Unleash the Power of Age

5/29/14

Employment Challenges Faced by Older Persons with Visual Impairments


Growth in Number of Older Persons with Vision Loss
May is designated as “Older Americans Month” and last year’s theme “Unleash the Power of Age” seemed an appropriate title for this article with the number of baby boomers who are coming down the pike. In fact, according to the U. S. Bureau of Labor Statistics, the annual growth rate of “boomers” (those 55 and older) is projected to be 4.1 percent, 4 times the rate of growth of the overall labor force. Indeed, the Governmental Accountability Office estimates that by 2015 (just next year!!), older workers will comprise one-fifth of the nation’s workforce.
man at computer
At the same time, the number of older persons with vision loss are growing dramatically due to age-related eye conditions such as macular degeneration . The 2011 National Health Interview Survey (NHIS) Preliminary Report indicated that an estimated 21.2 million adult Americans (or more than 10% of all adult Americans) reported they either “have trouble” seeing, even when wearing glasses or contact lenses, or that they are blind or unable to see at all. The survey also indicated that 12.2% of Americans 65 to 74 years of age and 15.2% of Americans 75 years of age report having loss of vision. These estimates only include the non-institutionalized civilian population.

Economic Burden of Vision Loss and Aging
According to Prevent Blindness, disorders of the eye and resulting vision loss result in a major economic burden to society, for all ages, but most dramatically with people 65 years of age and older: 77.27 billion of direct and indirect costs . Loss of productivity is estimated to be almost $25 billion for the 65 plus population.

Older People Want to Continue to Work
The loss of productivity costs are of particular concern given the fact that older people, including those with vision loss, want to continue to work. In fact, older persons are staying in the labor market beyond the usual retirement age. This is due to many reasons: people are living longer and often are in good health; because of the downturn in the economy, some need to work beyond the usual retirement age to meet to supplement diminished retirement funds; and some are looking for social engagement through the workplace.

Assets Versus Perceptions
Experienced workers who are older offer many assets to employers such as: an understanding of the expectations of employers; respect for co-workers and supervisors; loyalty; and skills and knowledge based on prior work experience. However, a major dichotomy is occurring in our society regarding older workers: “…companies are struggling with the large numbers of older workers who are retiring, and that the brain drain is a matter of concern to many…While the loss of experienced staff is a challenge that all companies must address, technology has improved the workplace and the work environment by enabling workers of all ages to complete work from other locations…Evidence shows that ageism, stereotypes, and misinformation about mature persons continue to be issues across all segments of society, including the workplace. … studies revealed that the positive perceptions characteristic of older workers held by managers include their experience, knowledge, work habits, attitudes, commitment to quality, loyalty, punctuality, even-temperedness, and respect for authority. These same studies also reveal some negative perceptions held by managers about the mature worker: inflexibility, unwillingness or inability to adapt to new technology, lack of aggression, resistance to change, complacency….. While the results of these findings may appear confusing or contradictory, they clearly focus on the precise and delicate balance between positive and negative perceptions that, depending on the industry or work environment, may affect a manager’s decision to hire, retain or advance an older worker.”

Kathy Martinez, Assistant Secretary of the Office of Disability Employment Policy at the Department of Labor, feels that this dichotomy, as it relates to people with disabilities, will not really change until disability becomes more of an environmental issue than a personal issue and that workplace flexibility is critical in terms of time, place, and task. (“Public Policy and Disability: A Conversation about Impact”, Disability Management Employment Coalition conference, April 1, 2014).

Challenges of Obtaining and Retaining a Job for Older Persons with Vision Loss
In addition to the negative perceptions noted above, older persons who experience vision loss, have additional challenges: learning to live with vision loss, dealing with the workplace to retain or obtain a job, working with a disability including having to learn new skills such as speech access for a computer, getting transportation to and from work (if they keep or land a job), dealing with co-workers and even managers who often don’t know what to say or do. Those persons with low vision or no vision whose medical condition is stabilized and with appropriate reasonable accommodations as assured by the Americans with Disability Act (ADA), can continue to be productive members of the workforce thereby contributing to the profitability of the business and to their quality of life.

An informal review of the latest available data submitted by public vocational rehabilitation agencies indicates the following: In 2011, there were 9609 blind and visually impaired individuals who obtained jobs through the vocational rehabilitation agencies; of these 505 (or 5%), were 65 years of age and older. We truly need to “unleash” the power of age in this country!

Resources
These resources listed can help older individuals with vision loss, employers, and professionals working with individuals with vision loss. The American Foundation for the Blind (AFB) hosts a family of web sites with information that can help older persons with adjusting to and living with vision loss, information on how to find and apply for jobs, adaptations to the work environment and assistive technology and workplace accommodations, and mentors who are blind or visually impaired and are willing to assist others with career choices. These sites can help individuals interested in working or retaining employment as well as employers seeking to know what to do. AFB has a directory of services for each state, which includes state vocational rehabilitation agencies charged with helping people with vision loss with the adjustment and career needs.

AFB Links
Information related to living with vision loss:
Visionaware.org/gettingstarted
Information about working:
Visionaware.org/work
AFB.org/careerconnect
Data base on how to find public and private agencies:
AFB.org/directory
Online courses including “Employment of Older Persons”, technology, etc. (for professionals):
Elearn.afb.org

Other Resources
Department of Labor funded Job Accommodations Network
http://askjan.org/
JAN provides consultation to employers and job seekers about the wide range of accommodations which can help to select the appropriate technology and job restructuring accommodations.
Department of Labor Office of Disability Policy
http://www.dol.gov/odep/topics/OlderWorkers.htm
Section on research and reports on employment of older workers.

Gil JohnsonGil Johnson
Contributing author to VisionAware ™
American Foundation for the Blind

End of the Day Syndrome

4/2/14

“Dr. S., my eyes are red and burning at the end of my work day.”

“Patient, what sort of work do you do?  Tell me something about your work conditions.”

“I am a computer graphics artist.  I sit and stare at my twenty-seven inch HD screen for hours on end gently adjusting the composition of each pixel.  My studio is air-conditioned but not humidified, so after some hours of work, I feel dry as a bone.”

“One more question…can you cry tears?  Say, when you peel and slice an onion?”

Rule of 20 - blinking

The need to blink

Blinking is a complex function of the eyelids that when completed results in a clean, refreshed, re-wetted corneal surface.  The tears that are washed across the outside of the eye with each blink bring oxygen and other nutrients to the outer cell layer aiding in the rebuilding and revitalizing of the surface tissue.

Blinking is characterized by a full sweep of the upper lid over the eye to meet the lower lid.  The completion of this motion is performed gently without squeezing.  And, to be effective full eye closure needs to be repeated fairly often.  Blink rates vary according to investigators but most sources report an average of between six and ten full blinks per minute under normal viewing circumstances.

The anti-blink problem of our generation

In olden times – say the years between 1750-1950 – the most aggravating problem to the ocular surface was a good book or intense study.  The reader would concern himself with the text at hand and slowly his eyes would dry until a “rest break” was necessary.

Environmental or vocational changes to our lifestyle over the generations have promoted reduced blink rates.  Most recently in this negatively developmental progression is the effect of the television screen, the CRT, the LED screen, the handheld and pocket computer on the blink rate.  It appears that as attention level increases, blinking suffers.  First the eyes close less, then incompletely, and finally rarely only when surface dryness drives the individual to desperate measures.  He must blink or (so he feels) his eyes will pop out of their sockets.

Adding insult to injury increasingly over the decades is air conditioning – both heating and cooling – when not humidified.  Staring at console screens in dry environs speeds the desiccation of the cornea and results in discomfort.

The surface of the eye is a biological system.  Living systems require some degree of moisture.  If the cells of the eye – or any biological surface — are permitted to dry out, they will die.  Dead corneal cells fall off the cornea and float in the tears on the surface of the eye until washed away with a blink.  Until the surface is cleaned the dead cells are considered by the eye to be foreign bodies with the consequent irritation and induced reflex to blink.

When cells die and fall off, the underlying nerve endings send pain signals to the nervous system.  The sensation can be felt as pain, burning, or mere irritation or itching depending upon the severity of cell loss.

How to handle environmentally induced dry eye

After the ocular surface is dry most treatments will seem to make matters worse:  to cause burning and stinging, perhaps, even more than the dry eye itself.  Any tear substitute, any amount of blinking will be irritating at first. But, that is really all that can be done at this stage:  wetting and blinking.

Prevention

As in many conditions, the best treatment, in fact a cure, for recurrent environmentally induced dry eye is prevention.  For the eye that has a naturally flowing tear supply, the act of blinking is the surest prevention to stinging and burning after a day’s work at the computer.  Additionally, many sources recommend using the ‘rule of 20’:  after each twenty minutes of work, look up from the text or away from the screen; blink and refocus on the page twenty times.  This repetitive exercise simultaneously re-wets the eye and relaxes the focusing mechanism of the eye.

The result is relaxed and comfortable eyes that can continue to provide important and high quality information for longer hours of work.

Bezalel-SchendowichBezalel Schendowich, OD
Chairperson and Education Coordinator, JOS
Fellow, IACLE
Member, Medical Advisory Board NKCF
Sha’are Zedek Medical Center, Jerusalem, ISRAEL

Help for Computer Users

Working long hours in front of the computer requires a fairly unchanging body, head and eye position which can cause discomfort.  Correct working position, periodic stretch breaks, frequent eye blinking, artificial tears for lubrication are all very important.  However, it’s not always easy to remember this when you are engrossed in work. Here are a few fun, free and easy-to-install “break reminders” to help:

WorkSafe Sam - break reminder
WorkSafe Sam

WorkSafe Sam is a desktop tool that provides stretching tips to help reduce eye and muscle strain for office workers (clicking on this link will open a file on your computer because this is a zip file).

Workrave is break reminder program that alerts you to take “micro-pauses” and stretch breaks.

Take Your Break is another break reminder designed to prevent or minimize repetitive strain injury, computer eye strain and other computer related health problems.  It has a friendly interface and a tray icon status indicator.  It runs quietly in the background, monitoring your activity and reminding you to take regular breaks.

And remember to blink.  Blinking cleans the ocular surface of debris and flushes fresh tears over the ocular surface. Each blink brings nutrients to the eye surface structures keeping them healthy. The flow of tears is responsible for wetting the lower third of the cornea. This is very important in KC, since this area is generally below the bulge of the cone and in many cases irritated by wobbly RGP lenses.  Maybe your job requires hours of work at a computer. Maybe you like to spend your free time surfing the internet. Whatever the reason, your body is probably feeling the effects of spending too much time staring at a computer monitor, which could result in Computer Vision Syndrome (CVS).  The most common symptoms are: eye strain, dry or irritated eyes,redness in eyes,difficulty in refocusing eye,neck pain,double vision,blurred vision, fatigue, and headaches.

Please join us on Thursday when Dr. Bezalel Schendowich will be providing a detailed insight into the importance of blinking, going beyond computer usage.

CathyW headshotCathy Warren, RN
Executive Director
National Keratoconus Foundation

Low Vision Resources

What to do when “There’s nothing more that can be done.”

“I’m sorry, but there’s nothing more that can be done. There is no cure for your eye condition.”

In your work as healthcare professionals and health educators, it’s likely you’ve encountered a significant number of adults and older adults who have been on the receiving end of this devastating news.

When an eye care provider says, “There’s nothing more that can be done,” what he or she likely means is, “There’s nothing more I can do for you surgically.” But instead of saying, “There’s nothing more that I can do,” the discouraging message delivered to the patient is, “There’s nothing more that can be done.”

Thus, in many cases, the discussion ends there. Patients will either exhaust their resources searching for an elusive cure or become resigned to a life that is restricted and defined by incurable vision loss.

When receiving a diagnosis of vision loss, many adults who have managed to overcome a host of obstacles in their lives may now believe they are facing an obstacle with no viable solution. A natural, and understandable, initial reaction is to focus instead on the devastating losses that are seen as an inevitable accompaniment to blindness and low vision such as:

  • Loss of independence: “How will I prepare meals, clean my home, or shop? Will I become a burden to my family and friends?” 
  • Loss of confidence and self-worth: “All my life I’ve been physically active and self-reliant. Has my life as an independent person come to an end?” 
  • Loss of privacy: “I won’t be able to handle my finances independently. Will I have to surrender control of my life to someone else?” 
  • Loss of employment: “I’ll have to quit my job. How will I earn a living?” 

It’s important to let your clients and patients know that there is indeed hope—and life—after vision loss. A wide range of vision rehabilitation services enable adults who are blind or have low vision to continue living independently. The term “vision rehabilitation” includes highly trained professionals and comprehensive services that can restore function after vision loss, just as physical therapy restores function after a stroke or other injury.

Patient working with a low vision therapist
Patient working with a low vision therapist

Vision rehabilitation professionals include:

Additional vision rehabilitation services can include:

  • Peer support and counseling: talking with peers, sharing common concerns and frustrations, and finding solutions to vision-related problems. 
  • Vocational rehabilitation: vocational evaluation and training, job training, job modification and restructuring, and job placement. 
  • Veterans’ services: vision rehabilitation and related support services for blinded veterans of all ages. 

There are many resources available to help your patients and clients locate vision rehabilitation services. For example, the VisionAware Directory of Services allows you to browse by state and type of service, including counseling resources, support groups, low vision services, independent living skills, and orientation and mobility. The VisionAware “Getting Started” Kit provides tip sheets on specialized services and products that can assist with everyday life after vision loss.

The National Eye Institute’s National Eye Health Education Program (NEHEP) also has low vision education resources. The video, Living with Low Vision: Stories of Hope and Independence, explains how, as a health professional, you can help your patients make the most of their remaining vision and improve their quality of life by referring them for vision rehabilitation services. Share it with your colleagues, too. You can find additional resources and ideas for promoting vision rehabilitation on the NEHEP Low Vision Program page.

 

Maureen Duffy, CVRTMaureen A. Duffy, CVRT
Social Media Specialist, visionaware.org
Associate Editor, Journal of Visual Impairment & Blindness
Adjunct Faculty, Salus University/College of Education and Rehabilitation

 

10 Ways to Save Your Vision

More than half of the people responding to a 2012 survey from the American Optometric Association said they valued their eyesight more than their memory or ability to walk. In honor of Save Your Vision Month, here are some everyday things you can control to help “save your vision.”

© Tammy Mcallister - save your vision
© Tammy Mcallister | Dreamstime Stock Photos

 1. Enjoy a cup of tea – Green tea contains antioxidants, like vitamins C and E, lutein, and zeaxanthin that help protect against AMD and cataracts.  It is it hydrating, helping you produce tears.

 2. Take time to blink – On an average you blink about 15 – 20 times a minute. However, that rate drops by half when viewing text on a screen. Try using the 20/20/20 rule when staring at a screen: Every 20 minutes, look 20 feet away for 20 seconds so you can blink naturally and give your eyes time to relax.

 3. Wear sunglasses and a hat – Exposure to ultraviolet (UV) rays can deteriorate vision over time, leading to cataracts and age-related macular degeneration (AMD). The American Optometric Association recommends sunglasses that block at least 99 percent of UVA and UVB radiation and that screen out 75 – 90% of visible light. And if you plan to spend a lot of time outdoors, it’s a good idea to get sunglasses with lenses that are polarized, which means that they’ve been treated to reduce glare.  Since the sun doesn’t just affect your eyes from the front, try wearing a large brimmed hat to further protect your eyes.

4. Increase the seafood in your diet – Omega-3 fatty acids have been shown to bolster heart and brain health, as well as decrease your risk of eye disease. According to a study published in the 2011 Archives of Ophthalmology, women who ate canned tuna and dark-fish meat (mackerel, salmon, sardines, bluefish, swordfish) just once a week reduced their risk for AMD by 42%, as opposed to people that ate the same fish less than once a month.

 5. Eat a rainbow – Eating a full rainbow of fruits and vegetables regularly helps give your body the nutrients it needs.  In addition to fiber, vitamins and minerals, naturally colored foods contain what are known as phytochemicals, which are disease-fighting substances that also give fruits and vegetable their array of colors.  Star nutrients are lutein and zeaxanthin—pigments found in such foods as dark, leafy greens, broccoli, zucchini, peas, and Brussels sprouts. Also important are antioxidants found in red foods such as strawberries, cherries, red peppers and raspberries,  Orange foods have beta-carotene and include carrots, pumpkins, sweet potatoes and yams.

6. Use digital screens at a safe distance – The brightness and glare from computers, tablets, smartphones and televisions can lead to eyestrain after prolonged use. Recent studies have also shown ill-effects from the UV rays from these devices.  Symptoms can include headaches, blurred vision, dry or red eyes and difficulty refocusing. Experts recommend keeping the computer screen at least an arm’s length away and that you hold a handheld device at least 16 inches from your eyes.

 7. Contact lens solutions serve a purpose – While approximately 85% of contact lens wearers claim that they’re caring for their lenses properly, only 2% are according to a study out of Texas. The most harmful but common problem is moistening contacts with saliva instead of saline solution.

 8. Make-up makeover – Replace tubes of mascara after three months, as it is a breeding ground for bacteria. Sharpen liner pencils regularly and while it is okay to line the base of your lashes, using the liner inside the lash line can block oil glands. Replace eye shadows yearly and don’t share your eye cosmetics.

 9. Use protective goggles –   According to a 2008 study from the American Academy of Ophthalmology and the American Society of Ocular Trauma, of the 2.5 million eye injuries in the US annually, nearly half happen at home.  Sports activities are another cause of eye injuries, from contact sports to sports that use balls that could catch you unaware.  When snowboarding or skiing remember to protect your eyes from the sun and wind with tinted goggles that have UV protection.

 10. Have a yearly eye exam – Even if you don’t wear corrective lenses, adults should get a comprehensive eye exam (which includes dilating your pupils with drops) by age 40. After that a yearly eye exam is recommended to keep your eyes healthy and catch any changes in your eyes that may be indicators of eye disease.  If you have a family history of glaucoma or age-related macular degeneration, or you have diabetes, you are at a higher risk for vision-related issues and your doctor may elect to see you more often.  If you have symptoms such as persistent pain inside or behind your eyes, redness, or gradual loss of vision, make an appointment with your doctor immediately.

Susan DeRemerSusan DeRemer, CFRE
VP of Development
Discovery Eye Foundation