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Sonia Mehta, G B. Hubbard, III; Avoiding Neck Strain in Vitreoretinal Surgery: An Ergonomic Approach to Indirect Ophthalmoscopy and Laser Photocoagulation. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3800.
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High rates of occupation related neck and back pain have been reported in ophthalmologists.1-5 A recent study found 15% of ophthalmologists had work limitations as a result of debilitating musculoskeletal disease.1 Indirect ophthalmoscopy and laser photocoagulation surgery have been identified as risk factors associated with neck and back pain in ophthalmologists.1,2 We describe a technique for indirect ophthalmoscopy and laser photocoagulation that is not only effective for examination and treatment of the peripheral fundus but also ergonomically superior to traditional methods.
In the traditional technique for indirect ophthalmoscopy, the surgeon stands and looks down at a supine patient causing the surgeon’s neck to be in flexion for the duration of the exam and laser. This increases strain on paraspinal muscles and ligaments and load on the cervical spine. In the proposed technique, the surgeon is seated with the cervical and lumbar spine in neutral position and instead the patient’s head is positioned at the appropriate height and tilt to examine and treat corresponding parts of the fundus.
Surgeons performing indirect ophthalmoscopy and laser photocoagulation for prolonged time in conditions such as retinopathy of prematurity, diabetic retinopathy, and retinoblastoma found increased comfort and decreased neck and back strain when performing this new technique.
Ophthalmologists are at risk for developing occupation related musculoskeletal diseases that can impact their ability to practice. We describe an ergonomically improved technique for indirect ophthalmoscopy and laser photocoagulation that is comfortable for the surgeon and effective for examining and treating the peripheral fundus.
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