While we do hold the phaco probe with a pencil grip, we do not use the same angle as writing with a pencil on paper. When we are accessing the cataract nucleus, particularly if it is at the iris plane, then the phaco probe is parallel to the iris and this means parallel to the floor of the room. This is necessary to avoid pushing the eye out of primary position and into the nasal canthus (when operating temporally).
This video is another picture-in-picture feature which shows a simultaneous view of the microscope field along with an external, side view of my hands. You can see how I am bracing my hands against the patient's face, how the instruments are held, and even how my assistant passes me the instruments in a timely and efficient manner. This video is highly educational and may be the most useful in this series of picture-in-picture teaching.
