Occupational Vision Manual: Part V

Medico-Legal and Ethical Concerns Regarding Standards and Regulations

by: James R. Scholles, O.D., J.D.

Every employer stands to benefit from an appropriate philosophy toward employee safety and visual performance. One goal of the optometric consultant to industry is to help management appreciate the risks and benefits of eye protection and correction.

The "golden rules" for industry are three: (1) What is good for the employee is good for the company, (2) Protect your employees as you would your own family, (2) Industrial ethics includes putting the interest of protecting your employee foremost.

Two important laws that provide requirements, guidelines, and standards with which employers must comply are the Occupational Safety and Health Act of 1970 (OSHA), administered by the U.S. Department of Labor, and the Americans with Disabilities Act (ADA) administered by the U.S. Department of Justice.

"Standards" include a measure of what a reasonable or prudent person would do in a given situation, whereas "Guidelines" detail procedures to follow under particular circumstances. Standards can be determined which measure safe levels. Breaching a standard could be construed to be reckless or negligent behavior. The term "occupational safety and health standard" is defined by OSHA as a standard that requires conditions reasonably necessary or appropriate to provide safe or healthful employment and places of employment.

OSHA Standards

OSHA has issued standards in two areas that are especially related to eye care:

Eye and Face Protection -1910.133. The general requirements state in part:

(a)(1) The employer shall ensure that each affected employee uses appropriate eye and face protection when exposed to eye and face hazards from flying particles, molten metal, liquid chemicals, acids, or caustic liquids, chemical gases or vapors or potentially injurious light radiation.

(a)(2) The employer shall ensure that each employee uses eye protection that provides side protection when there is a hazard from flying objects.

(a)(3) The employer shall ensure that each affected employee who wears prescription lenses while engaged in operations that involve eye hazards wears eye protection that incorporates the prescription in its design, or wears eye protection that can be worn over the prescription lenses without disturbing the position of the prescription eyewear or the protective lenses.

(a)(4) Eye and face PPE [personal protective equipment] shall be distinctly marked to facilitate identification of the manufacturer.

(a)(5) The employer shall ensure that each affected employee uses equipment with filter lenses that have a shade number appropriate for the work being performed for protection from injurious radiation. OSHA has incorporated by reference the American National Standard Practice for Occupational and Educational Eye and Face Protection of the American National Standards Institute (ANSI Z87.1 – 1989).

Bloodborne Pathogens - 1910.1030.

The second area especially related to eyecare comprises OSHA regulations that address occupational exposure to blood or other potentially infectious materials. "Bloodborne Pathogens" means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV). The OSHA regulations stipulate that the employer shall provide "appropriate protective equipment such as, but not limited to, gloves, gown, laboratory coats, face shields or masks, and eye protection." OSHA regulations also contain provisions for hand washing facilities and disposal of sharp objects.

With reference to "Masks, Eye Protection, and Face Shields", the OSHA regulation states, "Masks in combination with eye protective devices, such as goggles or glass with solid eye shields, or chin-length face shields, should be worn whenever splashes, spray, splatter or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated."

The OSHA regulations provide directives for labeling, signs, record keeping, communication with employees, and confidentiality regarding the application of the protections.

Americans with Disabilities Act

Passed in 1990, the Americans with Disabilities Act (ADA) prohibits discrimination on the basis of disability in employment, programs and services provided by state and local governments, goods and services provided by private companies, and in commercial facilities. The ADA covers effective communication with people with disabilities, prohibits eligibility criteria that may prevent access to employment, and requires reasonable modification of policies and practices that might be discriminatory. The ADA authorizes the Department of Justice (DOJ) to issue regulations, to provide technical assistance, and enforce those regulations. The Act defines "disability" to mean, with respect to an individual:
  1. A physical or mental impairment that substantially limits one or more of the major life activities of such individual;
  2. A record of such an impairment; or
  3. Being regarded as having such an impairment.
Under the ADA, an "employer" is defined as a person engaged in an industry affecting commerce who has 15 or more employees for each working day in each of 20 or more calendar weeks in the current or preceding calendar year.

A "qualified person with a disability" is an individual with a disability who, with or without reasonable accommodation, can perform the essential function of the employment position that the individual holds or desires.

"General rule: No covered entity shall discriminate against a qualified individual with a disability because of the disability of such individual in regard to job application procedures, the hiring, advancement or discharge of employees, employee compensation, job training, and other terms, conditions and privileges of employment." Discrimination includes in part "utilizing standards, criteria or methods of administration that have the effect of discrimination at the basis of disability." It also includes "using qualification standards, employment tests or other selection criteria to screen out or tend to screen out an individual with a disability unless the standard, test or other selected criteria is shown to be job related for the position in question and is consistent with business necessity."

It is the job of the vision consultant to industry to evaluate both vision requirements and standards for job performance and the safety of the employee and others. It is important that the application of such requirements and standards be consistent with the directives of the ADA.