When you’re faced with a full day’s caseload, it can be easy to sacrifice comfort in the interest of saving time. You might quickly lean over the slit lamp rather than taking a seat and using it properly, or reach for the ophthalmoscope instead of getting up to grab it. While these may seem like minor shortcuts, they can take a major toll on your body over the course of a workday.
A recent survey of Australian optometrists revealed that 82% of respondents experienced some form of work-related physical discomfort. The neck, shoulders and lower back are the most common problem areas.1
“I was amazed at how many optometrists told me that they had experienced discomfort and put up with pain for many years, but no one was able to provide an explanation,” says lead author Jennifer Long, B.Optom (Hons), M.Safety Sc., an optometrist and certified professional ergonomist from the School of Optometry and Vision Science at the University of New South Wales in Sydney.
The explanation involves many components—including the nature of the work itself. With so many instruments and pieces of equipment involved in a comprehensive eye exam, it’s no surprise that repetitive stress injuries are common. Research has suggested that clinical tasks such as slit-lamp examinations, ophthalmoscopy and refraction frequently contribute to discomfort.2
Or, in other instances, they may exacerbate an existing musculoskeletal issue, which was the case for Rebecca Hutchins, O.D., a behavioral optometrist in Niwot, Colo. She suffers from brachial outlet syndrome, causing tightness in her neck as well as numbness and tingling in her right arm, hand and wrist. After observing Dr. Hutchins perform a typical eye exam, a professional ergonomist told her that the clinical tasks required of optometrists were some of the worst repetitive motion behaviors he’d ever seen.
And he’s not the only one who thinks so. A recent study in Ophthalmology found that eye care providers suffer from more musculoskeletal disorders than family practice physicians.3 Results showed that eye doctors reported a higher prevalence of neck pain (46% vs. 21%), hand/wrist pain (17% vs. 7%) and lower back pain (26% vs. 9%).3
Performing repetitive tasks and continuing to work while injured increases the risk of experiencing severe discomfort.1 That’s why it’s important to address pain as soon as possible and take preventive measures to avoid injury in the first place.
Develop a Game Plan
There are many ways to assess ergonomic health in your exam lane—the choice depends on your personal preference, your practice and your budget. When evaluating your practices and techniques, ask yourself:
- Is this comfortable?
- Is this efficient?
- How can we make it better?
“Some people are very aware of their own bodies,” Ms. Long says. “If they videotape themselves, it might provide them with enough information to identify how they can improve their practices and techniques.”
Or, you may prefer to have a colleague observe you and provide suggestions. However, if your colleague works in the same practice, he or she may be too close to identify any problem areas or offer new solutions. In this case, it may be best to seek professional resources outside the practice. “An outsider might be able to provide a different perspective on an issue or come up with a novel solution based on their experience working in other industries or with other optometry practices,” Ms. Long says. “However, they would need to spend some time with the optometrist or in the practice to understand the nature of the job.”
To address specific physical injuries, you may want to consult a specialist. Dr. Hutchins, for example, sees a chiropractor, an osteopath and an acupuncturist monthly. For a more comprehensive approach, occupational therapists or ergonomists can perform jobsite analyses to help you make any necessary changes to your workspace and schedule.
Karen Jacobs, Ed.D., an occupational therapist, certified professional ergonomist and clinical professor of occupational therapy at Boston University, tells her clients to fill out a week-long time log and highlight any areas during which they experience musculoskeletal discomfort. “That helps us to better identify what’s going on so we can start to make changes to the tasks that seem to be more problematic,” she says.
Ergonomists can help to devise strategies to improve comfort and efficiency, even before problems manifest. Physical aspects like posture are only part of the problem, Ms. Long says. A broader solution also addresses cognitive factors, such as task complexity, and organizational components like stress, workload and time pressures.
• Use proper body mechanics. Try to relax your shoulders. Keep your elbows tight to your waist and your body as close to your core as possible rather than reaching or extending. When you’re using loose lenses, try to keep a neutral wrist position instead of pinching the lenses.
“When you have your wrist in a neutral position, it puts less strain on the joint,” says Jennifer Kaldenberg, M.S.A., O.T.R./L., director of occupational therapy services at the New England Eye Institute and the New England College of Optometry in Boston. “If you have pain or fatigue in your dominant hand, you can support that arm with a table or your other arm.”
• Switch things up. “If your exam rooms are set up with all the equipment on the right or all on the left, then it’s much more repetitive motion on only one side,” Dr. Hutchins says. She suggests setting up some exam rooms in a right-handed fashion and some in a left-handed fashion to distribute the work more evenly.
• Take advantage of adjustability. Get as much adjustability from your equipment as you can, as opposed to sitting or standing in an awkward position. “Instead of bringing yourself to the patient, use the chair—raising or lowering it—so you can properly position yourself and maintain a neutral spine position,” Ms. Kaldenberg says.
• Be mindful of technology use. “Holding an iPad or other tablet for an extended period of time may cause discomfort,” Dr. Jacobs says. “They are wonderful tools, but they should not be a complete substitute for inputting reports.” You might want to consider using voice recognition applications or software.
When you are using mobile devices or notebook computers, be mindful of your posture. Turn your chair all the way around to the screen, rather than twisting between the notebook computer and the patient, as that can cause neck strain. “A laptop riser allows you to raise the screen so you’re not straining your neck or head excessively,” Ms. Kaldenberg says. Once you have the laptop raised, it’s also important to use an external keyboard and mouse to ensure proper positioning.
• Put your best foot forward. Long periods of standing can really take a toll on your lower back, which is why supportive footwear is very important. “I know a lot of women wear high heels, and they do not give the proper support,” Dr. Hutchins says. “I did not go to athletic shoes, but I wear very, very dorky-looking, lace-up shoes and they really make a difference.” Invest in good carpet padding to ensure you’re getting support from the surface you’re standing on as well.
• Take a seat. Try to alternate between sitting and standing. Don’t sit side-saddle on a stool or a chair, and avoid arching your back. “Try to maintain ‘90-90-90’—keep your feet flat on the floor, your knees bent at a 90° angle and your hips at 90° angle,” Ms. Kaldenberg says. “If you can sit appropriately, you won’t fatigue as quickly.”
Dr. Hutchins invested in a saddle stool, which has helped to take pressure off of her legs while sitting for long periods of time, and it tips forward so she doesn’t have to lean in as much. “It goes up high enough for me to look into the slip lamp, and low enough to write and talk with the patient,” she says.
• Give yourself a break. Move throughout the day and give yourself a positional break every 30 minutes or so. “After I get the distance refraction, I tell the patient they can take a break while I write it down,” Dr. Hutchins says. “It might only be for a minute, but I’m giving myself a postural break because I’m no longer leaning forward.”
Break up your workday by alternating tasks. Dr. Jacobs suggests scheduling administrative work or a meeting in between clinic to free yourself from using the equipment periodically.
Making these adjustments to your practice may take extra time, but it can end up saving you physical pain or an early retirement in the long run. “Our field specifically—but the world, in general—needs to realize that the means and the ends do not add up,” Dr. Hutchins says. “If optometrists are working to the point where they’re messing up their bodies, they’re not going to be able to achieve their professional goals and provide optimal patient care.”
Ms. Long believes that shift in thinking starts by educating the next generation of optometrists so they can recognize the signs and symptoms in themselves and adjust their practices and techniques. “Talking about work-related discomfort is important so that optometrists are aware that this issue exists, can seek appropriate help and implement change to improve comfort,” she says.
1. Long J, Naduvilath TJ, Hao
LE, et al. Risk factors for physical discomfort in Australian
optometrists. Optom Vis Sci. 2011 Feb;88(2):317-26.
|What to Expect When You’re Expecting
Changes in a woman’s body during pregnancy put greater strain on her
muscles and ligaments, making proper ergonomics even more important.4
Key risk factors for injury include awkward postures, high force, no
rest and repetitive work.4
||“My staff has been very supportive of ‘our’ baby,” says Christine Sindt, O.D., who is nearing the end of her third trimester. “I don’t think I could get through the day without their tremendous effort and help. Having a supportive staff not only helps clinically but also emotionally.”
Equipment and workstations should be adjusted to reduce awkward
posture and accommodate the pregnant woman’s changing body.4 “[Pregnant
doctors] need to be very mindful of the lack of space they’re going to
have between them and the patient,” Dr. Jacobs says. “That’s going to
impact their body mechanics—a lot of times we see that they’re reaching
forward much more.” She suggests reorganizing your exam room to allow
for more movement and to take advantage of adjustable equipment. Pull
viewing objects closer to you. Use stools that accommodate different
Chris Sindt, O.D., director of the Contact Lens Service and
associate professor of clinical ophthalmology at the University of Iowa,
has found these types of changes very helpful. “When I do pediatric or
baby exams, I make sure the patient is elevated as opposed to me lying
on the floor,” says Dr. Sindt, who is nearing the end of her third
trimester. She’s also has her staff assist with scleral lens insertions
so she doesn’t have to bend as much to get the lens in the patient’s
A pregnant worker is at even higher risk for injury during the
third trimester when the abdomen is at its greatest size and the lower
back muscles have to work harder to maintain balance.4 Standing for long
periods can cause lower back discomfort and blood pooling in the legs,
which is more likely to lead to dizziness or pain when pregnant.4 That’s
why taking breaks is even more important.
“We have had to adjust the clinical schedule—I just can’t see the
high volume of people I was seeing,” Dr. Sindt says. “I have to sit down
more and put my feet up.” She also makes sure she’s wearing supportive
shoes to reduce the stress on her legs and back when she does have to
stand. “People don’t mind if you come in very pregnant looking wearing
sneakers,” she laughs.
Overall, self care needs to be at the top of the list for the
pregnant worker, which can be challenging for health care providers. “My
staff has been so supportive and wonderful throughout the whole
process. As optometrists, we spend all our time supporting other people,
so it was really difficult for me to ask for support,” Dr. Sindt says.
“It’s OK to slow down—that doesn’t come easily out of my mouth, but you
have to learn be the care recipient, instead of always being the
2. Long J, Yip W, Li A, et al. How do Australian optometrists manage
work-related physical discomfort. Clin Exp Optom. 2012 Apr 24. doi:
10.1111/j.1444-0938.2012.00711.x. [Epub ahead of print]
3. Kitzmann, AS, Fethke NB, Baratz KH, et al. A survey study of
musculoskeletal disorders among eye care physicians compared with family
medicine physicians. Ophthalmology. 2012 Feb;119(2):213-20. Epub 2011
4. Occupational Health Clinics for Ontario Workers Inc. Ergonomics and pregnancy [online]. Available at:
www.ohcow.on.ca/resources/handbooks/ergonomics_pregnancy/Ergonomics_And_Pregnancy.pdf. Accessed July 29, 2012.