OCCUPATIONAL AND ENVIRONMENTAL VISION

- The Role of the Optometrist in Occupational Safety and Health -

AUTHOR
Ralph B Chou: University of Waterloo, Canada

PEER REVIEWER
Rachel North: Cardiff University, United Kingdom

INTRODUCTION
Optometry has a long history of dealing with the problems of vision and eye safety in the workplace. Many
occupational safety and industrial hygiene experts lack the necessary knowledge and skills to manage industrial sight
conservation programmes. This is an introduction to the field of environmental vision and how the optometrist can
provide eye safety services to industry.

OUTLINE

 Introduction

 Workplace survey
- Oculo-Visual Hazard Analysis
- Ergonomic factors
- Work Place Lighting Assessment

 Matching the worker to the task

- Visual standards
- Clinical evaluation
- Personal protective strategies

 Pitfalls of industrial consulting

- The KISS principle
- Fees (chasing the client away)
- Worker vs employer conflicts

 Visual health in selected industries

- Chemical industry
- Outdoor worker / Recreation
- Welders
- Laser worker
- Transportation industry
- Health care worker

 References and Standards

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INTRODUCTION

Eye injuries comprise between 5 and 10% of the reported lost time that occur in the workplace. Many of these are
preventable, being due to the inappropriate use or lack of use, of eye protectors. Those affected tend to be young
and relatively inexperienced, or older experienced workers who have not followed established safety procedures.

Regardless of how an accidental eye injury occurs, it has substantial costs to the employee, employer and the health
care system.

An injured employee can suffer loss of income while recovering from the injury. In some cases, the worker may
become unemployable in his or her vocation, because of the decreased vision resulting from the injury.

There are also substantial costs to the employer. First, a replacement worker must be hired and trained. The
expense of hiring and training may be wasted since these employees will be discharged upon the return of the injured
worker. In addition, the premiums charged for public or private worker compensation plans may increase after
employees are injured. Finally, there may be fines and legal costs arising from the investigation of the accidental
injury, especially if it is proved that the employer or his agents failed to provide adequate safety instructions or
equipment to the injured worker.

Society as a whole also pays for the injured worker. Tax revenues are spent on providing emergency care,
hospitalisation, health care services, and costs of rehabilitation and retraining. In addition, the employer's costs
related to the injury will be added to the prices of commodities or services sold to the public.

As a provider of primary eye care, the optometrist is uniquely positioned to provide the consulting, diagnostic and
treatment services needed to establish and maintain an eye protection programme for a given workplace. By
identifying hazardous situations in the workplace and analysing the visual demands of the workers' tasks, the
optometrist can plan appropriate programmes to provide safety eyewear and to monitor the continued ocular health of
the worker.

The components of an industrial Eye Protection Programme include:

 Workplace environment survey

 Vision screening
 Steps for implementation of the programme
 Steps for maintenance of the programme.

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THE WORKPLACE SURVEY

A workplace survey is comprised of an analysis of ocular hazards present in the worker's environment, and an
analysis of the ergonomic factors affecting vision. While it is neither cost effective nor necessary to make an on-site
visit for every patient who requests occupational vision care, such a visit is mandatory when the practitioner is
considering the establishment of an occupational vision plan with a large group of employees with many different
tasks. By becoming familiar with the visual environments of the workers, the practitioner can provide services which
are appropriate for their particular needs.

An oculo-visual hazard analysis includes identification of all existing or potential ocular

hazards, a review of existing safety policies, procedures and facilities, worker complaints,
and recent accidental eye injury reports. Regulations made under occupational safety
legislation often require that workers, supervisors, and designated safety personnel in the
workplace be given information on hazardous materials and circumstances in the
workplace. This information includes the nature of the hazard, allowed limits of worker
exposure, safe handling procedures, and emergency measures. Selection of appropriate
personal protective equipment will be dictated by this information.

Physical Hazards
Ocular hazards can be classified according to the scheme outlined in Table 1.

Table 1. Ocular hazard classification

Dust
Particles
Mechanical Hazards Compression
Hot solids
Chemical
Thermal
Non-mechanical Hazards Radiation / radiant energy
Electrical

The following review of eye hazards is not intended to be an exhaustive list, but rather a
guide for the reader in identifying existing and potential hazards in the workplace.
OCULO-VISUAL
HAZARD ANALYSIS Mechanical Hazards
Mechanical eye injuries comprise approximately 70 to 80% of all work-related eye injuries.
The range of severity of these injuries is large because of the wide range of missile size,
mass and speed that may be involved.

Large slow-moving missiles cause contusive or concussive injuries to the eye and adnexa.
A contusion results from a direct blow to the eye, while a concussion arises from the
conduction of energy from a remote site to the target tissue. In both cases, massive
disruption of the eye and its adnexa may result, including rupture of the globe.

A blow from a missile with a rough surface or sharp edges may also result in lacerations and
abrasions. Cuts to the globe and eyelids should be checked to ensure that they are not
full-thickness lacerations.

Foreign bodies in the eye remain the most common cause of disabling ocular injuries.
These may be superficial, imbedded or intraocular, depending on the size, shape and speed
of the body. Ferrous foreign bodies should be removed as quickly as possible to prevent
siderosis.

Ocular siderosis is the formation of rust in the ocular tissues as a result of oxidation of iron
contained in a foreign body. Its most frequent manifestation is a rust ring surrounding a
superficial ferrous foreign body in the corneal epithelium. If the foreign body is lodged inside
the eyeball, siderosis may lead to heterochromia, papillary mydriasis, iron deposition on the
corneal endothelium and beneath the anterior lens capsule, cataract and changes in the
retinal pigment epithelium (RPE). The patient can experience visual loss which may be
profound and permanent without treatment.

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Mechanical Hazards (cont.)

Particles under 0.5 mm in diameter are usually too small to cause penetrating ocular
injuries. However, these bodies may become imbedded in the ocular surface if propelled at
high speed (e.g. sandblasting). Often present in airborne dusts and fumes, the tiny particles
cause a foreign body sensation upon contact with the eye. Some foreign bodies may
dissolve in the ocular fluids and cause chemical injuries in addition to the mechanical
trauma.

Chemical Hazards
Workers may be exposed to vapours and fumes from volatile solvents and corrosive
materials. While the tear film may protect the eye temporarily from the adverse effects of
exposure to fumes of non-polar organic solvents, it provides no protection against polar
solvents. The fumes of corrosive solutions such as strong acids and alkaline materials can
cause severe irritation to the cornea and conjunctiva.

Splash injuries are common among workers handling chemical solutions, comprising
between 5 and 10% of all lost time eye injuries. Highly concentrated solutions cause severe
sight-threatening chemical burns to the eye and adnexa. Immediate copious irrigation with
cool water is necessary to limit the damage due to chemical splash. It should be noted that
in weak solution, alkaline solutions penetrate the eye rapidly by saponification of cell
membranes and cause much more severe injuries than acids of the same concentration,
which are neutralised in the body fluids.

Electrical Hazards
When non-lethal, electrocution may result in damage to the central nervous system. In rare
OCULO-VISUAL cases, an electric cataract can be observed. Electrical utility repair workers are often
HAZARD ANALYSIS exposed to bright electric arcs from damaged power transmission lines, transformers, and
(cont.) isolation switches. Because of the high voltage and current levels involved, the arcs
dissipate a large amount of energy as plasma (ionised air along the path of the arc), optical
radiation (primarily visible light), and sound. Workers who come in contact with the arc
and/or plasma may suffer third degree burns and electrocution. Full body protection is
needed. Workers who are remote from the electric arc discharge may still be at risk of
ocular injury. Showers of molten metal droplets may be generated at the contact points of
the arc, and are a greater ocular hazard than the arc itself.

Optical Radiation Hazards

Optical radiation ranges from approximately 200 nm to 1 mm in the electromagnetic
spectrum. For convenient reference, it is divided into the following wavebands:

 UVC 200 to 280 nm

 UVB 280 to 315 nm
 UVA 315 to 380 nm
 Visible light 380 to 780 nm
 IR-A 780 to 1400 nm
 IR-B 1400 to 3000 nm
 IR-C 3000 nm to 1 mm

Although most optical radiation injuries to the eye are associated with high level acute
exposures (a large amount of radiant energy delivered in a relatively short time), long-term
exposure to moderate levels of UVB, UVA and short wavelength visible light may result in
chronic damage to the ocular tissues. Spectral transmittance of the ocular tissues and
media will determine how deeply into the eye a given wavelength of optical radiation will
penetrate. Ultraviolet (UV) and long-wavelength infrared (IR-B and IR-C) radiation affect
structures in the anterior eye, while visible light and IR-A affect the retina and RPE.

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Optical Radiation Hazards (cont.)

For a discussion of optical radiation hazards, see Ocular Effects of Radiant Energy in
"Environmental Vision: Interactions of the Eye, Vision, and the Environment" (Pitts and
Kleinstein, 1993). Welder's flash and exposure to electric arcs (without electrocution)
together account for about 10% of eye injuries. A comprehensive discussion of tinted
lenses for protection against optical radiation hazards can be found in Prescription of
Absorptive Lenses in “Borish’s Clinical Refraction, 2nd Ed.” (Benjamin), 2006. Table 2 (at
the end of this chapter) lists commonly prescribed medications that are known to be
photosensitising.

Modern technology has developed many artificial light sources that may emit not only visible
light but also significant amounts of UV and/or IR radiation. Examples include electric
welding arcs, high pressure gas discharge lamps (e.g. xenon and mercury-xenon lamps),
black light fluorescent lamps, projector lamps, tungsten halogen lamps, deuterium lamps
and light emitting diodes. Lasers are available with a wide range of output wavelengths,
beam power and temporal and spatial characteristics, and are found in many industrial,
health care and recreational settings. The optometrist will be challenged to identify the
optical radiation hazards and eye protective measures associated with these various light
sources.

Sunlight is a very important factor in the individual's total exposure to UVB radiation. The
solar UVB level varies diurnally as well as seasonally, becoming significant when the sun is
at an altitude of 30 above the horizon. Thus, solar exposures of 20 minutes duration
between 10h00 and 16h00 in the summer may result in acute effects such as sunburn and
mild photokeratitis, while a similar exposure at the same time of day in winter would not. It
Oculo-Visual should be noted, however, that environmental UV exposure is also determined by the
Hazard Analysis amount of UV scattered across the sky, and by ground reflectance. Surfaces such as fresh
(cont.) snow, white concrete, and white sand have UVB reflectances of over 90%; the effective
UVB exposure is therefore almost double the direct solar irradiance in these environments.
It is not surprising, then, that skiers suffer sunburn on their faces after a day on the slopes.
UV reflectance from water is also quite high, thus anyone who works or engages in leisure
activities on fresh or salt water requires UV protection for their eyes. Specular reflections
from water are a significant source of disability and discomfort glare, and can be well
controlled with polarising sunglass lenses.

Individuals whose occupational and leisure time activities require them to be outdoors in the
middle of the day are at higher risk of developing skin and eye damage due to the chronic
high exposure to solar UVB. This is because the cellular damage is cumulative. There is
particular concern about solar UVB exposure in childhood, when the eyes are transparent to
UVB. It has been estimated that most individuals in Europe and North America accumulate
over 50% of their lifetime exposure to solar UVB before the age of 18 years. It is thought
that chronic high level UVB retinal exposure in childhood may be a contributing factor in the
development of dry macular degeneration later in life. Individuals who have low levels of
skin and eye pigmentation, and those taking photosensitising medications are also at higher
risk.

An additional recent concern has been the depletion of the ozone layer in the earth's
stratosphere due to the action of atmospheric pollutants. Although only a very small amount
is present (at sea level, the ozone in the stratosphere would be reduced to a layer just 3 cm
thick), stratospheric ozone absorbs the UVC and most of the UVB in sunlight, shielding
organisms at the earth's surface from this radiation. A reduction by 1% of the stratospheric
ozone concentration results in a 1.1 to 1.4% increase in UVB irradiance at the earth's
surface.

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Ozone molecules are destroyed in a photochemical process catalysed by chlorine carried

into the upper atmosphere by CFCs released from fire retardation, refrigeration and
airconditioning systems. CFCs released at the surface of the earth take between 50 and
100 years to diffuse into the upper atmosphere; even if all CFC releases were stopped
immediately, the problem of ozone depletion due to CFCs and the associated increase in
solar UVB exposure would not end for another century.

This presents a serious public health problem. The combination of increased life
expectancy and high prevalence of sun exposure in occupational and leisure time activities
has already resulted in markedly increased incidence of cataract and macular degeneration
in the populations of North America and Europe. As environmental UVB irradiance levels
increase over the next century, it is possible that the prevalence rates of these conditions
will increase even more dramatically as the incidence among younger individuals increases.
An additional problem is the increase in skin cancers associated with chronic high level sun
exposure. The costs of these health consequences to the health care systems in the
developed countries will be enormous.

One way to prevent this scenario is to change people's attitude towards sun exposure. "Sun
Awareness" programmes in Australia, Canada and the United States have led to greater
public knowledge about the dangers of sun exposure to the skin and eyes. The Australian
programmes have been extremely successful, resulting in a recent decrease in the
incidence of skin cancers due to sun exposure. In addition, the meteorological services of
Australia, Canada, the United Kingdom, the European Union and the United States have
included information on solar UVB levels in their daily weather forecasts.

The UV Index is a number between 0 and 15 which forecasts the intensity of UVB radiation
OCULO-VISUAL in sunlight. A higher number implies greater risk of skin damage due to sunburn. On days
HAZARD ANALYSIS when the UV Index is expected to be high, it is recommended that people avoid sun
(cont.) exposure during the hours of peak UV irradiance, and if this is not possible, they should use
skin and eye protection (e.g. sunblock on the skin and UV-blocking sunglasses).

Concerns about environmental exposure to UV radiation in sunlight has also led to the
adoption of more strict standards for sunglasses. Manufacturers of sunglasses are taking
steps to ensure that their products meet the requirements of the following standards:

 ANSI Z80.3-2010 Requirements for non-prescription sunglasses and fashion eyewear

(USA)

 AS/NZ 1067-2003 Sunglasses and fashion spectacles (Australia)

 BS 2724-1987 Sun glare eye protectors for general use (UK)

 EN 172:1995 Specifications for sunglare filters used in personal eye-protectors for

industrial use (CEN).

Ionising Radiation
Gamma rays, X-rays and UVC radiation interact with matter by ionising atoms and
molecules. Particles arising from atomic and nuclear reactions such as alpha and beta
particles, protons, neutrons and positrons interact with orbiting electrons directly to cause
ionisation of atoms and molecules. They are often referred to collectively as “ionising
radiation”. Ocular exposure may result in cataract, radiation retinopathy, and
photokeratoconjunctivitis.

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Biological Materials
Workers handling biological materials must follow strict protocols to prevent contact with
infectious agents, toxins and allergenic substances. The design of isolation garments used
by some workers may limit their visual field.

Limits on Worker Exposure to Chemical and Physical Agents

The health effects of certain chemical and physical agents do not become apparent until a
threshold exposure is reached. At this point, clinical signs and symptoms first become
noticeable. Occupational exposure to ionising radiation, chemical agents and some
physical agents (e.g. heat, humidity, optical radiation) is controlled by setting limits
(maximum permissible exposure or MPE) at a fraction of the threshold limiting values (TLV)
which result in clinical onset of adverse effects.

The MPE may be expressed as a concentration in air (organic solvents, dusts), dose rate
(ionising radiation, optical radiation), or total dose (ionising radiation). A MPE expressed as
total dose is specified for a time period (e.g. 8 hours, 1 week, 1 month, 1 year, etc). A total
dose MPE may also vary according to the dose rate.

Health Surveillance Programmes

OCULO-VISUAL
An occupational oculo-visual assessment may be appropriate when long-term repeated
HAZARD ANALYSIS
exposure to hazardous materials may lead to changes in ocular health or visual function.
(cont.)
Vision standards must be established for each job area and task (see below). The
procedures comprising the assessment should detect workers who do not meet the vision
standard with high sensitivity and specificity.

Ownership and accessibility of the workers' health records are a matter of great concern to
both employees and their employers. The confidentiality of the patient-practitioner
relationship is often considered compromised unless appropriate safeguards are
established (see below).

Guidelines and Standards

The TLV and MPE values for most chemical substances and physical hazards (e.g. optical
radiation, heat, cold) are contained in ISO, DIN, EC, ANSI and/or NIOSH publications.
Good sources include the American Conference of Governmental Industrial Hygienists
(ACGIH) publication "Threshold Limit Values" which is revised each year, and the Current
Intelligence Bulletins series published by NIOSH. Information may also be available from
the local occupational health and safety authority, as well as the industrial hygienist or
occupational safety officer at the workplace. Hazardous Material Data Sheets which contain
information on safe handling and storage procedures as well as exposure limits, should be
available for review at the workplace.

Workstation Layout and Visual Demands Analysis

General considerations include:

 Working distances and lines of sight

ERGONOMIC
Consider whether there are any special working distances at the workstation, as well
FACTORS
as a need for the head or eyes to turn significant amounts from primary gaze position
to take up fixation. Also, consider whether the worker is sitting, standing, or looking at
overhead targets. Worker posture may be related to complaints of oculo-visual
discomfort, particularly if the worker must maintain awkward head and eye positions
or corrective lenses are not appropriate for the fixation distances.

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 General illumination
Consider the level of illumination, type of luminaire, existence of glare sources in the
worker's field of view. Is there a problem with flickering light sources? Are there
large windows which provide daylight that would be a significant glare source? Is
there low general illumination with task lighting? Are there areas which are
inadequately illuminated for the tasks being carried out?

The Illumination Engineering Society (IES) publishes the Lighting Handbook (IES,
2011) which is the authoritative reference on the theory and practice of measuring
and designing lighting. The IES also recommends illuminance levels for a variety of
visual tasks. Illumination for these tasks can be accomplished by general
illumination, task lighting and/or supplementary lighting. Visual tasks with high
demand for contrast and/or resolution generally require higher levels of illumination.

Recommended illuminance levels for visual tasks are usually specified as ranges of
illumination. Individual adjustments are needed for visual comfort and control of
glare.

 Public spaces (reception area, corridors) General lighting 20-50 lux

 Occasional visual tasks General lighting 100-200 lux
 Tasks with medium contrast or small size Task lighting 500-1000 lux
 Tasks with low contrast or small size Task lighting 1000-2000 lux
 Prolonged or exacting visual tasks Supplementary 5000-10000 lux

The factors to be considered in lighting design are summarised by Gupta and

ERGONOMIC Koshel (2010). Room dimensions may affect luminaire positioning and size, and
FACTORS (cont.) the type of light source used.

Glare is light that interferes with vision or adversely affects visual performance. It
may affect the luminance contrast between the object of regard and the
background. Veiling or disability glare is light that interferes with visual performance
or visibility. An example would be the light scattered through the air and the ocular
media from a flashlight that obscures the visibility of an object viewed next to the
light source. Discomfort glare is light of sufficient intensity that it causes discomfort
for the observer and may also interfere with the observer’s vision. Taking the
previous example of a flashlight, if it is so bright that the observer experiences
discomfort while looking at the scene, then there is discomfort glare in addition to
the veiling glare.

It should be noted that the luminous intensity of a light source is not an indication of
whether it is the cause of glare. The position of the source relative to the object of
regard, the luminance of the object of regard compared to the light source, and the
state of light adaptation of the eye all play a role in determining whether disability
and/or discomfort glare are present.

 Inappropriate Illumination
Illumination of the workplace may be too high for comfortable vision, or too low for
optimal resolution, contrast sensitivity and colour perception. For example, an office
with dim general illumination and intense task lighting may provide satisfactory
illumination at the desks, but be insufficient for maintenance staff to see areas of the
floor which need cleaning or repair. Office spaces with large windows facing the
mid-day sun often have problems with sunlight and heat buildup, especially when
computer equipment and VDTs are installed.

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 Inappropriate Illumination (cont.)

In some instances, the quality of the lighting is inappropriate. An example would be
the use of low pressure sodium lamps in a storage area where stock is identified by
colour-coded labels. The absence of short wavelength (blue and green) light in the
lamp emission would render blue and green labels as either black or shades of grey
even to most individuals with normal colour vision. Colour identification and
discrimination would be severely impaired, negating the efficacy of the colour code.
For individuals with colour vision defects, the effect may be even more severe.

The spectral power distribution of a light source with its effect on colour perception
is one aspect of the quality of lighting. Other aspects that should be considered
include the potential for causing disability and discomfort glare, and the potential for
flicker to adversely affect vision. These factors may affect the aesthetics of vision in
a given setting – does the visual environment encourage relaxation (e.g. dimmer
general illumination in a restaurant) or excite the observer (the bright flashing lights
of a casino or amusement park).

 Characteristics of reading material or visual targets

Consider size, colour, contrast and luminance of the objects being viewed by the
worker. Does the general illumination at the workstation decrease target contrast,
make colour discrimination more difficult, or otherwise adversely affect visibility of
the objects? Is the worker required to view moving objects and, if so, in what
direction, and how fast do they move? Does the worker have any complaints about
visual discomfort or fatigue?

Computer Monitors – Computer Vision Syndrome

ERGONOMIC Most worker complaints concerning computer monitors, often referred to in the literature as
FACTORS (cont.) video display terminals (VDTs), relate to the ergonomic design of the workstation, glare
interfering with visibility of the VDT screen, or visual discomfort due to inadequate refractive
correction or uncorrected oculomotor imbalance.

Consider the following:

 Visual demands
What is the nature of the visual task? Is it word processing, data entry, CAD-CAM
work? Is it graphics or text intensive? What are the needs to read / view hard
copy?

Consider the size of the VDT screen and the pixel size as it relates to resolution and
image quality. Additional factors: non-interlaced VGA or sVGA to reduce effect of
flicker; character size, colour and contrast on the screen; room illumination and
sources of discomfort and veiling glare in the immediate surround of the VDT.

 Workstation design
Is the workstation fully adjustable for a VDT operator, or is the computer system set
up on conventional office furniture? Consider stature and posture of worker when
working at the VDT, also gaze position to see VDT and source documents, working
distances to screen, keyboard, hard copy. The centre of the VDT screen should be
approximately 20 cm below the primary gaze position (straight ahead distance
viewing) of the worker. Check keyboard and desk height, foot support and lower
back support. Does task lighting or general room lighting act as a glare source?
Does lighting for an adjacent workstation act as a glare source? Fatigue and
discomfort is more often due to poor workstation physical design than due to
problems with worker's vision.

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 Worker's vision
Visual complaints may relate to uncorrected or inadequately corrected ametropia,
deficiencies of binocularity, accommodative fatigue. In presbyopic workers, the
reading addition is usually too high and the segment position of a bifocal lens
inappropriate for VDT use at 60 cm working distance.

Intense concentration required of work at the VDT will reduce the rate of blinking.
Individuals with dry eyes and contact lens wearers may complain of ocular irritation
due to decreased blinking.

 Solving the problem of VDT-related complaints

The first step in dealing with VDT-related complaints is to ensure that the workstation
has been properly adjusted to the worker. The keyboard and monitor should be
adjusted to proper height and distance directly in front of the worker's seat. The chair
height should be adjusted for optimal back and foot support, ensuring that proper
posture is maintained. A copy holder should be mounted beside the monitor screen
at the same working distance for intensive word processing or data entry. It may be
necessary to move or alter the workstation setup to eliminate sources of veiling or
reflected glare from the worker's field of view; light shields or antiglare screens may
be helpful. It is only after these changes have been made to the physical layout that
the visual demands can be dealt with.

Some complaints may be due to an improperly adjusted monitor. Adjusting screen

working distance and character colour, brightness and contrast may be all that is
ERGONOMIC needed. A monitor with poor resolution or coarse dot pitch may require replacement
FACTORS (cont.) with a better quality unit.

The worker's spectacle correction should be appropriate for the working distance,
taking into account both binocular function and accommodative demand. This is
especially important when the worker's habitual correction does not provide a full
correction of the ametropia. Presbyopic workers may require special occupational
lenses to optimise their vision at the VDT, especially if the reading addition is +1.75 or
greater. Examples of these lens designs are the SmartSeg (Sola), Zeiss Business,
Essilor Interview and modified progressive addition (multifocal) lenses such as Gradal
RD (Zeiss), Tact (Hoya) and Varilux Computer (Essilor). Recently, a number of lens
manufacturers have introduced lenses intended to relieve accommodative stress in
pre-presbyopic patients. Examples are the Essilor Anti-Fatigue and the Nikon
Relaxsee. The so-called VDT tints and coatings are normally of little or no use in
eliminating the worker's visual complaints with VDT use.

When the worker complains of burning, itching or uncomfortable eyes, the tear film
should be evaluated. Blinking exercises may be helpful to contact lens wearers and
workers with dry eyes. Tear substitutes or ocular lubricants may also help. If the
workplace is very dry, space humidifiers may be necessary.

Symptoms of ocular fatigue may be alleviated with properly fitted occupational

corrective lenses. A break of 5 to 10 minutes from intense near point work at the VDT
or desktop every 1 to 2 hours may also help to relieve ocular fatigue. This break is
simply a task at a different working distance intended to change the level of
accommodative demand.

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Principles of Radiometry and Photometry

Radiometry is the science of detection and measurement of electromagnetic energy at
optical wavelengths. For the practising optometrist, the optical wavelengths of concern
range from about 190 nm in the high-energy ultraviolet region of the spectrum through
visible light (380 to 780 nm) into the far infrared (1 mm). The physical mechanisms by
which optical radiation interacts with matter explain how radiant energy affects the eye and
visual system and how we measure it.

Photometry is the science of measurement of visible light, defined as electromagnetic

energy that is detectable by the human eye. All quantities are weighted by the spectral
response of the eye which is also referred to as the CIE Standard Observer or the spectral
luminous efficiency function for photopic vision. Its measurements are limited to the
waveband 380 to 780 nm.

While radiometry measures the quantity of electromagnetic energy present, photometry

measures the ability of light to produce a defined simulation of human vision.

We consider the radiant energy as it is emitted by an optical source and travels through an
isotropic optical medium. An isotropic medium is one in which the optical properties are the
same, regardless of the direction light travels. For example, the index of refraction and the
spectral transmittance of an isotropic optical medium are constant. The laws of geometrical
and physical optics predict how the radiation propagates and forms an image (if any). At
any location within the optical medium, we can describe the amount of radiant energy
arriving and leaving in terms of time and spatial distribution. This is the concept of energy
flow or flux (Figure 1).

WORKPLACE The radiant energy Qe is measured in Joules (J) in the SI system. Energy per unit of time
LIGHTING or flux is radiant power or flux ϕ which is measured in watts (W) or J/s. For continuous
ASSESSMENT sources, the most convenient measurement is ϕ. Qe is usually measured for a source that
is flashing or emits a single pulse of energy.

The way radiant energy leaves a source or falls upon a receiving surface can be described
in several ways. The direction of propagation of the radiant energy can also be taken into
account.

1m

1m2

Figure 1: The amount of radiant energy arriving and

leaving can be described in terms of spatial distribution

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Consider a sphere of radius 1 m on whose surface is traced out a circular area of 1 m2.
From the centre of the sphere, this area represents a solid angle of 1 steradian (sr). The
sphere’s surface has a total solid angle of 4 sr. The solid angle can be used to describe
the propagation of radiant energy in a given direction.

The radiant intensity Ie of a source is the radiant power per unit solid angle (W/sr) travelling
in a given direction. Another useful measurement to describe the source output is the
intensity per unit area, or radiance Le (W/m2-sr).

On a receiving surface, the radiant power per unit area is the irradiance Ee and the total
energy received per unit area is the radiant exposure He.

Although it is often assumed that the radiant energy departs from a source or arrives at a
receiver along the normal to the surface, this is not necessarily the only consideration.
Radiance, irradiance and exposure can also be determined at a direction θ from the normal
to the surface. In this case, the projected area of the surface in that direction must be used
in the calculation. The projected area is given by A cosθ, where A is the area of the surface.
This leads to the concept of cosine correction of measurements. Meters designed to
measure irradiance and exposure levels independent of the direction of propagation of the
radiant flux are described as “cosine corrected.”

Relationship Between Radiometric and Photometric Units

WORKPLACE Since photometry is related to the human visual response to light, its fundamental unit of
LIGHTING measurement, the candela, must take into account the spectral sensitivity of the eye as well
ASSESSMENT (cont.) as the spectral content of the light. There are different spectral sensitivity functions for
photopic and scotopic vision defined for the CIE standard observer, which are designated as
V (λ) and V’ (λ) respectively.

The candela (cd) is defined as the luminous intensity, in a given direction, of a source that
emits monochromatic radiation of frequency 540 x 1012 Hz and that has a radiant intensity in
that direction of 1/683 watt per steradian. This is the only SI unit of measurement that is
linked to human physiology.

The luminous flux φv is defined as:  v  K m    V( )d

Where φλ is the spectral radiant flux and Km is the constant 683 lm/W. Its unit is the lumen
or cd-sr. The function V(λ) is the spectral sensitivity function of the eye, and may be either
the photopic or scotopic function, as is appropriate for the circumstances. Tabulated values
of V(λ) are usually at 2, 5 or 10 nm intervals; the interval width is substituted for dλ in the
equation.

It is then possible to describe the luminance of a source and illuminance and luminous
exposure at a receiving surface in ways similar to source radiance and irradiance and
radiant exposure at a receiving surface. The SI unit for illuminance is the lux or lm/m2.
Since photometric quantities are related to the visual perception of light, it should be noted
that they only include optical radiation between 380 and 760 nm. While radiant energy in
the UV and IR may be present, these wavebands do not contribute to the photometric
properties.

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THE WORKPLACE SURVEY (cont.)

Radiometers and Photometers

There are a wide variety of instruments to measure light. They have in common
components to collect light and convert the radiant energy into an electronic signal, an
electronic circuit that converts the electronic signal into a measurement, and a way to
display the result.

Those instruments that directly measure the amount of radiant energy present are referred
to as radiometers. If the instrument is capable of measuring the spectral distribution of
radiant energy across the spectrum, it is called a spectroradiometer. Most radiometers
measure either irradiance or total radiant energy. Irradiance measurements are more
appropriate for continuous sources, while energy meters are more suitable for measuring
pulsed sources. The spectral bandwidth, wavelength resolution, sensitivity and responsivity
of an instrument are important performance characteristics that must be matched to the
properties of the light source being measured.

An instrument that is calibrated to produce a reading of luminous intensity or illuminance,

i.e. how the light appears to the human eye, is a photometer. Operating characteristics
similar to those of radiometers can be specified.
Workplace
Spectroradiometric data can be used to calculate photometric properties of a light source.
Lighting
Instruments equipped with imbedded microprocessors or computer control interfaces can
Assessment provide both radiometric and photometric data. However, it is not possible to fully
(cont.) characterise the radiometric characteristics of a light source by the reverse calculation
based on photometric measurements, since these are limited to the visual spectrum.

Lighting Assessment Procedure

A basic lighting assessment will include an inventory of the type, dimensions and distribution
of the luminaires in the room or space being examined. This will include light fixtures for
general, task and supplementary lighting. A floor plan with this information should be
prepared. The type of lamp or light source in each of the luminaires is recorded. Irradiance
and illuminance measurements are made at all important work surfaces with customary
illumination. Notes should be taken of any comments about the effect of the lighting on the
ability to perform the work conducted at each work surface.

At each work surface, the position and intensity of potential or actual sources of disability
and/or discomfort glare should be noted. These data can be compared with the overall
illumination of the work surface as well as the recommended illuminance levels for the visual
tasks being performed.

Lighting assessment protocols are set out in the IES Lighting Handbook for many
environments, both interior and exterior.

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MATCHING THE WORKER TO THE TASK

The level of visual performance for each job area and activity should be that needed to work
safely and efficiently. A visual task analysis should be conducted to determine the visual
demands of the work activity. For example, the size of the smallest visual details that must
be seen to perform the task, and the working distance between the object of regard and the
worker’s eyes can be measured. Is the work done at one viewing distance, or is the worker
expected to change fixation to different positions and distances in front of the eyes? Is
depth perception or stereo vision needed to perform the task? Does the work require colour
identification and discrimination? Would abnormal colour vision adversely affect the ability
of the worker to perform the task? What is the typical illumination level, and is there
disability or discomfort glare as a result? Accordingly, one can specify the minimum
acceptable level of visual acuity, binocular function, colour vision and stereopsis. If there
are possible adverse effects due to occupational exposure to chemicals, radiant energy or
VISUAL STANDARDS other physical hazards, minimum criteria for ocular health status may also be needed. A
programme of periodic ocular health assessments may be appropriate.

With the exception of workers in the transportation industry and military and police
personnel, whose visual performance may be set by regulations or government policy, there
are usually no documented occupational visual standards. The critical issue must be safety
of the worker and other employees as well as the public. It is therefore important that visual
standards not be set arbitrarily, but rather on the basis of the workplace survey, with due
regard to the visual task analysis.

Many jurisdictions have regulations setting out visual requirements for drivers. These
include monocular visual acuity at distance, distance phoria and stereopsis, colour vision,
and visual fields, all of which can be tested by a layperson using a vision screening tester.

It is rare that an occupational oculo-visual assessment will be as comprehensive or

intensive a procedure as a general oculo-visual assessment. Tests are selected on the
basis of the established visual standards for the job and the adverse effects of any known
hazards associated with it.

Vision screening instruments may be employed to obtain basic information on a worker’s

vision. These instruments can be operated by a lay person and offer a selection of tests
which measure distance and near visual acuities, colour vision, depth perception and
horizontal and vertical phorias. Some models may include other tests of binocular vision
and glare recovery. There is no ocular health assessment.
THE
The Modified Clinical Technique (MCT) is sometimes used as an occupational vision
OCCUPATIONAL
screening procedure. The battery of tests includes a case history (with emphasis on past
OCULO-VISUAL
exposure to the workplace hazards of the job in question, ocular and general health history,
ASSESSMENT
and history of vision care and previous injuries, if any), habitual visual acuity at distance and
near, objective binocular function assessment, stereopsis, amplitude of accommodation,
colour vision, retinoscopy, external health and pupil assessment, and direct
ophthalmoscopy. When a worker does not meet the visual standards for the job, a referral
for a full oculo-visual assessment is made.

The occupational vision assessment may be performed as a pre-employment procedure to

determine the suitability of the worker to perform a specific task. Failure to meet the criteria
would result in assignment to a different task if the deficiency cannot be corrected. As a
pre-employment assessment, the purpose is to screen out workers whose vision would
make their job performance hazardous to both themselves and fellow workers.

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MATCHING THE WORKER TO THE TASK (cont.)

Workers may be subject to periodic re-assessment. This is a monitoring programme

intended to identify workers who are developing early signs or symptoms of occupational
eye disease or dysfunction. A worker who is identified by this assessment would be
referred for rehabilitation or transferred to another job function until the signs and symptoms
disappear.

The nature of the occupational hazards of the workplace may make it prudent for workers to
undergo a post-employment assessment. This is intended to reduce an employer's liability
for occupationally induced oculo-visual disease or dysfunction by showing that upon leaving
THE
employment the worker was free of signs and symptoms. The worker may also be assured
OCCUPATIONAL
that on leaving employment there is no detectable change in ocular health status. It should
OCULO-VISUAL
be realised by both the employee and employer that exposure to some occupational
ASSESSMENT (cont.)
hazards may not have short-term adverse effects; serious deleterious effects may appear
long after the employee has left service.

Regardless of how the occupational oculo-visual assessment is to be carried out, the

optometrist must take care that the patient-practitioner confidentiality of information is
protected as much as possible when reporting to the employer and/or government agencies
on adverse changes in the oculo-visual status of the worker. The interests of both the
worker (good health and job security) and the employer (a workplace free of accident or
injury) must be satisfied.

There are three general approaches to occupational protection: avoidance, shielding, and
minimal exposure.

Avoidance
In principle, this is the ideal approach to occupational protection. Physical barriers isolate
the hazardous situation from the worker. A good example of this type of approach is the
remote manipulation of radioactive materials in the nuclear industry.

Shielding
If the hazard cannot be completely isolated, a worker may be provided with personal
protective equipment that physically shields him or her from the hazard. Protective clothing
and eye protective devices fall into this category.

Minimal exposure
PERSONAL
Some workers cannot be isolated or adequately shielded from physical hazards. Although
PROTECTIVE
these workers should be provided with personal protective equipment, an additional safety
STRATEGIES
measure is implemented. This is to place a limit on the worker's exposure to the hazard
which is well below the TLV. The exposure limit is the Maximum Permissible Exposure
(MPE). This minimises the worker's contact with the hazard and is expressed as a
maximum permitted dose rate or total dose. This approach is often taken with regard to
exposure to chemicals or ionising radiation.

Personal Protective Equipment

Selection of personal protective equipment such as eye and face protectors must balance
effective worker protection and cost. The workplace hazard analysis and consultation with
workplace safety personnel will enable the optometrist to specify which type of eye and face
protection is appropriate, and whether workers who use spectacles or contact lenses need a
different or modified protector design. Note however, that the workplace safety officer has
the responsibility of approving the selection of safety eyewear, and should be consulted in
this matter.

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MATCHING THE WORKER TO THE TASK (cont.)

Personal Protective Equipment (cont.)

Since industrial eye and face protectors are rated by the manufacturers according to the
hazard classifications of the various protective standards (e.g. EN, ISO, British CSA and
ANSI standards), the optometrist should be able to make appropriate selections based upon
the workplace hazard analysis.

Safety spectacles are probably the most widely used occupational eye protectors.
Designed to protect the contents of the orbit from the front and side, these appliances
usually feature full eyewires, side shields and polycarbonate lenses with a minimum
thickness of 2 mm (3 mm when there is high risk of high energy impact hazards). Goggles
may be used with or without safety spectacles for enhanced protection from a wide variety
of hazards. Face shields and various welding helmets should be worn in combination with
safety spectacles. Where appropriate, filter lenses that protect against the optical radiation
hazards of welding operations should be used.

The cost of occupational corrective lenses and eye protectors can be significant in certain
PERSONAL instances, e.g. VDT lenses. While large employers may be required by regulation to supply
PROTECTIVE occupational lenses and protectors without cost to their employees, this may not be the
STRATEGIES (cont.) case with smaller businesses and self-employed individuals. In such cases, the optometrist
must carefully balance the costs against the benefits of the protective appliance being
chosen.

One aspect of occupational vision plans that is sometimes ignored is the need to educate
the workers on the need to use eye protection at all times while on the job. The workers
must be discouraged from adopting the "Other Guy" or "Not Me" attitude that eye protection
is for everyone else. The use of eye protectors should be mandatory for all employees
entering certain areas of the workplace, and must be strictly enforced.

Compliance with a safety eyewear policy can be encouraged by ensuring that wherever
possible, the eyewear is cosmetically appealing, comfortable to wear and provides good
vision. Appliances that can be readily adjusted to fit (and do not lose adjustment) should be
chosen. When prescription lenses are fitted to the appliance, the optometrist should ensure
that lens and frame parameters are verified prior to dispensing to the worker. Proper lens
cleaning facilities should be set up throughout the workplace to encourage workers to
maintain their eyewear and inspect it regularly for defects.

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PITFALLS OF INDUSTRIAL CONSULTING

KISS = "Keep it simple, stupid!"

The optometrist who engages in industrial vision consulting must work with employees,
supervisors, management and safety personnel. Communications must be kept free of
technical jargon. Policies and procedures should be set out in as simple language as
possible to avoid misunderstandings over the purpose and processes involved in the
THE KISS PRINCIPLE
industrial vision programme.

The practitioner must also know his or her limitations in providing the diagnostic, dispensing
and consulting services. Set realistic goals and timelines. An overambitious programme
that cannot be delivered as promised damages the practitioner's credibility with all parties
involved.

An industrial vision programme is a contract negotiated with the employer for diagnostic,
dispensing and consulting services. It is important to realise that the balance of costs and
benefits will dictate whether the terms are acceptable to the employer who must pay for
FEES - CHASING
them. The employer must be convinced that the proposed programme is beneficial and cost
THE CLIENT AWAY
effective. While the optometrist must never undervalue his or her professional time and
expertise, setting a high fee may discourage the employer from following through with the
programme.

Because the optometrist is usually brought into the workplace by the employer or
management to deliver an occupational vision programme, employees may consider the
optometrist to be an agent of management. To be effective, the practitioner must ensure
that the employees understand that the programme is being set up in their best interest and
co-operate. Thus, employee representatives should be involved in the process of
establishing the programme and any reporting protocol arising from it.

It should be made clear to both employees and management that the information obtained
from the occupational oculo-visual assessment is only intended to ensure that the worker's
oculo-visual status meets the standards established for a particular task. There should also
be a clear statement of what happens if a worker does not meet the oculo-visual criteria.
WORKER VS
Information on an employee who has failed the criteria must be passed to the workplace
EMPLOYER
safety officer so that an appropriate referral can be made. The information will not be used
CONFLICTS
for any other purpose. The contract for the occupational vision plan should include
safeguards for confidentiality of information gathered by the optometrist. In some
jurisdictions, privacy legislation that protects the confidentiality of the worker’s health
information may take precedence over such contract clauses.

Confidentiality of worker information is a highly sensitive issue, but it is not the only potential
source of ethical conflicts. There is a potential conflict of interest in that the practitioner who
monitors the oculo-visual status of the workforce is also responsible under the occupational
vision plan for prescribing and/or supplying appropriate safety eyewear. The contract
should clearly state the process for approval of purchases, a schedule of fees and the terms
of payment.

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VISUAL HEALTH IN SELECTED INDUSTRIES

The following points of consideration are not meant to be exhaustive or comprehensive. They are provided for
guidance and as a starting point for discussion.

Ocular Hazard
 Systemic / ocular chronic exposure to chemicals
 Chemical splash
 Impact
 Optical radiation
CHEMICAL
Specialised Visual Tasks
INDUSTRY
 Reading colour-coded labels
 Detection and identification of colour indicators

Eye Protection
 Safety spectacles
 Goggles - protection against splash, dust, gases, optical radiation, impact
Ocular Hazard
 Solar UV exposure
 Impact
 Chemical exposure

Specialised Visual Tasks

OUTDOOR WORKER
 Reading coloured signs, signals

Eye Protection
 UV blocking lenses
 Safety spectacles
 Goggles and face shields as appropriate for task
Ocular Hazard
 Optical radiation – UV, visible, IR
 Impact
 Dust, gases

Specialised Visual Tasks

 Lighting welding flame / arc
WELDERS
 Locating site of weld

Eye Protection
 Safety spectacles
 Welding goggles / helmets
 Welding filters (may be mounted in helmet as window or as lenses in spectacles /
goggles, depending on type of welding)
Ocular Hazard
 Optical radiation
 Non-linear radiation effects (fast pulse lasers)
 Gases and fumes
 Fire
LASER WORKER  Impact

Specialised Visual Tasks

 Varies with job

Eye Protection
 Goggles with protective filter matched to laser line – frontal and side protection

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VISUAL HEALTH IN SELECTED INDUSTRIES (cont.)

Ocular Hazard
 Solar UV radiation
 Optical radiation from lamps
 Impact
 Chemical?

Specialised Visual Tasks

TRANSPORTATION
 Coloured signal detection and identification
INDUSTRY
 Peripheral motion detection
 Vision under low illumination and/or low contrast conditions

Eye Protection
 Tinted lenses for optical radiation protection
 Safety spectacles as appropriate

Ocular Hazard
 Impact
 Splash
 Chemical (drugs, disinfection and cleaning materials)
 Optical radiation (medical lamps / lasers)
 Xrays
HEALTH CARE
Specialised Visual Tasks
WORKER
 Reading coloured labels, indicator strips
 Identification of coloured signal lights

Eye Protection
 Safety spectacles
 Goggles (splash, optical radiation)

Table 2: Commonly Prescribed Photosensitising Drugs

Class of Drug Category Generic Name Effect with UVR
Sulfacetamide Phototoxic
Sulfonamides
Sulfanilamide Photoallergic
Antibiotics Cholotetracycline
Phototoxic
Tetracyclines Oxytetracycline
Cataracts
Doxytetracycline
Chloropropamide
Hyperglycemics Sulfonylureas Phototoxic
Tolbutamide
Benzothiadiazide
Diuretics Chlorothiazides Quinethazone Phototoxic
Trichloromethazide
Chlorpromazine
Phototoxic
Antipsychotics Phenothiazides Promethazine
Photoallergic
Mepazine
Librium
Antianxiety Chlordiazepoxides Phototoxic
Valium
8-Methoxypsoralen
Photochemotherapy Furocoumarins Phototoxic
Trimethylpsoralen
Estrogen
Hormones Oral contraceptives Phototoxic
Progesterone
Adapted from: Pitts DG and Kleinstein RN. Environmental Vision: Interactions of the Eye, Vision and the
Environment. London: Butterworth Heinemann, 1993.

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REFERENCES AND STANDARDS

 Benjamin WJ. Borish’s Clinical Refraction, 2nd Ed. Boston: Elsevier Butterworth-
Heinemann, 2006.
 Carson G, Doshi S, Harvey W. Eye Essentials: Environmental & Occupational
Optometry. Boston: Butterworth-Heinemann, 2008.
 Gupta A, Koshel RJ. Lighting and Applications. In Bass M (Ed.) Handbook of Optics,
3rd Ed. New York: McGraw Hill, 2010; Vol 2, Ch 40.
 Illumination Engineering Society. Lighting Handbook, 10th Ed. New York: IES, 2011.
REFERENCES
 Jalie M. Ophthalmic Lenses and Dispensing, 3rd Ed. Boston: Elsevier Butterworth-
Heinemann, 2008.
 North RV. Work and the Eye. Oxford: Oxford University Press, 1993.
 Pitts DG, Kleinstein RN. Environmental Vision: Interactions of the Eye, Vision and the
Environment. Boston: Butterworth-Heinemann, 1993.
 Sheedy JE, Shaw-McMinn PG. Diagnosing and Treating Computer-Related Vision
Problems. Boston: Butterworth-Heinemann, 2003.

 American National Standards Institute. ANSI Z80.3-2010 Ophthalmics –

Non-prescription Sunglass and Fashion Eyewear Requirements. New York: ANSI,
2010.
 American National Standards institute. ANSI/ISEA Z87.1-2010 American National
Standard for Occupational and Educational Personal Eye and Face Protection Devices.
New York: ANSI, 2010.
STANDARDS
 Canadian Standards Association. CAN/CSA Z94.3-07 Eye and Face Protectors.
Toronto: CSA, 2007.
 European Committee for Standardization. EN166:2002 Personal eye protection.
Specifications. Brussels: CEN, 2002.
 Standards Australia. AS/NZS 1336:1997 Recommended Practices for Occupational
Eye Protection. Sydney: Standards Australia, 1997.

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