Zachary D. Pearce, Mathew A. Zatkin, Jon Bruner. Musculoskeletal Disorders in Ophthalmologists After Simulated Cataract Operation: A Pilot Study. J Am Osteopath Assoc 2017;117(12):749–754. doi: 10.7556/jaoa.2017.146.
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Musculoskeletal disorders are a common problem among ophthalmologists, likely due to ergonomic challenges. Most research on the topic has been survey-based studies, which carry inherent weaknesses.
To examine the frequency and pattern of musculoskeletal dysfunction induced by performing a surgical procedure and to quantify the improvement after ergonomic interventions.
Ophthalmology residents from a single academic institution were invited to participate in the study on a volunteer basis. Preexisting musculoskeletal disorders; previous spinal, cervical, or shoulder surgery; or limited range of motion of the upper body or arms were exclusion criteria. The interventions consisted of a surgical simulation session and a control session, each lasting 2 hours. For the surgical simulation session, a musculoskeletal examination was performed at the beginning and end of the 2-hour session after the participants used the Eyesi Cataract Surgery Simulator (VRmagic). A musculoskeletal examination was performed by the palpatory screener (M.A.Z.) at the beginning and conclusion of the 2-hour control session, which consisted of both passive and active tasks. The musculoskeletal screener was blinded as to which session the participant was completing at the time of the examinations, as well as any musculoskeletal examination findings from before the intervention. All participants completed both sessions, but they were randomized into which session they were to complete first. Participants completed each session one after the other.
Eight participants completed both sessions, and 32 musculoskeletal examinations were performed. In the surgical simulation session, after using the simulator, 5 of 8 participants had an increase in the number of spinal levels with tissue texture abnormalities, and 3 had no change. Of those in the control session, 5 participants had a decrease in the number of spinal levels with tissue texture abnormalities after a period of rest. Three participants in the control session had an increase in the number of affected spinal levels. The mean (SD) change in number of affected spinal levels in the surgical simulation session and control session was 1.3 (1.2) and −0.6 (2.0), respectively (P=.125). Age, sex, level of training, baseline somatic dysfunction, and which session was completed first did not affect results.
The majority of participants in the surgical simulation session had an increase in degree of somatic dysfunction, whereas the majority in the control session had a decrease in degree of somatic dysfunction. Although the sample size of this pilot study was too small to show statistical significance, a trend was observed, and further study is warranted.
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