Avoiding Neck Strain in Vitreoretinal Surgery: An Ergonomic Approach to Indirect Ophthalmoscopy and Laser Photocoagulation

摘要

Several studies have evaluated the occurrence of occupation-related musculoskeletal diseases in ophthalmologists and report an incidence of 30% to 70% for neck pain and 40% to 80% for back pain. These studies have additionally identified indirect ophthalmoscopy and laser photocoagulation surgery as the factors associated with neck and back pain in ophthalmologists. Indirect ophthalmoscopy is indispensable for vitreoretinal surgeons. Indirect laser photocoagulation is particularly useful for surgeons treating diabetic reti-nopathy, retinopathy of prematurity, and retinoblastoma. The traditional technique for indirect ophthalmoscopy is to stand and look down while performing the examination (Figure I). Laser for retinoblastoma can require 10 minutes to 20 minutes of continuous application, whereas laser for retinopathy of prematurity can sometimes take an hour to perform. Here, we describe a technique for indirect ophthalmoscopy and laser photocoagulation that allows systematic and thorough examination and treatment of the fundus and is ergo-nomically superior to traditional techniques.