In 2015, I slipped and fell in the OR on some water on the floor while I was about to mark my next patient. After this accident, I developed a large L5-S1 disc herniation that resulted in severe back pain and right leg weakness that forced me to stop performing surgery for 2 weeks and traveling for 6 months. I was shocked to realize that I was “disabled.” I consulted with back surgeons and neurosurgeons who told me I wouldn’t be able to manage the pain without undergoing surgery.

Seeing surgery as a last resort, I looked for other options for recovery. After a conservative therapy regimen that included daily physical therapy, acupuncture and meditation along with other modifications in my life, I am now about 85% recovered without surgery. My disc herniation — coupled with a problematic spine after years of performing surgery — required me to make major adjustments in the OR, office and home.

Even if you have not experienced a similar injury, you could benefit from looking at how you can make your daily life more ergonomically friendly. A 2005 survey in American Journal of Ophthalmology revealed that about 50% of ophthalmologists report neck or back pain, and 15% had to curtail work as a consequence of this pain. Also, a 2018 JAMA Surgery article by Epstein et al stated that musculoskeletal disorders in high-risk physicians such as ophthalmologists are an impending epidemic due to a looming workforce shortage.

With ergonomics in mind, here are some of the steps you can take to reduce neck and back pain, prevent musculoskeletal disorders and improve your quality of life.

SHORT BREAKS

Micro-breaks throughout the day are very important for relieving pain and discomfort. After a few cases in the OR, I try to stretch for 20-30 seconds. One stretch involves pulling my shoulders back and lifting my chin up to stretch my shoulders and neck. Think of this as the reverse of the forward position your arms are in for an extended period of time during surgery.

A CONSISTENT APPROACH

The slit lamp can be a big source of pain due to the craning of the neck throughout the day. Rather than continuously adjusting to a variety of patient heights, I make sure my slit lamp and chair are set up in the same ergonomically friendly position throughout the day. Ideal position is to sit up straight up with your shoulders back, head over the pelvis and feet flat on the floor. I ask my patients to sit forward in the chair and lean into the slit lamp so I can keep my neck straight. Remember: It’s better for the patient to be uncomfortable for 2 minutes than for you to develop cervical disc disease.

The same applies to the indirect ophthalmoscope. I used to experience such bad neck pain after a long day in the office because my neck would be flexed forward while examining patients. Now I elevate the patient’s chair so I don’t have to flex my neck forward. It really makes a great difference in the amount of neck strain I experience (Figure).

TOO MUCH SITTING

Whether you’re at the at the slit lamp or microscope, working at your desk or watching TV or a webinar, odds are you sit too much every day. The human body experiences greater disc compressive forces while sitting than lying down (and even worse when sitting with bad posture), and standing is better than both.

Along with trying to maintain the posture noted above, good lumbar support is critical to help maintain the natural curve of the spine. One item that has changed my life and that I highly recommend is the Original McKenzie Lumbar Roll. I bought the firm type and keep it in the back of my chair all the time, including in the office, in conferences and when driving.

Other great options to avoid too much sitting are the use of a standing desk, arranging a “walking meeting” instead of sitting at a table and standing during phone calls. After 20 minutes of sitting, take a microbreak to stand or walk.

FOCUS ON EQUIPMENT

Investing in equipment with an ergonomic design can be a wise choice. Examples of equipment in the OR include:

• Chairs. Your choice of chair can make a significant difference in how you feel after a long day in surgery The typical OR chair is uncomfortable. I’ve used saddle stools as well, which help to keep the spine straight. Unfortunately, as an ophthalmologist who needs to use both hands and both feet during surgery, this is not an ideal alternative. I chose the CO:RE Surgical Chair (Haag-Streit), which is comfortable, provides proper lumbar support and offers many adjustability options to provide adequate support for all surgeons.
• Microscopes. Working many hours at a surgical microscope can be a big problem, especially during a longer, difficult case. An ergonomic-friendly microscope reduces the pain and discomfort you may experience during surgery. I tilt the head of the microscope down and pull the oculars up so I can keep my neck straight and look slightly down into the oculars during surgery. Most modern microscopes have this adjustability.
• Heads-up displays. This technology allows you to sit in a natural position and view the surgery by looking at a screen. Options include the NGENUITY 3D Visualization System (Alcon) and ARTEVO 800 (Zeiss).

CHANGES OUTSIDE THE OFFICE

Beyond making adjustments in the office and OR, you can benefit from other lifestyle changes. To help reduce the pain, consider the following:

• Take care of your body. Exercises to strengthen your core will help you to remain stable while in surgery or at the slit lamp. I find meditation, deep breathing and yoga are wonderful as well.
• Avoid “text neck.” This is similar to putting neck in an awkward position at the indirect ophthalmoscope. When you look down at your phones for long periods of time, you take the weight of your head and flex it forward, thus increasing the weight that your neck is carrying. To reduce your risk for deformation of soft tissue after prolonged stress and ligament creep, hold your phone at eye level rather than looking down.
• Seek help. If you have significant pain, consider acupuncture, occupational therapy and physical therapy. If you don’t have success with one of these, try another option. And if you don’t get the desired result from your first physical therapist, try another. I saw three different physical therapists until I found one who really helped me. Surgery should be the last resort.

CONCLUSION

In 2023, we will open a new vision institute in Pittsburgh, Pa. In the process of designing this institute, we have been thoughtful about the health of our doctors and staff so that we can best delivery ophthalmic care. Along with ordering the proper ergonomic equipment, we plan to take several steps to prevent a lifetime of pain and discomfort, and you can too. Be aware of your position and posture throughout the day. Take breaks to stand up and stretch on surgical days, and consider making adjustments in and out of the office to relieve pain.

You may not have suffered a significant injury like mine, but odds are you still feel pain and discomfort in your neck, back and shoulders throughout the day. Make your health a priority and consider what you can do to prolong your career and ease or prevent the level of pain you feel as it progresses. OM

About the Author

Deepinder K. Dhaliwal, MD, LAc, is a professor of ophthalmology at the University of Pittsburgh School of Medicine, vice chair for communication and wellness in the department of ophthalmology, and division chief of cornea and refractive surgery.

Disclosures: Dr. Dhaliwal revealed relationships with Allergan, AnkyrBio, Avedro, CorneaGen, CSI Dry Eye, Glaukos, Haag-Streit, Johnson & Johnson Vision, Novartis, Noveome, Ocular Therapeutix, STAAR Surgical and Trefoil.