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Are Your Loupes Supporting Your Healthy Neck Posture? In the School of ErgoPractice®, Part 2

ErgoPractice News – July 2014
By Jin Chang PhD

A clinician’s loupes can make or break their posture. If you practice with loupes that force you to excessively tilt your head, you are at risk of developing chronic pain in your neck, shoulders, and upper back. If you practice with loupes that guide your body into the correct posture, you will be able to work comfortably and safely while preventing work-related pain and injury. The use of improperly designed or adjusted loupes with small declination angles is the main cause of work-related chronic pain and injury in the neck and upper back. Therefore it is very important for your long-term health to assess your loupes. And to do so now. If you find your loupes do not support a healthy neck posture, you must switch to ergonomically correct loupes. Your health and the quality of your career depend on not compromising.

I recently interviewed Dr. Lance Rucker, a professor at the University of British Columbia who has been a pioneer in assessing and utilizing surgical telescopes (often called loupes) for the ergonomic practice of dentistry.1 Dr. Rucker’s research on loupes is fundamental to the technology and his findings can be applied to the medical and veterinary fields as well.2 In any procedure where a loupe user needs to work below eye level, while keeping their head upright, declination angle is the key to working safely.

To provide some additional background for Dr. Rucker’s interview I will review loupes available today, some of which are causing what he calls an avoidable epidemic.1

Manufacturers today will claim that their loupes are “ergonomic” since most loupes built since the 1950’s help a clinician sit with a straight lower back (if the working distance of loupes is correct). But most loupes today also have inadequate declination angles for the user’s work. Thus, they force the clinician to look down through their loupes creating poor neck posture. Essentially, we have traded an epidemic of lower back problems for neck and shoulder problems. Based on the declination angle we can classify loupes available today into four basic types:

  • Custom Through-The-Lens (TTL) loupes with small declination angles (about 22-degrees): Designs for Vision and Orascoptic/Surgical Acuity have been offering these types of loupes for many years.
  • Next-generation custom TTL loupes with custom declination angles up to 55-degrees: SurgiTel has developed special frames, ocular cells and special mounting techniques that allow for larger custom declination angles.
  • Generic Front-Lens-Mounted (FLM) loupes with fixed, small declination angles: Zeiss and many other companies have been offering these types of loupes. These loupe-mounting fixtures do not allow for the vertical adjustability of oculars. The achievable declination angle then varies according to the user’s nose height.
  • Next-generation custom FLM loupes with adjustable declination angles (up to 50-degrees): SurgiTel has invented unique loupe-mounting fixtures that feature the vertical adjustability of oculars.

Our investigation shows that the minimum declination angle for a lastingly comfortable and safe posture is about 35-degrees.3 Be aware that the use of term “ergonomic” is often overused in sales/marketing pitches. This term is often used by people who have no real understanding of what it means. In order to protect your health, evaluate your loupes using three non-negotiable criteria which Dr. Rucker, an experienced clinical researcher, relays in his interview.1 Take the word of an expert over a salesperson. And you should not purchase your loupes based on only non-ergonomic factors such as esthetic appearance and cost. Your long-term health strongly depends on the type of loupes you choose, and a slick-looking frame will not reverse the pain and/or injuries from non-ergonomic loupes. And remember the old adage when considering purchasing budget loupes: “when a deal seems too good to be true, it probably is.”

Over the last 20 years, SurgiTel has developed all the necessary tools for the ergonomic practice of dentistry and surgery. Over these 20 years, SurgiTel has helped many clinicians work comfortably and safely. We have heard many stories of clinicians switching to SurgiTel and experiencing freedom from pain and relief of injuries. As a part of ergonomic education, to share the true tenets of ergonomics that go beyond the sales pitch, SurgiTel published ErgoPractice® News starting June 2013. Click Here to view the newsletters. We have reviewed advances made in loupes and headlights, principles of clinical illumination, requirements of custom loupes, the blue light hazard of cool LED lights, and key factors for selecting the right loupes. We have also shared the stories of a sample of clinicians whose chronic neck pain, developed with traditional loupes, was alleviated or eliminated using SurgiTel’s ergonomic loupes. If you have peers who are working in pain, advise them to subscribe to our newsletter. Or sign up yourself and forward the information to them. There is no excuse for anyone to work another day in pain. I strongly believe that together we can bring the field’s attention to these risks that too many are taking and eventually make all our workplaces safer and more productive.

  1. Rucker, Lance, and Jin Chang. Assessing and Utilizing Surgical Telescopes for the Ergonomic Practice of Dentistry. Other, July 24, 2014.
  2. Rucker, Lance M. “Surgical magnification: posture maker or posture breaker.” Ergonomics and the dental care worker. Washington, DC: American Public Health Association (1998): 192-206.
  3. Chang, Jin. “Declination Angle as the Key Ergonomic Factor, Key Factors for Ordering Custom Loupes: Part 1.” SurgiTel. SurgiTel, April 1, 2014.