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How to Fulfill the VisualHow to Fulfill the VisualRequirements ofRequirements of
American Disability Act andAmerican Disability Act andAmendmentsAmendments
Bernard R. Bernard R. BlaisBlais, M.D., FAAO, FACOEM, FACS, M.D., FAAO, FACOEM, FACSClinical ProfessorClinical Professor
Albany Medical CollegeAlbany Medical CollegeAlbany, New YorkAlbany, New York
Blais Consulting, Ltd.Blais Consulting, Ltd.4 Innisbrook Drive4 Innisbrook DriveClifton Park, NY 12065Clifton Park, NY 12065
Phone: (518) 371-8147Phone: (518) 371-8147Fax: (518) 373-9347Fax: (518) 373-9347Email: [email protected]: [email protected]
11
Western Occupational and Environmental Medical AssociationCME Webinar - August 29, 2012
PLEASE STAND BY - WEBINAR WILL BEGIN AT 12:00pm (Pacific Time)FOR AUDIO: Call: 866-740-1260 / Access Code: 764 4915#
Disclosure: Disclosure: I have no actual or potentialfinancial conflicts of interests related tothis presentation.
22
Every fitness for dutyEvery fitness for dutycertification mustcertification must
Fulfill the requirements of the ADAFulfill the requirements of the ADA
33
VisionVision
Visual function Visual function –– How Eyes and How Eyes andVisual System FunctionVisual System Function
Functional Vision DescribesFunctional Vision Describeshow the PERSON functionshow the PERSON functionsA reduced functional vision A reduced functional vision
(visual dysfunction)(visual dysfunction)
44
Vision AspectsVision Aspects
The OrganThe OrganChanges in Structure leads toChanges in Structure leads to
Changes in FunctionChanges in FunctionThe PersonThe Person
Changes in Abilities leads toChanges in Abilities leads toPersonal ConsequencesPersonal Consequences
55
Parameters of Ocular FunctionParameters of Ocular Function
A. Central1. Macular function2. Provides Binocular Vision3. VA better than 20/2004. Central vision less than 10
degrees5. Stereopsis6. Color Vision
B. Peripheral1. VA worse than 20/2002. Peripheral visual fields more than 10 degrees3. Scotopic Vision - night vision
– exclusion area of macula/fovea control
6
Evaluation of Visual Performance Based on
Appropriate vision for the job proficiency
Safely performing the task
7
HOW TO ACCOMPLISH THE ADAAOCULAR (VISUAL) SCREENING
REQUIREMENTS
The ADA and ADAA require that an individual fulfill theposition’s essential tasks with or without accommodationwithout increased substantial risk or substantial threat tohimself or herself or others.
How to accomplish state requirements for evaluation ofchildren 7 years or less.
8
Job AnalysisJob Analysis
Basic visual functions and essential activities of daily life
1. Acuity testing for:Monocular (each eye) and binocular (both eyes) visionBoth distance and near visual acuityWith and without correction (the person’s eyeglasses or
contact lenses, intraocular lens)
2. Stereopsis findings as a baseline, note subsequent changes, if any
3. Color perception, of the 3 visual hues, as some color deficienciesinterfere with safety and efficiency of the employees and all ADLs
4. Visual fields to determine visual acuity from the fovea to the ciliarybody
5. Muscle balance (distance and near), also called binocular balance.The examination should be for vertical and horizontal phorias. ► General limits of normal functional balance are set for far
and near vision when performing the tests.9
Must be completed for all screened personnel
These steps are based on procedures instituted inthe Purdue studies
for WWII workers – 150,000 employees testedVerified by the US Army in 2002 and 2010 forusefulness for all active duty and civil serviceemployees.
Ocular (Visual) Screening BasicsSTEP-BY-STEP PROCEDURES
10
Visual History QuestionnaireName__________________________________________________________ Date __________________Address ______________________________________________________________________________Occupation _________________________________________________________________ Age ______
Eye HistoryDo you have a history of eye problem(s)? Yes NoIf so, what is the diagnosis? myopia (nearsightedness) hyperopia (farsightedness) astigmatism lazy eye presbyopia (needs reading glasses) color vision (red/green deficiency) color vision (blue/yellow deficiency) cataract macular degeneration night blindness congenital/acquired eye disease (specify) __________________________________________________________ eye injury (specify) ___________________________________________________________________________ other eye condition __________________________________________________________________________ Ocular surgery:
straightening eyes_________________________________________________________________cataracts – intraocular lens – type ____________________________________________________refractive surgery: type ____________________________________________________________other surgeries – type ____________________________________________________________
Surgical complication Difficulty with night driving Decreased contrast sensitivity Double visionFamily HistoryDoes your father’s family have an inherited eye condition? Yes NoIf yes, specify _______________________________________________________________________________________________________________________________________________________________________________Does your mother’s family have an inherited eye condition? Yes NoIf yes, specify _______________________________________________________________________________________________________________________________________________________________________________
General HistoryDo you have diabetes hypertension glaucomaDo you wear glasses? Yes NoDo you own more than one pair of prescription glasses? Yes NoIf so, for what do you use your second pair? sunglasses reading occupational sportsDo you use safety or protective goggles? Yes NoIf so, do you wear them over spectacles or contact lenses? Yes NoDo you use garden tools, such as weed whackers or lawn mowers? Yes NoDo you have a home workshop or power tools? Yes NoDo you use dangerous liquids such as alkalis or acids? Yes NoDo you have safety prescription glasses for use in your workshop, hobbies or home activities? Yes NoWhat are you hobbies? __________________________________________________________________________Do you participate in any sports? Yes NoIf so, which ones? _______________________________________________________________________Do you wear protective sports goggles? Yes NoHave you ever heard of polycarbonate lenses? Yes No
Preventive Medicine Guidelines CPT Codes Book’s Evaluation/Management Guidelines Requirements
1. Ocular history, which includes a general overview of the individual’s visual history
© American MedicalAssociation 2011. Allrights reserved.
11
Phases of development of Bausch & Lomb Optical Company Ophthalmic Instruments – Bausch & LombOrtho-Rater provided by Bausch & Lomb Archives Library
Vision Assessment Co.Ciber Vision Tester
Figure 4-2
Sperian Titmus Stereo Optical Co. Model V4 Optec 5000
Figure 4-3
Modified for presentation purposes.12
2. Complete visual (ocular) screening examinationsa. Visual acuity quantitative bilateral tests are measured for far, at infinity (at
minimum and especially in pediatrics), for near, and for intermediate distances(based on job description); all examinations are performed with and withoutcorrective devices (i.e. glasses, contact lenses, intraocular lens)
Alternate Optotypes – Sloan Letter SeriesBailey-Lovie Layout ETDRS Type
Source Stereo Optical Co., Inc. Slide 3000-037. Used with permission.
Left Eye Right Eye
© American Medical Association 2011. All rights reserved.13
a. 1. BinocularityFigure 4-3 Vision Testers for Binocularity - Far
Source: Archives of Titmus Optical Inc. and Stereo Optical Co.. Used with permission
Figure 4-4 Monocular Vision Figure 4-5 Diplopia
© American Medical Association 2011. All rights reserved.14
Who is doing color visionWho is doing color visiontesting?testing?
1515
Requirements for color visionRequirements for color visiontesting:testing:
· Activities of daily life · Activities of daily life · Specific job requirements · Specific job requirements
1616
Purpose of Color VisionPurpose of Color VisionTesting?Testing? Historically to determine if one is safe,Historically to determine if one is safe,
especially at driving:especially at driving:–– i.e. Red/Green Huesi.e. Red/Green Hues
Present activities of life have changedPresent activities of life have changed–– New polychromatic dials, gauges, safety devicesNew polychromatic dials, gauges, safety devices–– Reemphasis in the aviation & railroad industriesReemphasis in the aviation & railroad industries
as the purpose of colors.as the purpose of colors.–– Many job tasks now have varying needs.Many job tasks now have varying needs.
1717
Why are you doing colorWhy are you doing colorvision testing?vision testing?
Determine their activities of dailyDetermine their activities of dailyliving? (ADL)living? (ADL)
Determine if one is qualified for aDetermine if one is qualified for aspecific color vision task?specific color vision task?
1818
Retinal conesRetinal cones–– Contain classes of photo pigmentContain classes of photo pigment–– Overlapping spectral sensitivityOverlapping spectral sensitivity–– Have maximum sensitivity in the spectralHave maximum sensitivity in the spectral
regionsregions–– Classic photo pigmentClassic photo pigment
1919
Visual Spectrum DefectsVisual Spectrum Defects
Three primary colorsThree primary colors–– BlueBlue–– GreenGreen–– RedRed
2020
Trichromatic TheoryTrichromatic Theory
Mariotte (1681) Mariotte (1681) Newton (1704) Newton (1704) All colors couldAll colors could
be matched bybe matched bythree others.three others.
Cut-away view of the Munsell solid. McIntyre, D., Color Blindness Causes and Effects, Dalton Publishing, ChesterEngland, 2002 Figure 6 as modified from Britannica® DVD2000 © 1994-2000 Encyclopedia Britannica, Inc. 2121
So what does one actuallySo what does one actuallysee with each of thesesee with each of thesedeficiencies?deficiencies?
2222
B. Red-BlindA. Color Normal
Fruit stall. A fruit stall as seen by a color normal (A) and red-blind (B).
McIntyre, D., Color Blindness Causes and Effects, Dalton Publishing, ChesterEngland, 2002. Figure 32.
2323
A. Color Normal
Fruit stall. A fruit stall as seen by a color normal (A) and green-blind (C).
McIntyre, D., Color Blindness Causes and Effects, Dalton Publishing, ChesterEngland, 2002. Figure 32.
C. Green-Blind
2424
A. Color Normal
Fruit stall. A fruit stall as seen by a color normal (A) and blue-blind (D).
McIntyre, D., Color Blindness Causes and Effects, Dalton Publishing, ChesterEngland, 2002. Figure 32.
D. Blue-Blind
2525
TodayToday’’s needs fors needs for
Determination if color vision deficiencyDetermination if color vision deficiencyis anomalous or full defectis anomalous or full defect
Determination of blue deficiency asDetermination of blue deficiency aswell as red/greenwell as red/green
2626
Industrial NeedsIndustrial NeedsChangingChanging
So more specific deficiencies must beSo more specific deficiencies must beidentifiedidentified
Not Not ““Color Vision FailureColor Vision Failure””
2727
Industry no longer issatisfied with these colorvision blind reports.
We must know more thanwhat is determined in thefollowing slides.
2828
Traffic lights as seen with normal color vision on the leftand, as they might appear with some types of color
vision deficiency on the right.2929
Simplified terminology for theSimplified terminology for thestandard poorly understoodstandard poorly understoodcolor deficienciescolor deficiencies
TABLE 2TABLE 2
Formal TermFormal Term New TermNew Term
protanopicprotanopic red-blindred-blinddeuteranopicdeuteranopic green-blindgreen-blindtritanopictritanopic blue-blindblue-blindprotanomalousprotanomalous red-weakred-weakdeuteranomalousdeuteranomalous green-weakgreen-weaktritanomaloustritanomalous blue-weakblue-weakachromaticachromatic achromaticachromatic
McIntyre, D., Color Blindness Causes and Effects, Dalton Publishing, Chester England, 2002McIntyre, D., Color Blindness Causes and Effects, Dalton Publishing, Chester England, 2002Table 7 as modified from ©Transport for London. Reproduced by kind permission ofTable 7 as modified from ©Transport for London. Reproduced by kind permission ofLondonLondon’’s Transport Museum.s Transport Museum.
3030
The Nomenclature ofThe Nomenclature ofColor Vision DeficienciesColor Vision Deficiencies
Table IIncidence of Color Defects in Caucasian Males
Heredity %(1) Trichromatism (a) normal 91.8
(b) anomalous - (i) protanomaly 1.0(ii) deuteranomaly 4.6(iii) tritanomaly 0.0001
(2) Dichromatism (a) protanopia 1.2(b) deuteranopia 1.4(c) tritanopia 0.0001
(3) Monochromatism (a) of the rods 0.003(b) of the cones 0.000001
Acquired (a) tritanomalous or tritanopic possibly 5%(b) protanomalous, deuteranopic or anomalous
Duke Elder, S., Gloster, J. Weale, R. Physiology of The Eye, Chapter XVI on Color Vision, page 616, 1968Table XIV and Birch, Jennifer, Diagnosis of defective color vision, Oxford University Press (1993).
3131
Acquired Color Vision DefectsAcquired Color Vision DefectsResulting from OcularResulting from OcularPathologyPathology
Intracranial injuryIntracranial injury Excessive use of therapeutic drugsExcessive use of therapeutic drugs Chemical toxicological effectsChemical toxicological effects
3232
ChemicalChemical
Chemical toxicological effects seenChemical toxicological effects seen–– Xylene, toluene toxicityXylene, toluene toxicity–– Blue-yellow color deficiency present priorBlue-yellow color deficiency present prior
to findings of peripheral neuropathyto findings of peripheral neuropathy–– At what toxic level does the color visionAt what toxic level does the color vision
defect founddefect found more research needed? more research needed?
3333
BasisBasis for what is the appropriate color for what is the appropriate colorvision testvision test
Is it a screening or diagnostic procedure?Is it a screening or diagnostic procedure? Does it test for the three hues?Does it test for the three hues? Does it primarily answer what are consistentDoes it primarily answer what are consistent
with purpose?with purpose? What is the cost for performing the test?What is the cost for performing the test?
–– EmployeeEmployee–– Technical AdministratorTechnical Administrator
What is the complexity of the procedure?What is the complexity of the procedure?
3434
Basic Requirements ofBasic Requirements ofColor Vision Color Vision SCREENINGSCREENING Must be able to evaluate Red.Green.Blue huesMust be able to evaluate Red.Green.Blue hues Must be technically simple to operateMust be technically simple to operate Must take short period to completeMust take short period to complete
–– (1-2 minutes maximum)(1-2 minutes maximum)
Technician/nurse time normally 5 minutes.Technician/nurse time normally 5 minutes. Must be inexpensive to purchase test andMust be inexpensive to purchase test and
special illuminationspecial illumination Screening for R.G.B. should be with oneScreening for R.G.B. should be with one
testtest
3535
Goal in OccupationalGoal in OccupationalMedicineMedicine
A screening test that screens forA screening test that screens for RedRed GreenGreen Tritan (blue Tritan (blue –– yellow) yellow)
Fulfills basic requirement of screeningFulfills basic requirement of screening
3636
Printed PseudoisochromaticPrinted PseudoisochromaticPlatesPlates
Most widely used screening for colorMost widely used screening for colorvisionvision
Most design to detect congenital Red-Most design to detect congenital Red-GreenGreen
Only six tests Only six tests –– detects tritan (blue detects tritan (bluedefects)defects)
3737
Screening Test in VisionScreening Test in VisionScreenersScreeners
Armed ForcesArmed Forces*Titmus*Titmus*Stereo Optical*Stereo Optical+Vision Assessment Co.+Vision Assessment Co.
Ishihara TestIshihara Test–– Screens for only red and greenScreens for only red and green
*HRR will be new option in newer plates*HRR will be new option in newer plates+HRR screening and diagnostic and+HRR screening and diagnostic and
Ishihara TestIshihara Test3838
HRR PlatesHRR Plates
Consist of backgroundConsist of backgroundcolored circlescolored circles
Range of size andRange of size andlightnesslightness
HRR indicates severityHRR indicates severityof defect of any RGof defect of any RGdefectdefect
Screen for tritan (blue-Screen for tritan (blue-yellow)yellow)
3939
HRR PlatesHRR Plates
By itself can determine integrity ofBy itself can determine integrity ofthree huesthree hues
RedRed GreenGreen BlueBlue
4040
Two HRR PlatesTwo HRR PlatesAcceptableAcceptable
OriginalOriginal American Optical Plates American Optical Plates(1954)(1954)
Richmond Products, Inc. FourthRichmond Products, Inc. FourthEdition only (2002)Edition only (2002)
4141
ACOEM Guidance for the Medical Evaluationof Law Enforcement Officers (LEO)
4242
(No longer used)
Tests used for evaluation of congenital color deficiency (modified)
Function Scope Tests
Screening red-green defects Ishihara plates
blue defects CU (City University) tritan plates
HRR plates
Screening & grading Ishihara + CU tritan plates
HRR plates
D15 test, Anomaloscope
Evaluation D15, FM100
Anomaloscope
Occupational transport & armed Ishihara plates
screening services Falant
McIntyre, D, Color Blindness Causes and Effects, Dalton Publishing, Chester, England, 2002, p. 81.
Alternate TestAlternate Test
Two tests needed to identify Red-Two tests needed to identify Red-Green defects and tritan (blue-yellow)Green defects and tritan (blue-yellow)
Multiple test not satisfactory for non-Multiple test not satisfactory for non-ocular facilitiesocular facilities–– Not cost effectiveNot cost effective
c. Color vision – for the 3 Hues – Red, Green, Blue
Figure A-12 Ishihara Color Perception
Source: Archives of Titmus Optical Inc. and Stereo Optical Co. Used with permission.
Figure A-13 Alternate Color Perception – Hardy, Rand, and Rittler (HRR)
Source: Richmond Products. Used with permission.
4545
b. Depth of PerceptionFigure 4-11 Stereo Depth Perception – Far
Source: Archives of Titmus Optical Inc. and Stereo Optical Co.. Used with permission
© American Medical Association 2011. All rights reserved.
4646
Figure AA-3Binocular Field
95°
55°
95°
55°
Right Eye Peripheral Field
Left Eye Peripheral Field
Point of Fixation
Binocular Field
Left Eye Peripheral Field
Point of Fixation
d. Gross visual fields
Figure AA-1 Binocular vs. Monocular Field
4747
4. Ordering of appropriate laboratory/diagnostic procedures or by referralto an appropriate eye specialist, depending on the defect, when anindividual fails to meet standards.
5. A written summary of the case signed by the authorizing physician.
4848
Risk Analysis/Job Standards
Clerical Clerical
SnellenSnellen DecimalDecimal
FARFAR
BinocBinocBothBothRightRightLeftLeftDepthDepthColorColorVerticalVerticalLateralLateral
No RequirementNo Requirement5 out of 85 out of 80.5 LH or 0.5 RH0.5 LH or 0.5 RH4 EP or 5 XP4 EP or 5 XP
20/2520/2520/30-3220/30-3220/30-3220/30-32
0.80.80.630.630.630.63
NEANEARR
BinocBinocBothBothRightRightLeftLeftVerticalVerticalLateralLateral
0.5 LH or 0.5 RH0.5 LH or 0.5 RH4 EP or 5 XP4 EP or 5 XP
20/2020/2020/2520/2520/2520/25
1.01.00.80.80.80.8
Table 4-7 Visual Job FamilyClerical and Administrative Profile #1
Tiffin J. Visual Skills. In: Kuhn H. Eyes and Industry, 2nd ed. St. Louis, MO: Mosby: 1950;:111-117.Binoc indicates binoculars; LH, left hyperphoria; RH, right hyperphoria; EP, esophoria; and XP, exophoria
© American Medical Association 2011. All rights reserved.4949
Table 4-8 Visual Job FamilyOperator of Mobile Equipment
Profile #2
Mobile Mobile
SnellenSnellen DecimalDecimal
FARFAR
BinocBinocBothBothRightRightLeftLeftDepthDepthColorColorVerticalVerticalLateralLateral
4040””5 out of 85 out of 80.5 LH or 0.5 RH0.5 LH or 0.5 RH4 EP or 5 XP4 EP or 5 XP
20/2020/2020/2520/2520/2520/25
1.01.00.80.80.80.8
NEANEARR
BinocBinocBothBothRightRightLeftLeftVerticalVerticalLateralLateral
0.5 LH or 0.5 RH0.5 LH or 0.5 RH4 EP or 5 XP4 EP or 5 XP
20/30-3220/30-3220/32-3520/32-3520/32-3520/32-35
0.630.630.630.630.630.63
Tiffin J. Visual Skills. In: Kuhn H. Eyes and Industry, 2nd ed. St. Louis, MO: Mosby: 1950;:111-117.Binoc indicates binoculars; LH, left hyperphoria; RH, right hyperphoria; EP, esophoria; and XP, exophoria
© American Medical Association 2011. All rights reserved. 5050
InspectionInspection
SnellenSnellen DecimalDecimal
FARFAR
BinocBinocBothBothRightRightLeftLeftDepthDepthColorColorVerticalVerticalLateralLateral
4040”” * *5 out of 85 out of 80.5 LH or 0.5 RH0.5 LH or 0.5 RH4 EP or 5 XP4 EP or 5 XP
20/30-3220/30-3220/32-3520/32-3520/32-3520/32-35
0.630.630.630.630.630.63
NEANEARR
BinocBinocBothBothRightRightLeftLeftVerticalVerticalLateralLateral
0.5 LH or 0.5 RH0.5 LH or 0.5 RH4 EP or 5 XP4 EP or 5 XP
20/2020/2020/2520/2520/2520/25
1.01.00.80.80.80.8
Table 4-9 Visual Job Family Inspection and Close Machine Work Profile #3
Tiffin J. Visual Skills. In: Kuhn H. Eyes and Industry, 2nd ed. St. Louis, MO: Mosby: 1950;:111-117.Binoc indicates binoculars; LH, left hyperphoria; RH, right hyperphoria; EP, esophoria; and XP, exophoria.Tiffin (Kuhn) requirement of 83 seconds of arc is not consistent with the job analysis nor is it consistent with bifovealfixation as discussed in the book’s Appendix.Binoc indicates binoculars; LH, left hyperphoria, RH, right hyperphoria; EP, esophoria; and XP, exophoria.
© American Medical Association 2011. All rights reserved.
5151
MachineMachine
Titmus (1)Titmus (1) SnellenSnellen DecimalDecimal
FARFAR
BinocBinocBothBothRightRightLeftLeftDepthDepthColorColorVerticalVerticalLateralLateral
4040”” * *5 out of 85 out of 80.5 LH or 0.5 RH0.5 LH or 0.5 RH4 EP or 5 XP4 EP or 5 XP
20/2520/2520/30-3220/30-3220/30-3220/30-32
0.80.80.630.630.630.63
NEANEARR
BinocBinocBothBothRightRightLeftLeftVerticalVerticalLateralLateral
0.5 LH or 0.5 RH0.5 LH or 0.5 RH4 EP or 5 XP4 EP or 5 XP
20/2520/2520/30-3220/30-3220/30-3220/30-32
0.80.80.630.630.630.63
Table 4-10 Visual Job Family Machine Operators Profile #4
Tiffin J. Visual Skills. In: Kuhn H. Eyes and Industry, 2nd ed. St. Louis, MO: Mosby: 1950;:111-117.Binoc indicates binoculars; LH, left hyperphoria; RH, right hyperphoria; EP, esophoria; and XP, exophoria.Tiffin (Kuhn) requirement of 83 seconds of arc is not consistent with the job analysis nor is it consistentwith bifoveal fixation as discussed in the book’s Appendix.Binoc indicates binoculars; LH, left hyperphoria, RH, right hyperphoria; EP, esophoria; and XP, exophoria.
© American Medical Association 2011. All rights reserved.5252
SkilledSkilled
Titmus (1)Titmus (1) SnellenSnellen DecimalDecimal
FARFAR
BinocBinocBothBothRightRightLeftLeftDepthDepthColorColorVerticalVerticalLateralLateral
4040””5 out of 85 out of 80.5 LH or 0.5 RH0.5 LH or 0.5 RH4 EP or 5 XP4 EP or 5 XP
20/2520/2520/30-3220/30-3220/30-3220/30-32
0.80.80.630.630.630.63
NEANEARR
BinocBinocBothBothRightRightLeftLeftVerticalVerticalLateralLateral
0.5 LH or 0.5 RH0.5 LH or 0.5 RH4 EP or 5 XP4 EP or 5 XP
20/2020/2020/2520/2520/2520/25
1.01.00.80.80.80.80.630.63
Table 4-11 Visual Job Family Mechanics & Skilled Tradesmen Profile #5
Tiffin J. Visual Skills. In: Kuhn H. Eyes and Industry, 2nd ed. St. Louis, MO: Mosby: 1950;:111-117.Binoc indicates binoculars; LH, left hyperphoria; RH, right hyperphoria; EP, esophoria; and XP, exophoria
© American Medical Association 2011. All rights reserved.5353
UnskilledUnskilled
Titmus (1)Titmus (1) SnellenSnellen DecimalDecimal
FARFAR
BinocBinocBothBothRightRightLeftLeftDepthDepthColorColorVerticalVerticalLateralLateral
4040””5 out of 85 out of 80.5 LH or 0.5 RH0.5 LH or 0.5 RH4 EP or 5 XP4 EP or 5 XP
20/2520/2520/30-3220/30-3220/30-3220/30-32
0.80.80.630.630.630.63
NEANEARR
BinocBinocBothBothRightRightLeftLeftVerticalVerticalLateralLateral
0.5 LH or 0.5 RH0.5 LH or 0.5 RH4 EP or 5 XP4 EP or 5 XP
20/30-3220/30-3220/32-3520/32-3520/32-3520/32-35
0.630.630.630.630.630.63
Table 4-12 Visual Job Family Laborers Profile #6
Tiffin J. Visual Skills. In: Kuhn H. Eyes and Industry, 2nd ed. St. Louis, MO: Mosby: 1950;:111-117.Binoc indicates binoculars; LH, left hyperphoria; RH, right hyperphoria; EP, esophoria; and XP, exophoria
© American Medical Association 2011. All rights reserved. 5454
Specific Ocular Standards bySpecific Ocular Standards byVarious Regulatory BodiesVarious Regulatory Bodies
FAAFAA - - PilotsPilots DOTDOT -- Commercial DriversCommercial Drivers NRANRA -- Railroad Engineers etc.Railroad Engineers etc.
NB: Multiple detailed listing can be found in Appendix C of AMA Guides
5555
Impairment –Significant Disability, loss or less use of anystructure or body function in any individual with ahealth condition, disorder or process.
Examples –1. Cataract2. Macular Degeneration3. Retinitis Pigmatosa
A. The physician provides an independent, unbiasedassessment of the individual’s medical condition
B. including the effect on functionC. Or inhibition to the performance of activities of
daily living or ADLs
5656
Disability Disability –– Inability Inability
A. An altered ability to accomplish agiven task successfully
B. But would not help to distinguishwhat is being evaluated doing thedisability process
5757
Impairment – GenerallySignificant Disability, loss or less use of anystructure or body function in any individual with ahealth condition, disorder or process.
Examples – Ophthalmic1. Cataract2. Macular Degeneration3. Retinitis Pigmatosa
A. The physician provides an independent, unbiasedassessment of the individual’s medical condition
B. including the effect on functionC. Or inhibition to the performance of activities of
daily living or ADLs
5858
Rondelli R, Graves, Katz RT, et al. AMA Guides to the Evaluation ofPermanent Impairment, 6th Edition, Chicago, IL, AMA 2008.
Blais BR, Color Vision in the Occupational Setting, Analysis and Testing, R.P.Press, Atlanta, GA.
Blais BR, AMA Guides to the Evaluation of Ophthalmic Impairment andDisability – Measuring the Impact of Visual Impairment on Activitiesof Daily Living, AMA Press, Chicago, IL, 2011.
Voke J, Colour vision testing in specific industries and profession, Keeler,London, 1980.
Vingrys AS, Cole BL, Are colour vision standards justified for the transportindustry? Ophthalmic Physiol Opt. 1988;8(3):257-74.
References
5959
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Thank you!Thank you!
Thank you for participating in today’s webinar.At the conclusion of this call you will receive an email
with a link to a post-webinar questionnaire.
You will need to complete this questionnaire in order toreceive CME for this webinar.
This webinar presentation can be downloaded atwww.woema.org