sharps
disposals container underneath the sink. You will
need to bend awkwardly to throw away sharps. Put
the container on the wall for easier reach
instead.
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• Pediatrics
• The eyes are already two of the human bodys
  smallest structures, and for pediatric
  ophthalmologists, theyre even smaller. Olitsky
  gives these ergonomic tips for treating your
  smallest patients
• Failing to properly position the patient is one
  of the biggest problems. Taking just a few extra
  seconds to position yourself and the patient
  properly can greatly reduce the stress on your
  neck, back, and shoulders.
• For children, who tend to sit back far from the
  seat edge,
• consider using a foam wedge behind their backs to
  bring the forward and decrease the distance you
  must reach.
• Tilt chairs back so that you dont have to duck
  underneath the
• patient.
• Raising small patients to the right height will
  help keep your hand, wrist, arm and elbow in
  alignment.
• Many physicians were trained to sit at head of
  patient. Instead, try sitting on the side, or
  switching positions occasionally.
• Ergonomics in the Operating Room
• The main issue in the OR is posture.
  Ophthalmology surgeries dont often require much
  movement, so surgeons are stuck in the same
  position for long periods of time. For many
  surgeons, that means sitting, leaning forward,
  with the neck extended and the head bentand
  thats no good. Your head likely weighs somewhere
  between 10 and 12 pounds. As you tilt your head
  forward, the muscles, tendons, and ligaments that
  support your head must work increasingly harder
  the more the tilt. This creates wear and tear on
  the entire neck structure, resulting in neck and
  upper back pain, and could even lead to disc
  problems and spinal degeneration.
• Tip For your surgical chair, upper extremity
  support is important, says Jeremy Wehking PT,
  OCS, FAAOMPT, PRC, who also spoke at AAO. For
  some, turning a backed chair around so you have
  some lean in support works very well, he notes.
• Tip Consider standing. Dr. Glaucomflecken, a
  popular med-Twitter personality, recently joked
  that he chose ophthalmology as a specialty so he
  could operate sitting down. Thats good for a
  laugh, but unfortunately, its not as great as it
  sounds. Actually, standing in the OR is better
  for your body in the long run. Standing puts less
  weight on your lumbar spine, allows surgeons and
  staff of varying heights to all maintain proper
  posture, and it allows you to move more
  frequently and easily, notes Olitsky. Not only
  that, you burn approximately 800 calories more
  per day when you are standing as opposed to
  sitting.

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• And dont forget to periodically pause and
  stretch to get blood moving to muscles. According
  to a new study by Adrian Park, MD, chair of the
  Department of Surgery at Anne Arundel Medical
  Center, surgeons who periodically pause for 90
  seconds to perform a series of stretches
  throughout an operation report less work-related
  discomfort and an improvement in physical
  performance and mental focus. Granted, you may
  not want to interrupt a 10-minute cataract case
  with a minute and a half of stretching, but
  stretching afterwards and between cases is a
  smart idea.
• If your equipment has pedals of differing
  heights, put a towel under the lower ones so they
  are all the same height, recommends Marx.
• Make sure youre using the right binocular for
  your size and shape. One size does not fit all.
• Dont hunch. Adjust equipment to the proper level
  and working
• distance.
• This will vary depending on preference, but some
  surgeons opt for heads-up surgery, viewing on a
  screen (with 3D display) instead of directly
  through the microscope.
• Eyewear for Providers
• You dont want your patients buying cheap glasses
  and lenses online, so why would you? Get fitted
  for a good pair of loupes, and dont buy 16.99
  loupes on eBay, Olitsky quips.
• Choose a loupe that has a good declination angle
  for you, he recommends. You can find and measure
  this angle by drawing a line from where the
  temple piece of a spectacle rests on your ear to
  the bridge of your nose.
• This is the optimal angle to position your eyes
  when in balanced operating position, notes
  Olitsky.
• Your working distance needs to be individualized,
  Olitsky emphasizes. He often sees physicians, and
  especially residents, whose working distances are
  too short. When adjusting your working distance,
  youll need to also adjust the magnification of
  your loupes.
• 8 Steps to Find Your Balanced Operating Position
  (BOP)
• Finding and maintaining your BOP will reduce the
  risk of musculoskeletal pain. Olitsky explains
  how

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• Adjust head for comfort
• Bring arms to position for fine motor work
• Open eyes and look at hands
• Adjust eyes/head as needed but maintain comfort
• Ergonomics In the Office
• If you had your way, youd be spending far less
  time on paperwork and the computer.
  Unfortunately, thats not the reality for todays
  physicians. But seated deskwork presents its own
  ergonomic challenges
• Check your computer habits. Good computer posture
  means
• Sitting as far back as possible in the chair
• Feet flat on the floor with knees level with (or
  just below) your hips.
• Adjust armrest to a height where your shoulders
• are at rest.
• If you work on a laptop, get a stand. The top of
  the screen should be just above your seated eye
  level. Or, consider standing desks for you and
  your staff.
• Dont cradle the phone. If youre on the phone a
  lot, consider a headset.
• Stretch throughout your day or whenever
• possible. For example, a hip flexor stretch can
  help alleviate pain in the lower back hips caused
  by prolonged sitting.
• Our staff mirror the same things we do. Mirror
  good ergonomic habits for your staff.Jeffrey L.
  Marx, MD

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• yet, try limiting non-essential smart phone use
  as much as possible during non-work hours.
• Practice corrective exercises. Corrective
  exercises do two things they get you into a
  good position and get you strong enough to stay
  that way, Wehking explains. We dont want to
• put fitness on top of dysfunction, he adds.
  Corrective exercises can help alleviate pain
  caused by musculoskeletal
• imbalances.