Sonia Parveen
Research Mentor(s): Nita Valikodath
Mentor Department: Ophthalmology
Authors:
Session: Session 7 (4:00pm – 4: 50pm)
Presentation Type: Oral
Abstract
Purpose: Head positioning after retinal detachment repair with gas impacts surgical success rates. However, there is variability in instructed head positioning and patient compliance, and can pose significant challenges on patient’s quality of life. The purpose of this study is to understand the patient’s experience with head positioning. Methods: Patients were recruited from a retina clinic at a large tertiary care center. Inclusion criteria included patients who had undergone pars plana vitrectomy with gas tamponade. Informed consent was obtained from all participants. A 21-question survey was created. Participants were asked questions regarding compliance with head positioning, challenges of head positioning, and potential solutions before each survey, informed consent was obtained from all survey participants. Results: A total of 18 surveys were completed. Positioning recommendations varied by type of positioning (with some participants recommended for multiple positions) and duration. The most frequently recommended head position by physicians was the face down position (FDP), noted in 77.7% (14/18) of cases, followed by no lying flat on the back in 28.0% (5/18) of cases, right side down (22.2%, 4/18), left side down (16.7%, 3/18), no positioning restrictions (11.1%, 2/18), and sitting upright (5.6%, 1/18). The average duration of instructed positioning was 7 days (range 2–14 days). The majority of participants (66.7%, 12/18) reported being instructed to position for 7 days (range 2-14 days). Daily positioning times varied, with most participants positioning for an average of 4 hours (5/18, 27.8%; range 1 to 20 hours). Assistive devices for head positioning were used by 77.8% (14/18) of participants, while 22.2% (4/18) did not use any devices. Of the 18 participants, 5 (27%) reported receiving feedback on head positioning. Symptoms associated with head positioning were reported by 61.1% (11/18) of participants, including headache (7/18, 38.9%), difficulty sleeping (7/18, 38.9%), neck pain (6/18, 33.3%), eye pain (6/18, 33.3%), back pain (5/18, 27.8%), lightheadedness (2/18, 11.1%), and dizziness (1/18, 5.6%). The most difficult times for positioning were at night (6 PM–Sleep) or during sleep, each noted by 55.6% (10) of participants. Of the 18 participants, 11 (61.1%) agreed that positioning was easier immediately after surgery (post-operative days 1–3) compared to later in the week (post-operative days 4+). Suggestions to improve the positioning process included better pillows, minimizing trauma, fewer days of positioning, and additional preparation before positioning. Conclusion: The study found that face-down positioning (FDP) was the most commonly instructed recommendation, with an average instructed duration of 7 days. Patients had the most difficulty with positioning at night and during sleep and with post-operative days 4 or later. Study limitations included potential inaccuracies in participant self-reporting and the inability to capture actual compliance. Future work will explore the relationship between head positioning and surgical outcomes to optimize post-operative protocols.
