Working with Glaucoma
Chat Highlights
October 15, 2003

Norma Devine, Editor

On Wednesday, October 15, 2003, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Working with Glaucoma."

Moderator:  Tonight, we would like to discuss glaucoma and jobs.  Do any of your patients mention problems that glaucoma causes them in getting or keeping jobs?  

Dr. Rick Wilson:  Clearly, many of my patients have limited vision.  Since this often happens slowly, most people can make adjustments to their work.  However, if their vision is too poor, they may have to stop or limit their work.

P:  What kind of accommodations might be required?    

Dr. Rick Wilson:  Since many people these days use computers at work, employers often have to provide software that magnifies the print on the screen.  Some glaucoma patients may need more time to do their work, and some may need to find work that doesn't require excellent vision.

P:  I had trouble seeing the aisle markers in the store where I worked.  Luckily, I knew where everything was.

Dr. Rick Wilson:  Was your employer sympathetic?

P:  Yes, to some extent.  

P:  My husband is a graphic artist and is now trying to change professions because he has lost too much vision.  Could all of the computer work have contributed to his vision loss?

Dr. Rick Wilson:  I don't think so.

P:  After my trabeculectomy, my doctor kept me home from work for 11 weeks, because I had hypotony.  That's difficult to explain to an employer when you don't look or act ill.

Dr. Rick Wilson:  That is true.  I assume your vision was poor because of the hypotony.

P:  Yes, my vision was distorted.

P:  Are there any programs to retrain people who might need to find a different kind of work?

Dr. Rick Wilson:  Yes, one of the local county associations for the partially sighted has training programs for patients with limited vision.  I think Delaware County has such a program.

P:  I had to tell everybody at work to stop turning out the lights they didn't need, because I needed the lights on.

Dr. Rick Wilson:  That is true.  Light always makes vision clearer.  People with small pupils, brown cataracts, glaucoma, and retinal disease always like to increase the wattage in their light bulbs.

P:  At work in a clinic, I have view boxes turned off if they are not being used.  Everyone is okay with that and understands the reason.  

P:  Should people tell their employers if they have glaucoma or try to hide it?

Dr. Rick Wilson:  Clearly, no one wants to put himself or herself in a position where a mistake caused by poor vision could cause serious consequences.  

P:  Quite frankly, I'm reluctant to even tell people that I have glaucoma.  I'm a graphic artist, and I suspect the conclusion might be that I can no longer do my work (which isn't so, in my case).  I'm not so sure glaucoma patients need to say anything -- even outside the workplace -- unless and until vision actually limits performance.

P:  Many glaucoma patients have expressed concern here about heavy computer use adversely affecting their vision.  In an earlier chat (June 5, 2002), you said that looking at something close-up gives a mild effect like pilocarpine.  You said, "the muscle that focuses the eye also pulls on the trabecular meshwork, opening it up mechanically and lowering IOP (intraocular pressure)."  Shouldn't that relieve the minds of glaucoma patients whose work requires  using computers for many hours?

Dr. Rick Wilson:  Yes, it may relieve most people's minds concerning an adverse effect on glaucoma.  More important, several studies have shown that CRT (cathode ray tube) use causes no harm to the eyes, outside of a little eyestrain now and then.

P:  I asked for a counselor to help me at work in a clinic.  I was finding it difficult to be on call at all hours and having to drive at night.  After a long battle, my on-call time was reduced.  Eventually, I resigned from the part-time job with benefits so I wouldn't have to be on call. 

P:  I'm not looking forward to the early darkness this fall.  Although I take a bus to and from work, the glare from the car headlights is scary when I cross streets.

Dr. Rick Wilson:  Do you have cataracts, or are your symptoms due to glaucoma?

P:  I have ICE (iridio-corneal) syndrome, with halos.

Dr. Rick Wilson:  So your symptoms come from your cornea. 

P:  It would be interesting to know how many of us have had to stop driving.

P:  I don't drive at night any more.  

P:  Since deteriorating vision can affect driving privileges, it's good to know researchers have found that rehabilitation techniques, training and visual aids can help those with impaired vision. (Studies presented at The Eye and the Auto International Forum in Dearborn, Michigan in June.  Review of Ophthalmology, Vol No. 10:08, 08/15/03.)

P:  Where can someone with impaired vision get the auto-training assistance?

Dr. Rick Wilson:  I would check with your local society for the blind and partially sighted.  They can usually advise on low-vision services and training.

P:  It would be interesting to know how many patients here tonight have had to change jobs because of glaucoma-related problems.  

Dr. Rick Wilson:  That is a good question.  How many patients have had to change jobs because of their vision?  

P:  I had to stop working full time as an off-shore fisherman.  

P:  I changed jobs, even though my new job is more physical than mental.   

P:  I had to change jobs to accommodate frequent doctor appointments and the maintenance routine.  I'm now self-employed, which still may be a problem if I have eye-related problems for an extended time.  It's scary.  

P:  Generally speaking, how often do you find that glaucoma does interfere with the work people do?  

Dr. Rick Wilson:  Because glaucoma spares the central vision until late in the disease, most people are able to function quite well, even with advanced glaucoma.

Moderator:  Does anyone have any office tips to share with the group?  For instance, I keep my desk facing away from the windows and use Sharpies to write notes on big pads of paper.  

P:  Don't strain reading fine print.  Magnify.  Blink a lot.  Take frequent breaks.  Use moisturizing eye drops if needed while working on a computer.    

P:  I use a glare-reduction screen on my computer.

P:  I work in retail lighting.   To customers, I usually stress the balance of light, instead of just one big light source.  

P:  Dr. Wilson, are there any particular types of lighting products that you suggest to help people with limited vision?

Dr. Rick Wilson:  Yes, the light that is usually recommended for reading is a pharmacy light aimed over the shoulder of the non-dominant hand to avoid glare.

P:  What is a pharmacy light?

Dr. Rick Wilson:  A pharmacy light is a gooseneck light with a round reflector that shines the light in one direction.

Moderator:  Under what circumstances is a pharmacy light used? 

Dr. Rick Wilson:  Usually for reading and working at a desk.  Clearly, you would not want too much light shining on a computer screen as the glare would be detrimental.

P:  I have glaucoma, my best corrected vision in one eye is 20/80, and I am half way through my residency in pediatrics.   Being a doctor with low vision is not easy.  There are very few of us with handicaps, and it is really hard sometimes to communicate my specific, special needs as far as what I can and can't do (physical examination skills, reading radiographs, etc.) 

P:  What changes have you been able to make? 

P:  I have worked it out that I am not required to do any procedures, which makes my life much easier.  Do you have any words of wisdom about surviving the toughest critics (including myself) during my training?  Eventually, I am going to be a pediatric endocrinologist, with no procedures, lots of patient contact and general biochemistry.

Dr. Rick Wilson:  I think the best approach is to be straight-forward and honest, not overly apologetic or aggressive.  Most people should be impressed that you have reached the level you have with that poor vision.

Moderator:  Thank you again, Dr. Wilson, for your help.

Dr. Rick Wilson:  You're welcome.  I am impressed with the number of people whose vision has caused them problems at work.  Have a good week everyone.

End of highlights for October 15, 2003.

On October 22, Dr. Wilson discussed "Visual Field Testing" in the Chat room. Click here for highlights of that meeting.

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