Quiz: Surgical Ergonomics – Scope Positioning

Hey, everybody. I’m Dr. Wyche Coleman. We’re going to go over a few things that I think are under-emphasized. I think these things will help you be more successful with your cataract surgery technique if you get a good setup to begin with.

The next step is the tilt of our microscope, and this is critical to get your neck in a good position so that you’re not leaning forward. I think that’s what causes cervical disc disease in eye surgeons. This is a Zeiss scope; we want the Z focus to be at zero, so when you focus up and down, this reference is going to move. We can use the level function on our iPhone, find a flat spot on the scope; we can go to zero. If you’re not using NGENUITY® or another 3D heads-up system, 16 degrees puts me in a very good neck position. I’ve marked my scope at 16 and I just use the iPhone level to do this. We can see that’s getting oculars moving towards me. See how far they move to the left, away from you? This is going to lead to a poor neck position. If we tilt, they’re getting closer and they’re putting us in a better position.

31 degrees is for MIGS. A great thing to do to save you time and get you in a good position every time is to go ahead and set up your scope, make a few marks on it, and that way, you can get in a consistent position every time.

I’m demonstrating what happens if we leave the scope flat; this is zero degrees. When I get it in position, I have to lean way forward with my neck, and this is not good for my cervical spine. Now I’m going to tilt the scope to my pre-made mark at 16 degrees. This puts me in a much better position with my neck and a much more comfortable position.

We’re going to take a brief moment to talk about light color. Most microscopes have the ability to use a halogen filter or no filter, which is more of a blue xenon-colored light. When we’re looking through the ocular, we’re going to use a halogen filter. There’s more red wavelength of light that’s going to give you a greater depth of field. Let’s switch to halogen mode. This is a much warmer light. Let’s go back to the no-filter mode. This is fine for NGENUITY®, but your depth of field will be greater if you have more yellow in your light. You’ll have to do less fine focus in the Z-axis throughout the case. Let’s switch one more time just for demonstration purposes. Very good.