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EYES ON THE WORKPLACE by Ron Cowen for the Committee on Vision Commission on Behavioral and Social Sciences and Education National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1988

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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard to appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The National Aacdemy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the futherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Frank Press is president of the National Acad- emy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages edu- cation and research, and recognizes the superior achievements of engineers. Dr. Robert M. White is president of the National Academy of Engineering The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Samuel O. Thier is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of fathering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Frank Press and Dr. Robert White are chairman and vice chairman, respectively, of the National Research Council. This work relates to Department ofthe Navy contract N0014-80-C-0159 issued by the Office of Naval Research under Contract Authority NR 201-204. However, the content does not necessarily reflect the position or policy of the government, and no official endorsement should be inferred. The United States Government has at least a royalty-free, nonexclusive, and irrevocable license throughout the world for government purposes to publish, translate, reproduce, deliver, perform, dispose of, and to authorize others so as to do, all or any portion of this work. Copies available from: Committee on Vision National Research Council 2101 Constitution Avenue, N.W. Washington, D.C. 20418 Printed in the United States of America 2

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WORKING GROUP ON AGING WORKERS AND VISUAL IMPAIRMENT ROBERT SEKULER (Chair), Departments of Psychology, Ophthalmology, and Neurobiology/Physiology, Northwestern University STEVEN FERRIS, School of Medicine, New York University SAMUEL M. GENENSKY, The Center for the Partially Sighted, Santa Monica, Calif. ROBERT GOTTSDANKER, Department of Psychology, University of Cali- fornia, Santa Barbara DONALD KLINE, Department of Psychology, University of Notre Dame DAVID D. MICHAELS, Department of Ophthalmology, University of Cali- fornia, Los Angeles MEREDITH MORGAN, Walnut Creek, Calif. DONALD G. PITTS, College of Optometry, University of Houston 3

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COMMITTEE ON VISION ANTHONY J. ADAMS (Chair), School of Optometry, University of Califor- nia, Berkeley ROBERT SEKULER (Past Chair), Departments of Psychology, Ophthal- mology, and Neurobiology/Physiology, Northwestern University IRVING BIEDERMAN, Department of Psychology, University of Minne- sota RANDOLPH BLAKE, Cresap Neuroscience Laboratory, Northwestern University RONALD E. CARR, New York University Medical Center SHELDON EBENHOLTZ, College of Optometry, State University of New York ANNE B. FULTON, Department of Ophthalmology, Children's Hospital, Boston CHRIS A. JOHNSON, Department of Ophthalmology, University of Cali- fornia, Davis JO ANN KINNEY, vision consultant, Surry, Maine AZRIEL ROSENFELD, Center for Automation Research, University of Maryland PAMELA EBERT FLATTAU, Study Director CAROL METCALF, Administrative Secretary 4

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PREFACE At the request of the Veterans Administration and the National Institute on Aging, the National Research Council's Committee on Vision established in 1985 the Working Group on Aging Workers and Visual Impairment. The working group was asked to examine the issue of keeping older workers in the labor force longer, given the many changes in vision that occur with age. In order to accomplish its task, the working group organized an invitational conference to review the several dimensions of work, aging, and vision. Twenty-eight specialists, including members of the working group, met for two days at the National Academy of Sciences in Washing- ton, D.C., in February 1986. These specialists were drawn from the fields of gerontology, economics, sociology, statistics, psychology, political sci- ence, optometry, ophthalmology, human factors engineering, and physi- ology. Conference participants were asked to identify and describe major research findings related to changing visual capacities and the employ- ment of older workers, to recommend steps that could be taken by businesses to encourage the continued productive employment of older workers, and to identify research topics that have yet to be explored that might bear on this subject. Four panels were formed to explore various aspects of work, aging, and vision, including relationships between visual changes with age and changes in behavior; the role of health status in leaving the work force; the effects of changes in vision on job skills; screening practices; the availability of visual prosthetics; and economic incentives and disincen- fives for keeping older workers employed. A report based on conference papers and discussions has been prepared by the working group and published under the title Work, Aging, and Vision in ~ 987 by the National Academy Press. Conferees provided a rich assortment of ideas from which the working group selected those it felt would be of most interest and use to workers and employers. This pamphlet, prepared by science writer Ron Cowen, is based on the proceedings of the conference and working group discussions, supplemented by additional research materials. Individual chapters and the entire book were reviewed by conference participants and by reviewers selected by the National Research Council. On behalf of the Working Group on Aging Workers and Visual Impairment, ~ would like to thank each ofthe speakers who addressed the

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conference and to express our special appreciation to Ron Cowen for preparing this summary of our deliberations, and to Pamela Reznick for the design of this book. We would also like to thank Pamela Ebert Flattau, staff officer of the Committee on Vision, for overseeing the activities of the working group and the completion of our reports, and Patricia A. Anderson, who served as consultant to the committee on this project, contributing significantly to the design and scope of the February meeting. Carol Metcalf, the committee's administrative secretary, pro- vided valuable secretarial and administrative assistance. To all ofthese, we express our thanks for their efforts. Robert Sekuler, Chair Working Group on Aging Workers and Visual Impairment 6

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ACKNOWLEDGEMENTS The Committee on Vision is a standing committee of the National Research Council's Commission on Behavioral and Social Sciences and Education. The committee provides analysis and advice on scientific issues and applied problems involving vision. It also attempts to stimulate the further development of visual science and to provide a forum in which basic and applied scientists, engineers, and clinicians can interact. Working groups of the committee study questions that may involve engineering and equipment, physiological and physical optics, neurophysiology, psychophysics, perception, environmental effects on vision, and treatment of visual disorders. In order for the committee to perform its role effectively, it draws on experts from a wide range of scientific, engineering, and clinical disciplines. The members of this working group were chosen for their expertise in research related to the aging of the human eye and for their familiarity with the application ofthose research findings to employment issues. This report reflects their evaluation of our present understand- ing of the interactive effects of work, aging, and vision. This publication and its dissemination have been made possible by funding from the Veterans Administration and the National Institute on Aging of the National Institutes of Health. David Worthen, assistant chief medical director, Veterans Administration, and Leonard Jakubczak, National Institute on Aging, provided valuable guidance to the working group and the Committee on Vision throughout this effort. 7

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60NTE PART ~ Introduction, 10 "I am a camera, with its shutter open," 11 P~T 2 PART 3 P - T 4 8 The Aging Eye, 13 Changing Eyesight: Significance for Daily Living, 14 The Retina, 13; Changes in Lighting, 16 Looking at Life Through Cloudy Glasses, 16 Clutter, 17 Diabetic Retinopathy, 78 Driving, 19 In the Workplace, 21 Vision Care on the Job, 22 A Tale of Two Companies, 22 More than Safety Glasses, 22 Free Eye Care at a Small Company, 23 Job Coding, 23 Glaucoma, 24 Benefits of Company Vision Care Programs, 24 Redesigning the Workplace, 27 Coloring the Job, 27 Light and Glare, 28 Diseases of the Retina, 28 On-the-Job Experience, Retraining, and Compensating for Impaired Vision, 29 10 ~3 21 27

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PART ~ Looking to the Future, 31 What Do Companies Want?, 32 Microscopes, Telescopes, and in Between, 33 The Need for More Information, 34 What We Do Know from Statistics, 34 Driving as a Mode! for Working, 35 Efforts of Private Companies, 35 Selected Resources for Vision Care, 36 VICTORS: A Resource for Veterans, 36 Job Network, 37 An Index for Jobs, 37 Remaining on the Job in New York City, 37 Cataracts, 38 Federally Sponsored Projects, 39 Helping the Partially Sighted, 39 Optometry Schools, 39 The Aging Eye: A Personal View, 40 Conclusion, 41 Additional Readings, 42 1986 Conference Participants, 43 31