Reflected Surgical Lighting Exposure at the Mohs Surgeon's Eye Level: Quantifying Effects of Working Distance, Drape Color, and Lamp Positioning.

Abstract

Background: Mohs surgeons operate at close working distances under intense surgical illumination. Ocular symptoms, including eye strain and visual fatigue, are commonly reported, yet quantitative data on eye-level exposure to reflected surgical lighting are limited.

Objective: To quantify reflected surgical lighting at the Mohs surgeon's eye position and identify modifiable operative factors influencing ocular exposure.

Materials and methods: This observational, device-based experimental study was conducted in a Mohs surgical suite using a simulated surgical model. Reflected illuminance was measured with a calibrated digital lux meter positioned at the surgeon's eye level. Overhead light-emitting diode lighting was fixed 40 inches from the surgical field. Measurements were obtained at eye-to-field distances of 14, 20, and 26 inches across 2 lamp orientations, 2 drape colors, and 3 simulated skin tone categories.

Results: Reflected illuminance was highest at shorter working distances, measuring approximately 1.5 to 2.0 times higher at 14 inches than at 20 inches and up to 2 to 3 times higher than at 26 inches. White drapes increased reflected illuminance compared with blue drapes, while behind-the-surgeon lamp positioning reduced exposure compared with perpendicular lamp positioning. Skin tone had minimal impact.

Conclusion: Modifiable operative factors significantly influence ocular light exposure and represent low-cost strategies to reduce exposure without compromising visualization.