Occupational Vision Manual Part I: Introduction

Occupational optometry is the portion of optometric practice that is concerned with the efficient and safe visual functioning of an individual within the work environment. It encompasses more than just the prevention of occupational eye injuries, although that certainly is a major component. It also includes vision assessments of workers/patients, taking into account their specific vision requirements and the demands these requirements place upon them.

Optometrists provide occupational vision services at three general areas or levels: primary care, eye safety consultation, vision consultation.

Primary Care Optometrist. The primary care optometrist is concerned with all aspects of patients’ visual well-being, whether it involves home, work, or play. As a primary care provider, the optometrist must be prepared to meet certain occupational vision objectives (Pitts and Kleinstein, 1993):

  • Complete an occupational history on each adult patient
  • Diagnose and manage occupationally induced conditions (making referrals when necessary)
  • Assess his or her patients’ occupational vision demands and provide appropriate treatments as necessary
  • Educate patients on the need to incorporate eye safety principles into their daily activities.

An occupational history should include questions concerning the specific visual tasks performed, as well as questions regarding possible exposure to eye and health hazards. The optometrist should also inquire about what personal protective precautions the patient takes to help ensure eye safety. Kleinstein (Pitts and Kleinstein, 1993) provides several sample occupational history forms (see example in Appendix A) that can be used to initiate a vocational dialogue.

When hazards or specific visual tasks reported in the occupational history are unclear, the optometrist may contact the employer and ask to observe plant operations first hand as a way to provide better vision and safety services. A worksite tour can be especially informative when many of the practitioner’s patients work in the same facility.

When visiting a plant, the optometrist should first meet with the safety officer or personnel director who should be asked to participate in a tour of the plant. During the tour, information on various aspects of vision conditions and eye protection pertaining to the different jobs within the plant should be recorded. The primary care optometrist who has first hand knowledge of the occupational demands placed upon workers is better prepared to prescribe the proper refractive corrections, lens materials, contact lenses, vision training, or safety devices for each one’s specific needs.

Eye Safety Consultant. When retained as a consultant, the optometrist can be more involved in the daily operations of an occupational setting. In this capacity an optometrist can more directly make recommendations and set policies that help to ensure safe visual functioning for all workers.

The duties of an optometrist serving as an eye safety consultant may include overseeing the facility’s entire eye safety program. Specific components of such a program may include:

  • writing and helping to enforce an eye safety policy
  • performing an eye-safety workplace assessment
  • overseeing the procurement of eye protection devices (both prescription and nonprescription)
  • educating workers on eye safety issues
  • overseeing pre-placement and periodic vision screenings
  • writing policy concerning contact lens wear.

The Occupational Safety and Health Administration (OSHA) mandates the use of eye and face protection whenever there is a reasonable probability of injury that could be prevented by such equipment.

The Code of Federal Regulations specifies that employers must provide personal protective equipment to their employees and that employers are responsible for ensuring employee compliance with its use (29CFR1910.133 OSHA Regulations – Eye and Face Protection).

The optometrist can participate in an eye safety program by helping to determine the types of hazards present at different workstations within a plant (workplace assessment) and selecting protective devices appropriate for each workstation. The optometrist can oversee the ordering, verifying, dispensing, and periodic adjustment of safety eyewear. Safety glasses and other protectors should be individually sized and fit. Inappropriately sized or uncomfortable protectors are much less likely to be worn and therefore may not provide protection when it is needed. The optometrist can lead periodic safety sessions with workers concerning eye safety issues. Workers who understand the issues, including the consequences of eye injury, are more likely to comply with company safety policy.

The identification of individuals with less than optimal vision is an important component of a comprehensive eye safety program because workers can perform most occupational activities more efficiently and safely with clear and comfortable vision. A wide range of possibilities exist as to how optometrists can participate in employee vision screening. One issue to be addressed is contact lens wear in the workplace. Although contact lenses have been shown to be safe for most industrial operations, their use remains controversial. Optometrists can educate workers and safety personnel on contact lens issues as a means of arriving at a wearing policy that has wide acceptance.

Vision Consultant. In addition to addressing eye safety and primary eye care issues, the optometrist is uniquely qualified to provide consulting services concerning the general area of visual efficiency. Poor design of the work environment often limits productivity due to improper or inefficient lighting, contrast, or working distance. By recommending changes the optometrist can help improve productivity and reduce errors.

In areas where poor productivity or high error rates have been identified, a systematic investigation with remediation can lead to enhanced performance. The first step in addressing occupational vision issues is to ensure that workers have the vision skills to see task details clearly with little effort. Custom-designed eyewear may be required to deal with unusual viewing distances or task positioning. When these measures fail to resolve task-related problems, a change in the procedure itself may be needed.

Modification of any one of the following four task characteristics can enhance visual performance (Bullimore et al., 1995):

  • Contrast
  • Size
  • Lighting
  • Viewing time.

Increasing task contrast, angular size (by increasing size or decreasing distance), task luminance (increasing illumination or reflectance), or viewing time generally provides greater task visibility.

Occupational eye care is not limited to industrial situations. Many white collar workers can benefit from occupational vision care services as well. Providing eye care for video display terminal operators is a growing area of occupational vision care. Although the concerns for their eye safety may be minimal in comparison with the issues confronting blue collar workers, the issues of visual efficiency, productivity and worker comfort are nevertheless of considerable importance.

Practicing optometrists have a responsibility to address the occupational vision issues confronted by their patients. The level at which the optometrist decides to participate in occupational vision issues varies depending upon his or her interests and professional opportunities. Regardless of these variations, all optometrists can benefit from the information that follows in effectively carrying out their professional responsibilities in this area.

Providing these specialized and unique occupational vision services (including occupational lens design for patients) will require additional chair time and expertise. This additional chair time and expertise should be assessed in the same manner as is done for providing other specialized services, such as contact lens services and low vision services.