Vision Problems for Shift Workers
The generational issues that are beginning to affect the whole country as Baby Boomers age are reaching into the shift work population as well. Managers and co-workers will have to understand specific needs of an aging workforce, especially issues with sight and vision. As the population of shiftworkers age, vision issues will continue to further plague the shiftwork population and their employers. Shiftworkers may complain of blurred or distorted vision. Workers should be educated about the risk factors and prevention of vision disorders, how to identify the major disorders, and what the treatment options are.
AARP and others report that 79% of baby boomers say they don’t plan to stop working at age 65. By the year 2030 approximately 70 million Americans will be over 65. The U.S. Census Bureau has reported that:
- By 2020, people age 55 and over are expected to make up 20.3 percent of the labor force, up from 15.1 percent in 2003.
- As employed men and women get older, their likelihood of working part time increases. In 2003, about half of employed men age 70 and over and almost two-thirds of employed women aged 70 and over worked part time.
Approximately one out of three seniors experience vision problems. Visually impaired persons often have a decreased ability to perform regular daily tasks and often suffer from depression. There are many common causes of vision loss. There are four broad categories of vision loss that might be present in the middle – to – senior age shiftwork population:
- Age-related macular degeneration
- Glaucoma, which can occur at any age
- Cataracts
- Diabetic retinopathy
Age-related macular degeneration (AMD)
AMG is the leading cause of loss of vision in people over 65 years of age. The primary risk factors for AMD include advancing age, family history of AMD and cardiovascular risk factors such as hypertension and cigarette smoking. Circadian Technologies’ Health study reported that there is a relationship between the number of years that workers in extended hours operations have smoked and an increased prevalence of hypertension.
People with AMD complain about having difficulty reading or driving and report increased reliance on brighter light or magnifying lenses to perform tasks requiring fine visual acuity. Cigarette smoking should be strongly discouraged. A higher dietary intake of foods rich in certain carotenoids may lower the risk of developing advanced AMD (such as egg yolk, kiwi, squash and yellow squash, spinach, peas, honeydew melon, brussels sprouts, green beans, apples, corn, grapes, pumpkin, peppers, cucumber, orange juice, celery, scallions, broccoli and mango).
On June 30, 2006, the FDA approved Lucentis, manufactured by Genentech, to treat wet-age related macular degeneration. Lucentis inhibits the formation and leakage of new blood vessels in the back of the eye, which is the cause of central vision loss from this disease. For a full text of the Genentech press release announcing the FDA approval, please log onto http://www.gene.com/gene/news/press-releases/display.do?method=detail&id=9787.
Although vision may become severely impaired, patients with loss of vision related to AMD should be reassured that complete blindness is not associated with this condition.
While everyone is at risk for glaucoma, older people are at a higher risk. It is estimated that over 3 million Americans have glaucoma but only half of those know they have it. Estimates put the total number of suspected cases of glaucoma at around 65 million worldwide. Babies can be born with glaucoma (approximately 1 out of every 10,000 babies born in the United States). Young adults can get glaucoma, too. African-Americans in particular are susceptible at a younger age.
Glaucoma related vision loss is caused by damage to the optic nerve. This nerve acts like an electric cable with over a million wires carrying images from the eye to the brain. It was once thought that high pressure within the eye was the main cause of this optic nerve damage. Although pressure is clearly a risk factor, people with “normal” levels of pressure can experience vision loss from glaucoma. Glaucoma can occur as the result of an eye injury, inflammation, a tumor or in advanced cases of cataract or diabetes. It can also be caused by certain drugs such as steroids.
Vision loss begins with peripheral or side vision. Usually the impacted person compensates for this by unconsciously by turning their head to the side. They may not notice anything until significant vision is lost. The key to glaucoma prevention is to get tested annually.
Depending upon the type of glaucoma, treatment may include medication, usually prescription eye drops, or surgery to lower the pressure in the eye and prevent further damage to the optic nerve.
Cataract
A cataract is a clouding of the eye’s natural lens. The eye’s natural lens works much like a camera lens, focusing light onto the retina at the back of the eye. The lens also adjusts the eye’s focus, allowing us to see things clearly both up close and far away.
The lens is mostly made of water and protein. The protein is arranged in a precise way, keeping the lens clear, so light can pass through. As we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see.
Cataracts are classified as one of three types:
- A nuclear cataract forms in the nucleus, the center of the lens, and is due to natural aging changes. This is the most common type of cataract.
- A cortical cataract, forms in the lens cortex and, over time extends its spokes from the outside of the lens to the center. Many diabetics develop cortical cataracts.
- A subcapsular cataract begins at the back of the lens. People with diabetes, high farsightedness, retinitis pigmentosa or those taking high doses of steroids may develop this type of cataract.
Many studies suggest that exposure to ultraviolet light is associated with cataract development, so eye practitioners recommend wearing sunglasses and a wide-brimmed hat to reduce exposure. Other types of radiation may also be causes. Studies suggest people with diabetes are at risk for developing cataracts. The same goes for users of steroids, diuretics and major tranquilizers.
Other risk factors include exposure to cigarette smoke and air pollution and heavy alcohol consumption. Some eye practitioners believe that a diet high in antioxidants, such as beta carotene (vitamin A), selenium and vitamins C and E, may forestall cataract development. But, eating a lot of salt may increase the risk of developing cataracts.
When symptoms first appear, vision may be able to be improved for a while using new glasses, strong bifocals, magnification, appropriate lighting or other visual aids. When cataracts have progressed enough to seriously impair vision and affect daily life surgery is recommended. Cataract surgery is the most frequently performed surgery in the United States; there are over 1.5 million cataract surgeries done each year. And, nine out of 10 people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40.
Diabetic Retinopathy
Diabetic retinopathy is a complication of diabetes. It is a leading cause of blindness. It occurs when diabetes damages blood vessels inside the retina, the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision. At first, a person with diabetic retinopathy may not notice changes to their vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.
Floaters can be a sign of diabetic retinopathy. Sometimes difficulty reading or doing close work can indicate that fluid is collecting in the most light-sensitive area of the retina. This fluid buildup is called macular edema. Another sign is double vision, which occurs when the nerves controlling the eye muscles are affected.
Fortunately, using common sense can significantly reduce the risk of developing diabetic retinopathy:
• Monitor your blood pressure and keep it under good control, or seek appropriate care.
• Maintain a healthy diet.
• Exercise regularly
According to the American Academy of Ophthalmology, 95% of those with significant diabetic retinopathy can avoid substantial vision loss if they are treated in time. Diabetic retinopathy can be treated with laser photocoagulation to seal off leaking blood vessels and destroy new growth. In this procedure, a surgeon uses a laser to coagulate tissue, usually to seal leaking blood vessels and destroy new ones.
Recommendations for Shiftworkers
1. Maintain a healthy diet
2. Exercise regularly
3. Reduce alcohol consumption
4. Stop smoking
5. Be screened by an eye specialist annually
6. Reduce exposure to ultraviolet light; wear sunglasses with UV protection and a sun visor.
7. Adjust workplace lighting levels to the worker population as much as possible (older workers usually require more light, although those with cataracts may require less light).
8. Diabetics should monitor their blood sugar and keep it under control
Shmuely-Dulitzki Y, Rovner BW. Screening for depression in older persons with low vision. Somatic eye symptoms and the Geriatric Depression Scale. Am J Geriatr Psychiatry 1997;5:216-20
2 Prevent Blindness America
3 Quigley, “Number of people with glaucoma worldwide,” 1996
4 http://www.allaboutvision.com/conditions/cataracts.htm
5 http://www.allaboutvision.com/conditions/diabetic.htm
©2006workingnights
This material is provided for personal, non-commercial, educational and informational purposes only and does not constitute a recommendation or endorsement
Tags: chronic problems, smoking, vision
