• Cataract/Anterior Segment, Comprehensive Ophthalmology, Retina/Vitreous

    Review of: Comparative assessment of ergonomic experience with heads-up display and conventional surgical microscope in the operating room

    Weinstock R, Ainslie-Garcia M, Ferko N, et al. Clinical Ophthalmology, 2021

    Investigators describe ergonomic outcomes using a heads-up display (HUD) versus a conventional optical microscope in the operating room.

    Study design

    Researchers distributed an online questionnaire to 64 U.S.-based surgeons who had experience using HUDs during surgery for a little more than 2 years. The cohort included 37 posterior-segment surgeons, 25 anterior-segment surgeons, and 2 mixed surgeons with an average of 15 years of practice. The authors built a multivariable model to identify factors that may indicate improvement in pain-related issues.


    Survey results revealed that approximately 63% of surgeons agreed or strongly agreed that use of a HUD mitigated severity and frequency of pain and discomfort. More than 70% of surgeons also reported that HUDs improved posture and overall comfort. Multivariable modeling suggested that using a HUD in more than 50% of cases could lead to 5-fold greater odds of reporting improvement in pain.


    There may have been bias toward favorable initial impressions because the study participants already had these systems installed. Since only physicians with access to or experience with the device were eligible for the study, there was no control group, limiting the generalizability of the findings for a larger population.

    Clinical significance

    Ergonomics is crucial for surgeon health and productivity. These findings show that many surgeons reported ergonomic improvements using a HUD system compared with conventional microscopes. In addition to improving posture, comfort, and pain, the system also led to an unexpected increase in confidence and mental performance. One of the main limiting factors to use of HUD systems is the cost, though the price may become lower with widespread use.