The Hidden Toll of Musculoskeletal Pain in Ophthalmology
Ophthalmologists spend their days leaning into slit lamps, looking through surgical microscopes, and staying steady during some of the most precise procedures in medicine. This work requires great skill, but it also takes a physical toll. While the profession has been slow to talk about this issue, that is beginning to change.
How Widespread Is the Problem?
The numbers speak for themselves. Surveys from the United States, Canada, Saudi Arabia, South India, and other countries show that most ophthalmologists deal with significant work-related musculoskeletal (MSK) pain. One US survey found that 81% reported pain, discomfort, or disability in a single year; a Saudi study of ophthalmic surgeons found a similar rate at 82%.³ In some groups, neck pain alone affects up to 87% of practitioners.²
A 2025 mixed-methods study of eye care professionals in South India found the same pattern. Both optometrists and ophthalmologists scored in the “medium risk” range on the Rapid Entire Body Assessment (REBA) scale, even during regular clinic days rather than long surgeries.⁷ The areas most affected were consistently the same: neck, shoulders, and lower back.
These aches are not minor. In several studies, about 14% of ophthalmologists reported planning to retire early due to MSK symptoms. Some have already reduced their surgical hours or stopped operating altogether, putting extra strain on an already understaffed specialty.
Why Is Ophthalmology Especially Risky?
Physical demands are built into the work. Slit-lamp exams require holding the neck in a bent position, indirect ophthalmoscopy keeps vitreoretinal surgeons’ spines flexed for up to 75% of their time,⁸ and surgical loupes force the head and neck into awkward positions for most of an operation.² Add fine motor demands, repetitive small movements, and prolonged stillness, and the daily risk for MSK injury becomes clear.
A 2024 ergonomic study of ophthalmology residents using the REBA scale found that trainees already scored in the medium-risk range — meaning harmful postural habits can begin forming well before independent practice. REBA scores varied widely among residents, confirming that early intervention can prevent long-term damage.⁴
What the Evidence Says?
A 2025 systematic review — the first to focus specifically on ophthalmologists — examined 13 studies and 712 eye care specialists, identifying three main types of effective intervention: exercise, equipment modifications, and posture training aids.
Exercise and yoga had the strongest support. In a pilot study published in the Digital Journal of Ophthalmology, 50 ophthalmologists followed a 15-minute Iyengar yoga video three times a week for four weeks. Cervical pain dropped from an average of 4.89 to 3.19 on a 10-point scale, lumbar pain fell from 4.25 to 2.88, and wrist and hand pain nearly halved. Notably, 91% of participants said the program made them more aware of their posture at the slit lamp and in the operating room.¹ Yoga requires no equipment, costs nothing, and can be adopted at any career stage.⁵
On the equipment side, heads-up display (HUD) systems allow surgeons to operate while looking forward at a 3D screen rather than hunching over an eyepiece — projecting the surgical field at eye level and reducing neck strain. These systems showed a positive effect on MSK pain in 8 of 10 studies reviewed. Cost and a learning curve remain challenges, but the ergonomic benefits are clear and the technology is becoming more widely available.⁸
Wearable posture trainers offer a newer, promising option. In a Canadian pilot study, ophthalmology residents used the UPRIGHT GO 2 — a small sensor worn on the upper back that vibrates when the wearer slouches. Time spent in upright posture increased from 68.9% to 78.5%, and pain scores improved for all participants. The benefit lessened when vibration feedback was removed, suggesting that ongoing use matters; even partial improvements, however, brought meaningful symptom relief.⁴
The Gap Between Knowing and Doing
One finding that comes up in almost all these studies is a clear gap between knowing and doing. For example, in the Iyengar yoga pilot study, 66% of participating ophthalmologists reported learning about ergonomics in their practices. However, only 46% thought about posture most or all of the time in clinics, and just 37% did so in the operating room. Every respondent said they wanted to learn more.¹
That gap has real consequences. Ergonomics education is rarely included in ophthalmology training programs, even though early habits shape long-term outcomes. The systematic review made it clear: ergonomic instruction should be part of residency programs from the beginning. The South India mixed-methods study found that participants wanted better workplace design, fewer patients per day, and more regular breaks. These practical changes could reduce strain without any new technology.⁷
Research points to solutions that already exist. Practicing yoga or stretching for just 15 minutes three times a week can reduce pain.¹ You can also use posture habits and wearables every day.⁴ Small ergonomic changes, such as adjusting chair height, adjusting slit-lamp distance, and taking standing breaks, can make a noticeable difference.⁶
The Weight of Workload
Beyond posture and equipment, sheer volume of work plays a significant role. High patient loads, long hours, and back-to-back procedures leave the body little time to recover. A US survey found that ophthalmologists performed an average of over 5,400 outpatient visits and more than 1,000 surgical cases annually, working nearly 45 hours per week.⁹ Research adds another layer: ophthalmologists show measurable declines in tear secretion and binocular vision parameters by the end of a working day, strongly linked to sustained near-vision work and insufficient breaks.¹⁰
Organizational changes can make a meaningful difference — scheduling short breaks between patients, capping procedures per session, rotating between clinical and administrative tasks, and ensuring adequate staffing. Protecting ophthalmologists’ health is not only an individual responsibility; it is also an organizational one, and embedding awareness into departmental culture from residency onward is essential.
References
Akler ME, Eid KT, Herrera A. Pilot study of musculoskeletal pain in ophthalmologists following participation in a fifteen-minute online Iyengar yoga program. Digital Journal of Ophthalmology. 2024;30.
Aloqab A, Alturkistany W, Ali HMN. The relationship between surgical loupes usage, workplace ergonomics, and musculoskeletal disorders among Saudi ophthalmologists. Saudi Journal of Ophthalmology. 2025;39:166–173.
Al Taisan A, Al Qurainees AE, AL Sowayigh OM, Al Owayfir MA. Musculoskeletal pain among eye care professionals. Cureus. 2023;15(5):e39403.
Bolis M, Garg A, Chan B. Real-time postural feedback to optimize ergonomics and musculoskeletal health in ophthalmology residents: a Canadian pilot quality improvement study. Cureus. 2025;17(7):e88736.
Palma CV, Gottlieb JL. Stress? Back pain? Try yoga sequences tailored for ophthalmology. EyeNet Magazine. July 2019:53–54.
Rafique A, Shaheer M, Rasheed U. Ergonomics in ophthalmology practice: cross-sectional survey among Pakistani ophthalmologists. Khyber Medical University Journal. 2022;14(2):110–115.
Robert R, Babu M, Sudhakar NA, Sumanth B. Digital survey assessment of individual and occupational factors associated with musculoskeletal disorders among Indian ophthalmologists. Journal of Current Ophthalmology. 2024;35:281–286.
Sahare H, Clement B, Arul A, Gokul A. Heads up in surgery: the ergonomics revolution for vitreo-retina surgeons with review of literature. TNOA Journal of Ophthalmic Science and Research. 2025;63:507–508.
Tan NE, Wortz BT, Rosenberg ED, Radcliffe NM, Gupta PK. Digital survey assessment of factors associated with musculoskeletal complaints among US ophthalmologists. Clinical Ophthalmology. 2021;15:4865–4874.
Dzhodzhua V, Serranheira F, Sacadura Leite E, Monteiro Grillo M, Sousa Uva A. Visual demands and visual fatigue among ophthalmologists. Rev Bras Med Trab. 2017;15(3):209–216.
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