A Scoping Review of Ergonomics in Ophthalmology: Working in Pain

Work-related musculoskeletal disorders (WMSDs) are highly prevalent among ophthalmologists.A previous review reported rates of WMSDs to be between 46% and 94%, placing the specialty among the highest-risk groups in medicine. Despite this high burden, ergonomics in ophthalmology has received little structured attention compared with other surgical and allied health disciplines, where ergonomic training and equipment redesign have been progressively incorporated into professional practice. This scoping review examined all English-language literature on WMSDs in ophthalmology, including epidemiology, ergonomic challenges, and complications.

Scoping review of literature.

Medline (Ovid), Embase (Ovid), CENTRAL, Scopus, CINAHL, and Web of Science were systematically searched from inception to June 2023. Primary research articles, secondary research articles, and conference abstracts reporting on at least one ergonomics outcome related to ophthalmology were included. Additionally, reference lists of included publications were hand-searched to identify relevant publications.

The main outcome measures focused on assessing WMSD prevalence, identifying ergonomic risk factors , and evaluating the impact on physician well-being and work productivity. Other measures such as protective factors and interventions for ergonomic optimization and injury prevention have been reviewed and summarized by the authors in a recent scoping review (A Scoping Review of Ergonomics in Ophthalmology: Working Smarter).

Among 3596 retrieved articles, 33 epidemiologic studies, 36 interventional studies, and 25 secondary research articles were included. The average weighted prevalence of WMSDs among 3246 ophthalmologists was 62.9 ± 14.9% (range 35.9% to 93.8%). Disorders affecting the neck, lower back and shoulders were most commonly reported. The literature indicated WMSDs are predominantly associated with suboptimal ergonomics in workspaces and maladaptive working postures adopted to interface with slit lamp and operating microscope oculars. Cervical spine disease related to disc herniation was most prevalent with 7.6% of ophthalmologists requiring spine surgery. WMSDs result in loss of work productivity, surgical scope of practice restriction, and early retirement (up to 72%, 9%, and 13.4% of ophthalmologists, respectively). Female gender, higher patient care and surgical volumes, elevated job stress, and previously diagnosed musculoskeletal disorders are factors associated with increased WMSD risk.

WMSDs are highly prevalent in ophthalmologists, resulting in significant disability, lost productivity, and early retirement. This review reveals the significant costs of WMSDs to physician wellbeing and eyecare delivery. Ergonomic reform is required in ophthalmology to promote physician wellbeing and productivity as well as the sustainability of the ophthalmology workforce. This will require a collaborative strategy involving multiple stateholders including individual ophthalmologists, healthcare institutions, residency training programs, professional organizations and the ophthalmology equipment industry.