Ergonomics and the Optometric Practice

Consider these six tips to alleviate the stress on the body that practicing optometry may cause

Andrey Popov/

Many of us have innate drivers that put a patient’s needs before our own, causing us to sacrifice the health of our bodies as a result. The fact is, we often use small shortcuts and time savers when performing diagnostic testing and working at desks, and they can take significant tolls on our bodies over time.* This is referred to as work-related musculoskeletal disorders, defined by the CDC as “injuries or disorders of the muscles, nerves, tendons, joints, cartilage and spinal discs” in which (1) “the work environment and performance of work contribute significantly to the condition and/or (2) the condition is made worse or persists longer due to work conditions.” The CDC defines “work conditions” as “routine lifting of heavy objects, daily exposure to whole body vibration, routine overhead work, work with the neck in chronic flexion position, or performing repetitive forceful tasks.1 (See “Back Attack,” p. 22.)

While seeing patients, I have found that there are areas where adjustments can make a positive impact on both our bodies and, sometimes, the equipment we use over time. Here, I discuss these adjustments.


All of us have our routine for seeing patients, but we need to be aware that this routine may be having negative effects on our bodies.

For example, having one’s chair in the same spot in every exam room can cause one’s neck to be turned toward patients in the same direction throughout the day, which can cause stress on a single side of one’s body.

To alleviate such stress, we should consider situating equipment in different areas within each exam room: So, Exam Room 1 may have the room computer on the right of the patient, and Exam Room 2 may have it to the left of the patient. I have found that a change as simple as this can significantly reduce the tension in the body that builds unevenly over time.


A stool is a common choice for seating, as it is efficient and compact. But many do not provide lumbar back support, which aids in promoting good posture via filling in the gap between the lumbar spine and the seat to support the lower back’s natural inward curve, according to . Additionally, a chair should help to maintain active posture that begins with pelvic positioning, as this has an impact on the trunk’s position and lower extremities.

Chairs and stools are available that are specifically designed for back and forth tilt for additional core activation.2 There are several great resources for finding an ergonomic chair that would provide such support, including retail office supply chains, such as Best Buy, Office Depot and Staples.

Additionally, let’s choose the proper chair. Office work can lead to stress on the back, neck, shoulders, hands and wrists and may also leave us with headaches and eyestrain.3 To prevent these issues, we should use an extended seating option that keeps our thighs parallel with the floor and has a back and arm rest. Exercise balls are not recommended as chairs, as they appear to “spread out the contact area, possibly resulting in uncomfortable soft tissue compression perhaps explaining the reported discomfort.”4


Ophthalmic devices that offer adjustability may help us avoid sitting or standing in awkward or uncomfortable positions.

For example, many times, for efficiency’s sake, we can find ourselves leaning into the slit lamp and hunching rather than bringing the slit lamp to our height. Taking the moment to properly adjust the height of the slit lamp can save our spines enormous amounts of pressure over time. Further, bringing the slit lamp table in closer to us helps prevent hyperextension of the neck, wrists and back. Maintaining a neutral position is an active process that we should all try to be more conscious of.5 A neutral position can be defined as positioning when the body is aligned and balanced while standing or sitting. It describes positioning that places minimal stress on the body and keeps the body aligned. It allows for the body to have maximum control and force production.5

Something else to remember: Let’s not stabilize our hands by placing our elbows on the slit lamp table, as this maneuver may cause tingling, numbness and may even lead to nerve damage over time.6

Additionally, the slit lamp tables, in most cases, aren’t designed to bear this kind of uneven weight, so when continually used in this manner, it can lead to wear on our equipment that can be easily avoided.2 In many cases using one’s own body weight to stabilize may elongate the life of your equipment.


In using a tablet or laptop continuously, we tend to hunch over it. Consider using a computer stand — a worthy investment for our bodies, long term.

A computer stand allows for several positive outcomes, in addition to the decreased need to bend over. An example: It provides the ability to maintain our screens at eye level. This is important because a screen that is too low causes the body to lean forward, while a screen that is too high causes upward leaning, both of which can create neck and shoulder pain.


Stretching during the day should not be underestimated. Breaks to stretch tend to reduce muscle strain when our bodies remain static.2 When our muscles remain static, they “tend to fatigue more easily, and circulation is decreased.”2 One easy stretch to do while working is neck stretches. Simply deliberately tucking the chin, tilting the head toward each shoulder and turning the head to look over each shoulder can make a significant impact.4

Back Attack

Good posture can help reduce stress and strain, while sitting or standing at workstations.
CG Bear/

WORK-RELATED MUSCULOSKELETAL DISORDERS that have resulted in missed work days most often involve just the back, reports the Bureau of Labor Statistics. In 2016, for example, such disorders related to the back made up 38.5% of all work-related musculoskeletal disorders (134,550 back cases out of 349,050 total cases).

In fact, 70% of eye care professionals reported back and neck pain, describing the pain as mild to moderate. These same eye care professionals said they experienced improvements in pain during holidays, reports a study, comprised of 165 eye care professionals, in Occupational Medicine.

Additionally, 82% of optometrists reported work-related physical discomfort, most commonly in their lower backs, necks and shoulders, according to a study, made up of 416 O.D.s, in Optometry and Visual Science. – Jennifer Kirby, senior editor


Many handheld devices reduce the amount of strain put on our bodies. For example, a handheld tonometer may place less strain on the user when compared to a traditional non-contact tonometer. My office personally uses such a device frequently.


As optometrists, we hold our duty of caring for our patients to the highest standard. That said, being able to care for them does not have to be mutually exclusive with taking care of our bodies. By implementing these small adjustments, we can make a remarkable impact on health over time. OM

* Optometrists should consult their primary care physicians regarding any body pains before employing any of the tips included in the article.


  1. National Center for Health Statistics, & Centers for Disease Control and Prevention. (2013). National Health Interview Survey [Data set]. Retrieved from
  2. Wilson JR. Fundamentals of Ergonomics in Theory and Practice. Appl Ergon 2000;31(6):557-67.
  3. Laestadius JG, Xiaodong Cai JY, Ross S, Dimberg L, Klekner M. The proactive approach — is it worthwhile? A prospective controlled ergonomic intervention study in office workers. J Occup Environ Med. 2009 Oct;51(10):1116-24.
  4. McGill SM, Kavcic NS, Harvey E. Sitting on a chair or an exercise ball: various perspectives to guide decision making. Clin Biomech. 2006;21(4):353-60.
  5. Westgaard RH. Work-related musculoskeletal complaints: some ergonomics challenges upon the start of a new century. Appl Ergon. 2000;31(6):569-80.
  6. Conrad S, Bourkiza R, Wickham L, McCarthy I, McKechnie C. Mechanical exposure of ophthalmic surgeons: a quantitative ergonomic evaluation of indirect ophthalmoscopy and slit-lamp biomicroscopy. Can J Ophthalmol. 2017 Jun;52(3):302-307.