Dear Editor,
Musculoskeletal disorders are common among ophthalmologists due to prolonged sitting posture during the slit-lamp examination, laser treatments, gonioscopy, and while performing long-duration surgeries. The slit-lamp is the equipment used by all eye specialists, which needs a leaning forward posture to reach the oculars, which leads to chronic pain and discomfort. Hyer et al. observed 62.4% of the consultant ophthalmologists under study had back or neck pain. The prevalence of symptoms varies among different countries. A survey of American ophthalmologists revealed comparatively less report of neck, upper body, or lower back pain in 52% of their respondents.[1] A study from Saudi Arabia published on ergonomics in ophthalmic practice reported the highest prevalence of low back symptoms, around 26–79%, and among them, 5–7% required surgical intervention. Among the Indian studies, 71% had low back pain, and 80% among Iranian ophthalmologists.[1-3]
Early signs and symptoms of musculoskeletal disorders are most often overlooked and the structural changes happen silently, leading to physical disability, reduced work performance, or even irreversible damage. The pressure on the spine varies significantly among the most common postures we all assume daily [Fig. 1]. The intradiscal pressure is the highest in sitting posture with leaning forward (0.83 MPa) and lifting weight from a seated forward leaning position (1.70 MPa). The intradiscal pressure is the lowest in the supine position (0.10 MPa) because the body weight is evenly distributed and supported in this posture.[4] The forward leaning position while using slit lamps overstretches the examiner's neck and brings the upper neck joints into an extremely strong extension or flexion depending on the patient's posture.[5] This causes an abnormal burden on the cervical spine with asymmetric pressure of the intervertebral discs below and fatigue in the neck muscles including the strap muscles of the neck as well as the trapezius. The anteriorly directed position of the head leads to an overall non-physiological kyphosis along the spine and an additional burden on the lumbar region, including discs, nerves, and vessels. Similarly, while operating on the microscope, there is a tendency to recline the upper cervical spine and tilt the pelvis backward with a non-physiologic kyphosis in the lumbar spine.[5] Over time, this leads to discomfort and pain in the lower back causing sciatica. Long sitting hours on an uncomfortable chair have also made ophthalmologists prone to coccygeal pain. The foresight on intradiscal pressure and the requisite for ergonomically designed equipment such as operating microscopes, and slit-lamps to prevent structural damage in the spine among ophthalmologists is important to spare them from a lifetime of pain and discomfort.[5-8]
Figure 1.
The image shows the percentage of intradiscal pressure on the spine varying with the most common postures we all assume daily
Though the ultimate treatment is a holistic approach by regular exercises, yoga, stretches, maintenance of correct posture, and taking micro-breaks, a less tedious solution by making our ophthalmic equipment ergonomic friendly could prove to be of extreme help in the long run.
Constantly maintaining the correct straight body posture and acquiring micro breaks is impossible in the busy daily routine of a full-time ophthalmologist. Also, the demand for ophthalmologists is high due to increasing patient volume and the transition to electronic medical records. Due to their personal experience of low back pain, neck pain, and structural damage, the authors have developed a novel idea of adding an extra device to the slit-lamp microscope to enable a straight posture. The addition of this tool to the slit lamp will permanently prevent back and neck pain.
The authors propose a prototype model; the Third-I Camera tool [Fig. 2] with software is a beam splitter slit lamp camera (breadth is 6 cm) developed by Aurolab for high-definition imaging of the anterior segment. An extra, unused device was placed between the eyepiece and the illumination system, thus elongating the illumination arm of the slit-lamp by 6 cm. This reduces the angle between the ophthalmologist's spine and the imaginary vertical plane from leaning forward to the straight posture of the back and neck. This reduces the stress on both neck and back muscles. To improve the work ergonomics, based on the prototype model, a similar low-cost effective model can be equipped with the slit-lamp and made readily accessible for ophthalmologists, in the future. The images in [Fig. 3a and b] depict the angle between the imaginary straight line and the back surface, without and with the addition of the tool. The angle reduced from 45 degrees to less than 25 degrees, which reduces the percentage of intradiscal pressure from 275 to 140% [Fig. 1].[4] The default addition of a similar extension in the slit-lamp would aid to improve the work efficiency of ophthalmologists in the future.
Figure 2.
The Third I tool developed by Aurolab
Figure 3.
(a and b) Image showing the angle between the imaginary straight line and back surface, without and with the addition of the tool
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Conflicts of interest
There are no conflicts of interest.
References
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