Evaluating the efficacy of an educational ergonomics module for improving slit lamp positioning in ophthalmology residents.

OBJECTIVE: To characterize changes in body positioning while performing a standardized slit lamp examination after exposure to an educational module on ergonomics. DESIGN: Prospective interventional pilot study. PARTICIPANTS: Ten ophthalmology residents. METHODS: An educational module discussing ergonomic issues in ophthalmology was created. In a standardized examination lane, participants were recorded performing 3 trials of an indirect slit lamp examination of a volunteer patient, adjusting equipment as they saw fit. Participants were then sent the module and within 2 weeks repeated the trial process. Data were processed using biomechanical software to obtain the Rapid Upper Limb Assessment (RULA) injury risk score, elbow and shoulder joint reaction moments, neck and trunk flexion angles, and spinal curvature magnitudes. RESULTS: The RULA injury risk scores decreased after completion of the module (95% CI 2.10-2.77), indicating a lesser risk for injury to the resident. Shoulder flexion and elbow abduction moments also decreased (95% CI -3.2 to -1.5 and -0.44 to -0.04, respectively), suggesting a more neutral body posture. The trunk flexion angle increased after completion of the module (95% CI -5.1 to -1.6), signifying a more upright trunk posture; this was confirmed by the lumbar spine curvature, which flattened postmodule (95% CI 6.6-940). CONCLUSIONS: These results suggest a promising ability for an educational module to mitigate some injury risk in this population during indirect slit lamp examination. It also delineated some awkward postures that persisted despite the module. These results will be reintegrated into the module to optimize its educational utility.

Prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation.

PURPOSE: To report the prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation. SETTING: Duke University Eye Center and Weill Cornell Ophthalmology, single-physician practices. DESIGN: Prospective case series. METHODS: Consecutive patients presenting for cataract surgery evaluation were identified. Patient information including demographics, medical history, slitlamp findings, tear osmolarity, and tear matrix metalloproteinase-9 (MMP-9) levels were recorded. Patients were considered to have ocular surface dysfunction if any of the following outcomes were present: visually significant abnormal corneal surface examination, positive MMP-9 test, or abnormal osmolarity values (>307 mOsm/L or >7 mOsm/L intereye difference). Patient symptoms were recorded using the ocular surface disease index (OSDI) or Symptom Assessment iN Dry Eye questionnaires. RESULTS: There were 120 patients (69% women), mean age 69.5 years ± 8.4 (SD). Abnormal osmolarity was found in 68 patients (56.7%), and abnormal MMP-9 in 76 patients (63.3%). Clinical findings showed that 47 patients (39.2%) had positive corneal staining on presentation, 9 patients (7.5%) had epithelial basement membrane dystrophy, and 2 patients (1.6%) had Salzmann nodules. Questionnaire data showed 54 (54.0%) of 100 patients reported symptoms suggestive of ocular surface dysfunction. In the asymptomatic group of 46 patients, 39 (85%) had at least 1 abnormal tear test (osmolarity or MMP-9) and 22 (48%) had both tests abnormal. Overall, 96 (80%) of 120 patients had at least 1 abnormal tear test result suggestive of ocular surface dysfunction and 48 patients (40%) had 2 abnormal results. CONCLUSIONS: Objective ocular surface dysfunction findings were common among patients presenting for cataract surgery, yet many presented undiagnosed. Clinicians should be aware of this high prevalence and consider screening with tear testing before surgery.