OBJECTIVES: Musculoskeletal disorders (MSDs) are prevalent in ophthalmic surgeons and can impact surgeon well-being and productivity. 3D heads-up display visualization systems (HUD) may reduce ergonomic stress, with a growing body of literature demonstrating favorable ergonomics for HUD compared to conventional microscopes (CM). A literature review was conducted to collate and assess the existing evidence on the ergonomic benefits of HUD for ophthalmic surgeons.

METHODS: MEDLINE was searched from Jan-01-2001 to May-26-2022 using terms related to ophthalmology (eg, ophthalmic, eye surgery, cataract) and ergonomics.

RESULTS: Of 452 sources screened, eight studies evaluating ergonomic benefits of HUD for ophthalmic surgeons were identified. Benefits related to preference, comfort, ergonomics, muscle tone and stiffness for HUD compared to CM during surgeries were reported. A cross sectional survey of US ophthalmic surgeons, many agreed that HUD reduced the severity (64%) and frequency (63%) of pain and discomfort, improved posture (73%), and overall comfort (77%). A similar survey revealed that use of HUD led to improvements in eyestrain (54%), less pain and discomfort (72%) and improvements with MSDs (63%). A study from Malaysia reported that postgraduate trainees had significantly better experience with HUD for eye strain (P=0.008), neck and upper back strain (P=0.000), lower back pain (P=0.019), and comfortable environment (P=0.001). While in a consecutive case-control study of vitreoretinal surgeries in China, surgeons and residents rated ergonomics higher in the HUD group than the CM group using a 5-point scale (P<0.001). While in a prospective study from Korea, a quantitative measurement of retinal surgeons’ muscle tone and stiffness was performed. The intraoperative muscle tone and stiffness were higher for CM (P<0.01), with no difference in muscle properties post-surgery with HUD (P>0.05).

CONCLUSIONS: This literature review indicates that HUD is associated with improved comfort and wellness in the operating room, benefiting surgeons across several ergonomic measures and procedure types.