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From beach lifeguard to astronaut: occupational vision standards and the implications of refractive surgery
  1. Gerry Clare1,
  2. John A Pitts2,
  3. Ken Edgington3,
  4. Bruce D Allan4
  1. 1University of Nottingham, Queen's Medical Centre, Division of Ophthalmology and Visual Sciences, Nottingham, UK
  2. 2Bayview Hospital, Barbados and UK Civil Aviation Authority, UK
  3. 3Airport Medical Services Ltd, Horley, UK
  4. 4Moorfields Eye Hospital, London, UK
  1. Correspondence to Major Gerry Clare, Visual Sciences, Nottingham NG7 2UH, UK; msxgc{at}nottingham.ac.uk

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Minimum vision standards for employees are used in manufacturing,1 transport industries,2 3 and the emergency4 and armed servicesi.5 Traditionally, these standards have applied to colour vision, visual acuity and refractive error, with the later addition of visual fields for driving.6 Vision standards are often historic and differ between countries, and their validity may be questioned as technological advances obviate some visual tasks.7 Furthermore, entry standards applied to uncorrected acuity are being bypassed by advances in refractive surgery. This is of special significance in the armed services, where operational constraints must be taken into account. Our understanding of the interplay between visual demands at work and the effects of refractive surgery is evolving. Vision standards and official policies on refractive surgery should be understood in relation to the work environment, by both surgeons and patients. Performance-based and parametric tests are helping to define vision standards in a variety of occupations. Surgical correction of refractive errors can in many cases allow previously ineligible candidates to pursue their chosen occupation.

The rationale for visual standards

Visual standards are commonly based on concepts of public safety, selection for training and competition. The public safety angle invokes a balance between the individual's right to work and the right of society to expect a safe level of health—for example, in its public transport workers. Selection reduces the cost of training by precluding unsuitable individuals who, if selected, would go on to fail. High standards of performance permit the competitive selection of highly able personnel.

Organisations frequently have separate vision standards for entry and retention, accommodating personnel whose vision has changed since joining. In accordance with modern precepts of equality of opportunity (eg Disability Discrimination Act 2005), exclusion requires justification based on evidence,8 and if organisations lean too far towards very high standards …

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