Comparison of Ergonomics in Vitreoretinal Surgery With Heads-up Visualization Versus the Standard Operating Microscope as Measured by a Wearable Device.

Background and objective: Three-dimensional heads-up display (HUD) systems have emerged as an alternative to standard operating microscope (SOM) in the operating room. The goal of this study was to quantitatively measure vitreoretinal surgeon posture across visualization methods.

Methods: Ergonomic data was collected from 64 cases at two tertiary eye care centers. Surgeons wore an Upright Go 2^TM posture training device while operating either using the NGENUITY 3D heads-up display visualization system or the SOM.

Results: Total percentage of time with upright posture as primary surgeon was significantly higher in surgeries performed using HUD (median 100%, interquartile range [IQR], 85.1% to 100.0%) as compared to surgeries performed using the SOM (median 60.0%, IQR 1.8% to 98.8%) (P = 0.001, Wilcoxon rank-sum test). Percent time with upright posture was significantly higher in surgeries performed using HUD for two of the three surgeons when assessed independently across systems. Results remained significant when accounting for length of surgery (P < 0.001, multiple linear regression).

Conclusions: Ergonomic positioning was improved for surgeons operating using HUD. Given the high prevalence of back and neck pain among vitreoretinal surgeons, increased use of HUD systems may limit musculoskeletal pain and long-term disability from poor ergonomics. [Ophthalmic Surg Lasers Imaging Retina 2024;55:638-645.].