Review| Volume 55, ISSUE 3, SUPPLEMENT 1, 17-21, June 2020

Ergonomics in the operating room: it doesn’t hurt to think about it, but it may hurt not to!


      Ergonomics has gained increasing recognition as an integral component of career longevity in ophthalmology. Residents and fellows may encounter unique ergonomic challenges when learning surgical techniques. A systematic review of the literature, specifically looking for recommendations on optimizing ergonomics in the operating room (OR) and articles that explicitly mentioned suggestions for trainees, was conducted. Of the identified 41 pieces of literature, 31 specifically mentioned ergonomics in the OR, 10 discussed vitreoretinal surgery, 2 mentioned strabismus surgery, and 2 described ergonomics in oculoplastics surgeries. Only 9 of the 41 articles explicitly mentioned either residents or fellows. Based on this review, as well as anecdotal experience, recommendations for residents, fellows, and staff ophthalmologists while working in the OR were compiled. To help offset risk for musculoskeletal injury, recommendations related to relaxation, movement, and maintenance of ergonomic focus are proposed. In addition, methods to optimize ergonomics for the patient, surgeon, surgical bed, foot pedals, surgeon’s chair, and the microscope are identified. Trainees may be at particular risk for injury owing to their placement at the surgical bed, and the fact that they may be less likely to get set up ergonomically either owing to a lack of awareness and teaching on the subject, or secondary to perceived time pressures in the OR. Ergonomics should ideally be considered across all domains of life, including in the OR, clinic, and office and at home. The earlier proper positioning is adopted and becomes habitual, the less likely potentially career-threatening musculoskeletal disorders will develop.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Canadian Journal of Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dhimitri KC
        • McGwin Jr, G
        • McNeal SF
        • et al.
        Symptoms of musculoskeletal disorders in ophthalmologists.
        Am J Ophthalmol. 2005; 139: 179-181
        • Hyer JN
        • Lee RM
        • Chowdhury HR
        • Smith HB
        • Dhital A
        • Khandwala M
        National survey of back and neck pain amongst consultant ophthalmologists in the United Kingdom.
        Int Ophthalmol. 2015; 35: 769-775
        • Venkatesh R
        • Kumar S
        Back pain in ophthalmology: national survey of Indian ophthalmologists.
        Indian J Ophthalmol. 2017; 65: 678-682
        • Kaup S
        • Shivalli S
        • Kulkarni U
        • Arunachalam C
        Ergonomic practices and musculoskeletal disorders among ophthalmologists in India: an online appraisal.
        Eur J Ophthalmol. 2018; 30: 196-200
        • Diaconita V
        • Uhlman K
        • Mao A
        • Mather R
        Survey of occupational musculoskeletal pain and injury in Canadian ophthalmology.
        Can J Ophthalmol. 2018; 54: 314-322
        • Agranat JS
        • Miller JB
        • Douglas VP
        • et al.
        The scope of three-dimensional digital visualization systems in vitreoretinal surgery.
        Clin Ophthalmol. 2019; 13: 2093-2096
        • Eckardt C
        • Paulo EB
        Heads-up surgery for vitreoretinal procedures: an experimental and clinical study.
        Retina. 2016; 36: 137-147
        • Martínez-Toldos JJ
        • Fernández-Martínez C
        • Navarro-Navarro A
        Experience using a 3D head-mounted display system in ophthalmic surgery.
        Retina. 2017; 37: 1419-1421
        • Chatterjee A
        • Ryan WG
        • Rosen ES
        Back pain in ophthalmologists.
        Eye (Lond). 1994; 8: 473-474
      1. Bernard BP (ed). Musculoskeletal disorders and workplace factors. A critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back. Cincinnati: DHHS (NIOSH) Publication Number 97-141. July 1997. (accessed December 27, 2019).

        • Kitzmann AS
        • Fethke NB
        • Baratz KH
        • Zimmerman MB
        • Hackbarth DJ
        • Gehrs KM
        A survey study of musculoskeletal disorders among eye care physicians compared with family medicine physicians.
        Ophthalmology. 2012; 119: 213-220
        • Alrashed WA
        Ergonomics and work-related musculoskeletaldisorders in ophthalmic practice.
        Imam J Appl Sci. 2016; 1: 48-63
      2. Roach L. Practice perfect: business operations & finance. Ergonomics, part one: is the job you love a pain in the neck? EyeNet Magazine, September 2009:49–50. (accessed December 27, 2019).

      3. Jordan L. Ergonomics: how not to sacrifice your body. Rev Ophthalmol. October 14, 2018. (accessed December 27, 2019).

      4. Roach L. Practice perfect: business operations & finance. Seven risk factors for injury, and seven solutions. Ergonomics, part two. EyeNet Magazine, September 2009:45–6. (accessed December 27, 2019).

        • Dennerlein JT
        The state of ergonomics for mobile computing technology.
        Work. 2015; 52: 269-277
      5. UCLA Health. Ergonomic tips for the use of hand-held devices. (accessed December 27, 2019).

        • Nichols M
        • Marx J
        Ergonomics for the retinal physician.
        Retinal Physician. 2019; 16: 26-29
        • Tremblay MS
        • Colley RC
        • Saunders TJ
        • Healy GN
        • Owen N
        Physiological and health implications of a sedentary lifestyle.
        Appl Physiol Nutr Metab. 2010; 35: 725-740
        • Garber CE
        • Blissmer B
        • Deschenes MR
        • et al.
        American College of Sports Medicine. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercises.
        Med Sci Sports Exerc. 2011; 43: 1334-1359
      6. Ratzlaff T, Brissette A. Musculoskeletal disorders in ophthalmologists. (accessed March 18, 2020).

      7. Ratzlaff T, Brissette A. Watch your back (and neck and wrists). CRST Europe: Editorial spotlight 2018. Accessed March 18, 2020.

        • Ratzlaff T
        • Diesbourg TL
        • McAllister MJ
        • von Hacht M
        • Brissette A
        Evaluating the efficacy of an educational ergonomics model for improving slit lamp positioning in ophthalmology residents.
        Can J Ophthalmol. 2018; 54: 159-163
      8. Kent C. Will ophthalmology cripple you? Rev Ophthalmol. October 4, 2011. (accessed December 27, 2019).

      9. Charles S, Hanovar SG, Hyer JN, Marx JL, Olitsky SE, Singh IP. Ophthalmologists raise awareness of workstyle-related ergonomic problems. Ocular Surgery News US Edition C, 2019. (accessed December 27, 2019).

      10. Dollin M, Garg SJ, Mehta S, Spirn M. Ergonomics and retina. Retina Today, May/June 2014. (accessed December 27, 2019).

        • Wand M
        Ergonomics for ophthalmologists at home and in practice.
        Audio Digest Ophthalmology. 2014; 52 ( (accessed December 27, 2019))
      11. Daly R. Prioritizing ergonomics in the OR. EyeWorld, 2018. (accessed December 27, 2019).