Glaucoma and the Workplace
Chat Highlights
June 5, 2002

Norma Devine, Editor

On Wednesday, June 5, 2002, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Glaucoma and the Workplace."

Moderator:  Good evening, Dr. Wilson.  Our topic tonight is "Glaucoma and the Workplace." 

Dr. Rick Wilson:  Good evening.  I'm ready when you are.  

P:  Are there any jobs that might make glaucoma, especially narrow-angle glaucoma, worse? 

Dr. Rick Wilson:  Dangerous jobs in dark locations would be the worst for narrow and occludable angles.  Frightening movies are just as bad.  The adrenalin makes the pupils, which are already large in the dark, even larger, pushing the iris into the angle.

P:  Are jobs that require heavy lifting harmful for glaucoma patients?  

Dr. Rick Wilson:  Hard work and exercise, especially aerobic exercise, should be good for the glaucoma patient.  Heavy straining, when the straining might last for several minutes -- such as furniture movers carrying a piano up four flights of stairs -- would probably raise the eye pressure for that amount of time.  No one knows whether that amount of fluctuation is harmful or not.

P:  In my work, I look at a computer screen most of the day.  Would that have any effect on my glaucoma?

Dr. Rick Wilson:  The American Academy of Ophthalmology has studied that effect and concluded that there may be occasional eye strain, but no harmful long-term effects.  Actually, looking at something close-up, or reading, gives a mild effect like pilocarpine.  The muscle that focuses the eye also pulls on the trabecular meshwork, opening it up mechanically and lowering IOP (intraocular pressure). 

P:  Do you think glaucoma patients tell their employers about their glaucoma or try to keep it from them because of fear of losing their jobs?  

Dr. Rick Wilson:  I would guess that most patients keep it to themselves, unless taking eye drops during the workday or doing eye compression after surgery pushes them to explain.

P:  How do you think most employers feel about employees who have glaucoma?  

Dr. Rick Wilson:  I think there is a wide range in how much support and understanding employers offer their glaucoma-afflicted employees.

P:  When I returned to work, I had to prove to the nurse that I could read a line or two from the employee handbook.  

P:  Are jobs outdoors in the wind worse for eyes already irritated by eye drops?  

Dr. Rick Wilson:  The wind will dry out an eye that is already irritated,  and will cause more irritation.  

P:  I use a lot more light at my desk than I need in the hope that constricting the pupil might increase the outflow of fluid and thus lower the IOP.  Is that logical?

Dr. Rick Wilson:  There is logic, but the sphincter muscle of the iris is not the one that pulls on the trabecular meshwork.  It is the focusing muscle that will lower IOP, and reading will do that.

P:  So would reading a lot be good for hypotony?  

Dr. Rick Wilson:  If the hypotonous eye remains reasonably comfortable when reading, I think that it would be fine to continue reading,

P:  Is doing close-up work, such as sewing, good for our eyes?  

Dr. Rick Wilson:  Yes, though you should look out into the distance every 5 or 10 minutes for a few seconds to rest the muscles in the eye.

P:  I've had co-workers ask me why my eyelid was drooping.  So the cat was out of the bag. 

Dr. Rick Wilson:  Have you had surgery?  If so, the cat was out of the bag.  I think that most of the time, honesty is the best policy.  Also, each of you can act as an educator, alerting others to the subtle nature of glaucoma and the need to be checked by an eye doctor, especially if there is any history of glaucoma in the family.  Most people misunderstand glaucoma and, as a rule, the more you teach others, the more supporting they will become. 

P:  I've been asked about my red eyes.   I suspect people think they are caused by drinking alcohol.

Dr. Rick Wilson:  Alphagan and the prostaglandins like Lumigan or Travatan are frequent causes of the post-binge look. 

P:  If, because of glaucoma, we can no longer do the jobs we are trained for and have done for many years, are we eligible for disability compensation? 

Dr. Rick Wilson:  Most people, even with advanced glaucoma, can continue with desk jobs or sedentary occupations.  That is because the central vision is lost last in glaucoma.  Occupations that require good peripheral vision, like drivers or machine operators on an assembly line, will have trouble.

P:  My fellow employees thought anyone who has glaucoma will become blind.  

Dr. Rick Wilson:  Before pilocarpine and surgery, that was the case.  We've come a long way since then.  Most glaucoma damage in the U. S. occurs before the patient sees a doctor and the glaucoma is discovered.

P:  Does "disability" mean you can't do your particular job, or any job at all?  Is there a definition that doctors apply for recommendation of disability benefits?

Dr. Rick Wilson:  You are correct in that there are many definitions of disability.  The forms I fill out have a space for disability for the job activities of the present job, and for any job, and whether additional training would help to keep the patient working.  

P:  Do you know any adults who have had glaucoma from infancy?  If so, what types of work do they do now?  

Dr. Rick Wilson:  They hold many kinds of  jobs -- everything from professional singer to engineer.

P:  Are there any guidelines for when to give up driving?  

Dr. Rick Wilson:  In Pennsylvania, a driver needs 120 degrees of visual field with both eyes open, and 20/50 or better vision in at least one eye.  Clearly, decreased depth perception should limit or prohibit driving.  Poor vision at times of reduced contrast -- such as at twilight or at night -- may make driving inappropriate at those times when driving during daylight would be okay.  

P:  How is that 120 degrees of visual field measured? 

Dr. Rick Wilson:  The Esterman test on the Humphrey will test that.  Confrontation visual fields can estimate that, too.  

P:  Can the ophthalmologist be held liable if  limited vision is not reported?

Dr. Rick Wilson:  In Pennsylvania, that is true.   So if one of my patients with limited vision has an accident, I can be sued.  The award to the plaintiff is not covered by my malpractice insurance, but by my house and son's education funds.

End of highlights for June 5, 2002.

On June 12, Dr. Werner discussed "Trabeculectomy" in the Chat room. Click here for highlights of that meeting.

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