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PART 3 In the Workplace In 1713, Bernardo Ramazzini, one of the first chroniclers of job- related illnesses, offered little hope to workers who suffered from poor eyesight. He advised blacksmiths with eye pain "to apply woman's milk and barley water" and to consider bloodletting "if there be acute inflam- mation." Printers who developed eyestrain were even worse off. Declared Ramazzini, ~ fad] to see that the art of medicine can give any kind of help to these workers . . . or what safeguard can be suggested, except that they should be warned to spare themselves when they are doing this sort of work, to snatch some hours of the day from their toil, and when they leave the shop in winter they should wrap well before they go home. Today we can rely on more than woman's milk and barley water to help the worker with vision problems remain on the job. Improved eye care and screening techniques help catch problems before they interfere seriously with work. Simple and inexpensive redesign of the workplace can help compensate for diminished eyesight: a strategically placed, high-intensity desk lamp can shed extra light on a visual task; glare from a window or overhead light can be reduced; labeling tools, desktop equipment, and even ~tnirwavs with hi~h-contrast colors mav enhance visibility. Retraining and closer matching of visual skills to work require- ments can keep older people on the job longer. In addition, several private and government groups provide advice and resources for workers with vision impairment and their employers. Among the visual aids tailored to the individual are high-powered prescription eyeglasses and magnifying glasses that cost under $100. More expensive items, such as talking computers and closed-circuit television systems that magnify print, are permanent resources that can be used successively by many workers. This chapter includes material presented at the conference by Ian Bailey, Roberta Alex, Louise Birkholz, and Bruce Rosenthal. 21

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To be used effectively, these resources and techniques must go hand in hand with knowledge of the needs of companies and of their workers. Are some jobs more easily handled by older workers than others? Are businesses generally interested in methods to retain long- term employees? How many older workers, faced with changes in vision that interfere with job performance, would rather retire than accept a new assignment? These questions have only recently come into focus, in part because few statistics keep tabs on older workers with impaired vision. Answers to these questions will become more important, and resources to assess and treat eye problems on the job will become more critical, as the average age ofthe American worker continues to increase. Vision Care on the dote Regular eye checkups and a company health care program that includes vision monitoring are still the most effective ways of identifying and keeping people with impaired vision in the work force, according to ophthalmologists, optometrists, and rehabilitation experts. Annual eye examinations may catch problems early, when drugs, surgery, or other treatment are most effective. For example, early detection can usually halt, although not reverse, eye damage due to glaucoma, a leading cause of blindness. A checkup may also reveal cataracts, which can be surgically removed to prevent blindness. Even if a specialist determines that further deterioration of eyesight is inevitable, the worker at least has additional time to adapt to the condition and seek help, both on and off the job. Through the efforts of unions in collective bargaining, larger numbers of U.S. workers and their families now have access to vision care. According to a study by the Bureau of National Affairs, 40 percent of collective bargaining plans contained vision care programs in May 1986. This compares with only 3 percent in 1975 and 10 percent in 1979. A Tale of Two companies Two firms that provide vision care as part of their health benefits package are the S&C Electric Company in Chicago and the Convair division of General Dynamics Corporation in San Diego. Their vision care programs can serve as models for other companies, both large and small. More than Safety Glasses These companies go far beyond providing the standard safety glasses and goggles required by federal regulations in many manufactur- ing plants. Convair, for example, conducts more than 3,000 free basic eye examinations each year. Every new worker receives a physical examina- tion, including testing for visual acuity and retinal diseases. About i,800 out of 12,500 employees those who assemble and manufacture compo- 22

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nents receive follow-up eye tests annually. Both eyeglasses and com- plete eye examinations are available at a discount. Older workers who develop presbyopia impaired ability to focus on objects close unaware required by many companies to wear prescrip- tion glasses at all times. Metalworkers and drillers at Convair are issued goggles and face shields, as well as the required safety glasses. Visually impaired workers are supplied with magnifying glasses and extra light- ing, including high-magnification, high-intensity inspection lamps. These workers are limited to daylight hours, and their tasks may be restricted. Free Eye Care at a Small Company Paralleling Convair's vision care program is that of S&C Electric Co., a firm with 1,350 employees that manufactures high-voltage switches and fuses for utility companies. A local optometrist visits the firm for free eye examinations twice a month, and since the ~ 950s the firm has provided all employees with free prescription glasses, in addition to safety glasses, if needed. The optometrist sees about 25 people in a half day, about 600 in a year. Prescriptions for glasses are filled at a cost to S&C ranging from $1~ to $30 the employee pays nothing. An ophthalmologist is on call in the event that eye injuries or special eye problems need immediate care. Many, but not all, S&C employees receive the free eye examina- tions. These people include all new employees in the manufacturing area; all workers age 60 and over, forklift drivers and others who operate vehicles, and those who assemble solid-state electronic parts. Other workers in the manufacturing area and persons whose jobs often take them into that part of the building are given eye exams once every two years. According to S&C's medical aid administrator, eye problems are most common in workers over the age of 35. Cataracts, glaucoma, and visual problems arising from diabetes have been detectedconditions that might otherwise have gone unnoticed. Job Coding A unique feature of the Convair program is that the physical abilities of each worker, including vision, are coded and matched to job tasks. The codes, which also indicate such conditions as hearing impair- ment and sensitivity to chemicals, are designed to protect the worker's health, enhance safety for fellow employees, and improve productivity, according to Roberta Alex, medical supervisor at Convair. For example, a worker who has good vision in only one eye (better than 20/40 with glasses in one eye, but less than 20/70 in the other) is coded for wearing safety prescription glasses at all times. Both the supervisor and the employee are notified and educated about the code, and such a worker would never operate a crane or perform other tasks 23

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GLAUCOMA The National Eye Institute estimates that glaucoma ac- counts for more than 12 percent of all reported cases of blindness. A recent analysis of data from the 1960s indicates that blacks develop the disease at a rate ~ to ~ 6 times that of whites, and at an earlier age. Nearly 2 million Americans age 35 and over, or ~ out of every 50 people in that age group, have the disease, according to the National Society to Prevent Blindness. The older the person, the greater the risk: 3 out of 10() nenol~ SPAR R.~; and nvPr hove glaucoma. ~ ~ _O ~ _ ~ ~ ~ , A. .. ~ , ~ Glaucoma occurs when the natural fluids produced in the eye do not drain away but collect and exert pressure inside the eyeball. If left untreated, the pressure eventually destroys fibers in the optic nerve and blindness results. Loss of peripheral vision is the main symptom, but by the time patients are aware of the problem, considerable damage has usually occurred. Regular t~ checkups for glaucoma, usually recommended after the age of 40, can catch the problem early. Doctors use three standard tests for diagnosis. Photograph- ing the back of the eyeball can indicate telltale indentations of the optic nerve, called cupping, which is one of the earliest signs of disease. Measuring eyeball pressure with a tonometer, a sensing device that either lightly touches the surface of the eye or aims a gentle stream of air at the eyeball, catches abnormalities early on. The third test examines the patient's field of vision. Glaucoma can usually be controlled, but not cured, with special eyedrops and other drugs. For some patients, surgery, including laser therapy, may reduce pressure from fluid buildup. that require good vision in both eyes. A worker with better vision has a less restrictive code and can perform a wider range of tasks. Separate codes are used for people with color blindness or reduced sensitivity color; these employees would not work with color-coded wires. Benefices of Company Vision Care Programs Increased safety and higher productivity are prime motivators for including vision care in the company health package. There maybe other reasons as well. Reductions in force may leave a company with substan- tially fewer employees, many of whom, due to their seniority, are older. The companies might then take a special interest in retaining and monitoring the health of older workers who are productive despite minor 24

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visual impairment. If the firm begins rehiring, it may find that its older managers are invaluable in passing on knowledge to junior staff. Main- taining the visual health of older workers may play an important part in retaining experienced employees. In the words of one industrial health specialist, a company's eye care program "costs absolutely nothing,' compared to the resulting increase in employee morale, early detection of disease and preservation of eyesight, improvement in work performance, and added safety in the workplace. Rather than being operated separately, as a costly white elephant, vision care services can easily be integrated with other health care benefits offered by a company. 25

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