Ergonomics in Ophthalmic Surgery

“It’s Easy to Neglect One’s Own Health”

December 01, 2009

Every operation demands a maximum of concentration from surgeons and their teams. A comfortable, pain-free working posture helped by the ergonomic design of the surgical microscope aids concentration – and contributes significantly to the success of the operation. Andrew Morris, Consultant Ophthalmologist at the Royal Bournemouth Hospital, England, since 2002, reports on his experience with ergonomics in everyday working life.

Dr. Morris, please tell us something about the sort of work you do.

My subspecialty interest is vitreoretinal surgery. I am one of two "VR" surgeons in the Bournemouth eye unit as part of a team of 10 ophthalmologists. Most of my microscope work involves vitrectomy surgery and the most common condition that we treat with this technique is retinal detachment. The microscope is adapted with the BIOM attachment (Binocular Indirect Operating Microscope) for viewing the retina and vitreous cavity through the dilated pupil of the eye.

“The ergonomics of the equipment I use are a key factor in my working day.”

In vitrectomy we need a well-illuminated, wide field of view, and good stereopsis. A complex vitreoretinal procedure may take 90 minutes or more, so the ergonomics of the equipment that I use are a key factor in my working day.

Andrew Morris appreciates the ergonomic features of his Leica M844 C40 surgical microscope: the eyepieces can be adjusted to allow surgeons of all heights to sit in an upright position.

Leica Microsystems’ crisp, sharp APO OptiChrome™ M844 optics and exclusive direct illumination system offer the best clarity, contrast, and colour at safer low-light levels. The ceiling mount provides a convenient alternative solution for the operating room that frees up floor space while allowing flexibility for the surgical team to access either side of the operating table.

Which ergonomic features of your microscope do you consider helpful?

The Leica M844 C40 surgical microscope offers several key features: It is easy to move and adjust to the required position. The eyepieces can be adjusted to suit most heights of surgeons allowing him or her to sit in an upright position. It is straightforward to fit the vitreoretinal equipment and this can be left in place for cataract surgery.

I also greatly appreciate the co-observation unit: First­ly, the assistant enjoys the same degree of stereopsis as the operating surgeon. Secondly, the second binocular tube can be effortlessly swivelled through 180 degrees if the assistant has to change sides. The Leica Microsystems sales team offered us optimal assistance in choosing the right equipment.

How important is ergonomics in your department?

It can be easy in busy practice to neglect one’s own health. Back trouble is relatively common! High quality, reliable equipment that is quick to adjust is essential for dealing with a heavy workload.

What fascinates you about ophthalmology?

I gathered my first experience in this field as a student in East Africa. We flew to remote clinics equipped with a bag of simple surgical instruments that were sterilised in boiling water before the operation (SightByWings/Christian Blind Mission). Without a microscope operating was done with the aide of a loupe. The operating lamp was a car headlamp powered by a 12 V battery. Yet in spite of various adverse conditions we were, in many cases, able to restore people’s eyesight with relatively simple surgical techniques. New techniques, advances in technology and the awesome visualisation achieved with the operating microscope have had a great impact on our working lives.

The Leica ErgonOptic™ System

Of all the suppliers of surgical microscopes, Leica Microsystems offers the widest range of binocular tubes and adapters that meet the special requirements of every surgeon and assistant. Choosing from the large selection of binocular tubes and accessories, the customer builds an individual microscope system that provides him or her with optimum vision and perfect ergonomics for long workdays.

Variable binoculars

For the <b>10°–50° Ultralow™ II binocular tube</b>, the viewing height is shifted far downwards, which allows the use of accessories such as a beamsplitter, inverter or laser shutter without impairing vision.
The variable, but still compact <b>30°–150° binocular tube with low viewing height</b> reduces the distance to the field of operation. This is also ideal for the assistant, who can adjust the viewing angle and height of the assistant’s attachment according to his or her body height.
The long tubes of the <b>binocular tube with variable viewing angle from 10°–50°</b> create a greater distance to the field of operation and enable an upright posture. The higher position of the swivel range provides ergonomic viewing conditions to surgeons of different body heights.
The tubes of the <b>binocular tube with a viewing angle variable from 5°–25°</b> create a medium distance to the field of operation and provide ergonomic viewing conditions to surgeons of different body heights. Ideal for a microscope configuration with few accessories.
The <b>binocular tube with a viewing angle variable from 0°–180°</b> provides optimum viewing comfort in all microscope positions, from horizontal to vertical.

Fixed binocular tubes and accessories

With the <b>ErgoWedge 5°–25°</b> and the <b>ErgoWedge +/–15°</b>, the viewing angle of the binocular tube can be varied for better viewing comfort.
The tubes of the <b>highly inclined binocular tube</b> and the <b>inclined binocular tube</b> are fixed at an angle of 45°. They are particularly suitable for assistants’ accessories such as the stereo attachment for a second observer and enable an upright posture.