Ergonomics for Ophthalmologists at Home and in Practice

Educational Objectives

The goal of this program is to improve ergonomics for ophthalmologists. After hearing and assimilating this program, the clinician will be better able to:

1. Incorporate proper ergonomic practices into the office environment and operating room.

2. Discuss the negative effects of sitting for long periods of time.

Summary

Natural posture: normally, cervical spine lordotic, thoracic spine kyphotic, and lumbar spine lordotic; ergonomic practices should strive for these natural positions; as demonstrated during space program, body assumes neutral position under weightless conditions, minimizing tension and pressure on nerves, muscles, tendons, and bones; from this position, individual can exert greatest amount of force with least stress on structures of body

Musculoskeletal disease: in addition to age, trauma, and arthritic disorders, risk factors for musculoskeletal disease include static and awkward postures, repetitive and contact stress, and use of fine motor control for long periods of time; ophthalmologists therefore at risk

Ophthalmologic profession: task force formed to assess ergonomic issues, but ophthalmologists lag behind dentists and other professions in addressing ergonomics; in survey of 697 ophthalmologists, 40% reported low back pain within previous month, and prevalence of pain higher in female physicians; annual surveys of ≈7000 members of American Academy of Ophthalmology show that prevalence of pain increases significantly with number of years in practice; studies (including age-matched, case-control study of 94 ophthalmologists and 92 private practitioners) find that physicians who do many procedures have significantly higher prevalence of musculoskeletal disease; 30% of ophthalmologists have problems with cervical spine or lower back

National statistics: 80% of Americans have lower back pain during lifetime; average American spends 8.5 hr/day looking at screens; 45- to 50-yr-old age group sits for average of 9 hr/day

Effect of sitting: sitting increases pressure on nucleus pulposus of lumbar discs by ≥50% compared with standing; leaning back and using lumbar support decreases pressure by 75%; sitting while leaning forward, as when leaning on desk, eliminates lordosis and increases pressure on discs; backrest helpful, but most chairs imperfect; ergonomic chairs allow user to adjust chair and positions of backrests and armrests; shift position frequently to promote health of back; lying flat or standing easier on spine than sitting; most kitchen counters not at proper ergonomic height, causing user to lean forward; bending over and lifting cause additional stress on back

Benefits of standing: standing produces less pressure on spine than sitting; standing burns 33% more calories than sitting down; standing associated with more movement and use of muscles of legs and core; spine maintained in normal lordotic position during standing; individuals who sit for prolonged periods have 50% increase in risk for death from any cause and 125% increase in risk for cardiovascular events; vigorous exercise does not prevent this; after sitting for 1 hr, metabolism changes significantly, and blood pressure, blood sugar, and cholesterol rise

Ergonomic aids: desks that move up and down easily allow adjustment of position; standing on gel pad permits longer periods of comfortable standing; using bar to elevate feet increases comfort; improved keyboards allow user to work with arm and wrist in neutral positions; ergonomic keyboard uses negative tilt for wrist; split keyboard reduces ulnar deviation, and curvature reduces pronation of forearm; good practices include using eyeglasses designed for use with computer and avoiding use of shoulder to hold phone

Construction of home: vanities in bathrooms and counters in kitchens too low for comfortable use; ideal height for kitchen counter 3 in below elbow; washing dishes in deep sink encourages bending over

Workplace: computer — poor posture during work common among physicians, partly because equipment not well designed; use of electronic health records demands additional use of computer; physician should adjust materials to proper height when sitting or standing; slit-lamp examination — equipment designed for comfort and safety of patient; to use slit-lamp microscope more comfortably, move patient forward (toward yourself); adjust own chair as necessary, then move patient forward and adjust chair up and down to align patient’s eyes slightly below your eyes; avoid leaning forward; support back by using armrest or knee; attire — for women, slacks allow ergonomic posture during slit-lamp examination; dress creates more difficulty with posture because physician must sit sideways while crossing legs; moving patient — when chair and its roller make it difficult to get close to patient, either raise patient up so that standing examination feasible, or fold patient’s footrest upward to permit your chair to move closer to patient; slit lamp poorly designed; top of lamp too deep for safety and comfort of physician, and moving patient toward you alters focus; when using laser or lens to examine patient, keep elbows and wrists in neutral position; retina surgeons have highest prevalence of musculoskeletal diseases; take extra time needed to move patient so you can work comfortably

Operating room: avoid moving patients on and off table, or use mechanical aids to do so; use surgical towel to adjust foot pedal and microscope to same height; when possible, use sterile towels to create padded arm rests; tilt microscope as needed to avoid backward extension of neck; video screens that show 3-dimensional images improving, and can eliminate need to look through microscope

Summary: Dutch dental society recommended adoption of many ergonomic practices; implementation of 50% of these recommendations resulted in decrease or complete resolution of musculoskeletal disorders; maintain neutral position when possible during all activities; move patient or task toward you; avoid prolonged static position, whether sitting or standing; take breaks, move around, and stretch between cases

Readings

Disclosures

In adherence to ACCME Standards for Commercial Support, Audio Digest requires all faculty and members of the planning committee to disclose relevant financial relationships within the past 12 months that might create any personal conflicts of interest. Any identified conflicts were resolved to ensure that this educational activity promotes quality in health care and not a proprietary business or commercial interest. For this program, members of the faculty and planning committee reported nothing to disclose.

Acknowledgements

Dr. Wand was recorded at the 12th Annual Downeast Ophthalmology Symposium, presented by the Maine Society of Eye Physicians and Surgeons, and held September 20-22, 2013, in Bar Harbor, ME.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

OP521801

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

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