Making Contact Lenses Work in the Workplace

A CONTACT LENS SPECTRUM STAFF REPORT
SEPT. 1997

When deciding which contact lens modality to prescribe, remember to consider your patient's occupational needs and his work environment. While most practitioners report that the number one workplace challenge related to vision is managing presbyopia, there are numerous environmental and task-related issues that the eyecare provider must consider.For many people, wearing contact lenses on the job is no different from wearing them at home or at play. But certain occupational conditions challenge comfort and good vision for contact lens wearers.

THE AGING WORKFORCE

Often, the first telltale signs of presbyopia become undeniably apparent in the workplace, so it follows that the first challenge a contact lens practitioner will have is to satisfy a presbyope's job-related needs. While multifocal contact lenses in a translating design may work well for a priest or an executive, it's likely they will not be the answer for a bookkeeper or a libarian. Anyone who needs good intermediate vision, including computer users, may do better with an aspheric, progressive multifocal. Some occupations that require unusual working distances (a jeweler for instance) will call for resourceful solutions -- contact lenses that don't dry out, monocular magnifiers or near point eyeglasses with prism.

One of the greatest fears of the elderly and patients with degenerative conditions such as keratoconus is losing their independence, including their ability to function well in their jobs. For them, contact lens wear is not an issue of vanity or comfort. Caring, regular follow-up and good communication are paramount for optimal ocular health, best vision and to prevent overwear.

Once you've addressed a patient's visual needs, including age-related factors, workplace issues most often translate to environmental issues. If your patient wields a jackhammer every day, dust, sweat and sun glare will affect his contact lens wear. RGPs are probably out. UV-absorbing soft lenses are in.

For an air traffic controller who stares at a video screen for 12 hours at time, you'll need to take steps to prevent dry eye. And for emergency services personnel who work 12-hour shifts and prefer to sleep in their lenses, extended wear may be the answer. As always, your first goal is eye health and best corrected vision.

A DAILY DOSE OF DUST AND DIRT

When you think about people who work in dusty, dirty work environments, you probably think first of auto mechanics, carpenters and loading dock workers. Others who encounter environmental hazards include:

• Beauticians -- chemical fumes and splashes, airborne lacquers.
• Firefighters -- fumes, smoke, water.
• Florists -- chemical fumes and splashes, allergens.
• Lifeguards -- sun glare, water.

People who must contend with a lot of debris in their work tend to develop a buildup of deposits on their lenses. This may influence you to prescribe disposable or planned replacement lenses. Or you may suggest that a patient switch from soft lenses to RGPs for easier cleaning. Remember to recommend that patients have spare pairs of RGP lenses.

If changing the lens material is not practical, you may want to switch the patient to a more aggressive cleaning regimen. For example, instead of a one-bottle system, you may want to recommend a hydrogen peroxide regimen for more intensive cleaning. Often, the choice of a care system has more to do with a patient's need for convenience, but patients who are exposed to contaminants that are likely to build up on their lenses might benefit from using an alcohol-based surfactant or a liquid or tablet enzyme protein remover.

DRY AIR MEANS EXTRA CARE

Accountants, editors, bookkeepers -- anyone who reads extensively, either hard copy or on a computer screen -- are at risk for dry eye. These patients tend to blink less while they're working, so their contact lenses are apt to dry out. Airline personnel have the added challenge of working in very low humidity, which often causes irritation and red eye. In addition to recommending frequent use of rewetting drops or artificial tears, some practitioners report success when they switch these patients to contact lenses manufacturered from omafilcon A material.

KNOW WHEN TO SAY NO

There are times when contact lenses are inappropriate as well as ineffective and unsafe. In the military, for example, regulations regarding the types of vision correction that are permitted prevail. Personnel who must function while wearing gas masks must remove their contact lenses. In a field setting with questionable sanitation, personnel are issued eyeglasses. Training in a hyperbaric chamber also precludes contact lens wear. Despite these restrictions, however, astronauts have reported great success with contact lenses, as have military personnel, even pilots, who served in the Gulf War.

KNOW YOUR PATIENTS

Contact lenses of whatever type can be worn under various conditions. Patient selection is important and communication is key. Practitioners must be aware of the environmental conditions in which patients work so they can say 'no, you shouldn't' or 'yes, you can' wear contact lenses on the job. [See Table 1 for a sample patient history questionnaire.]

There are many variations in vision standards for pilots, police officers, firefighters and other professions. Ask patients or their employer or potential employer to explain the standards they must meet before you counsel them on what treatment plan is best. Getting to know our patients' jobs in detail will help us gain some insight and enable us to provide better care. CLS

We thank the following for their contributions to this report: Bruce Bridgewater, O.D., Phoenix, Ariz.; Michael D. Eckstein, O.D., Boiling Spring, Pa.; Arthur Epstein, O.D., Roslyn, N.Y.; and David Geffen, O.D., San Diego.