Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Cataract


Related Terms

  • Vision Loss
  • Visual Deficit

Differential Diagnosis

  • Corneal disease
  • Eye injury
  • Eye tumors
  • Glaucoma
  • Head injury
  • Macular disease
  • Medications affecting central nervous system
  • Optic nerve disease
  • Pupil defects
  • Refractive shift
  • Retinal detachment or disease

Specialists

  • Ophthalmologist

Comorbid Conditions

  • Endocrine disorders

Factors Influencing Duration

Factors influencing length of disability include severity of symptoms, age, mental status, and response to treatment. Duration depends on type of procedure, presence of complications, and individual's job requirements.

Medical Codes

ICD-9-CM:
366.10 - Unspecified Senile Cataract
366.11 - Pseudoexfoliation of Lens Capsule
366.12 - Incipient Cataract, Coronary, Immature NOS, Punctate; Water Clefts
366.13 - Anterior Subcapsular Polar Senile Cataract
366.14 - Posterior Subcapsular Polar Senile Cataract
366.15 - Cortical Senile Cataract
366.17 - Total or Mature Cataract
366.18 - Hypermature Cataract; Morgagni Cataract
366.19 - Senile Cataract, Other and Combined Forms
366.20 - Traumatic Cataract, Unspecified
366.22 - Total Traumatic Cataract
366.23 - Partially Resolved Traumatic Cataract
366.30 - Cataracta Complicata, Unspecified
366.32 - Cataract in Inflammatory Disorders
366.33 - Cataract with neovascularization
366.34 - Cataract in Degenerative Disorders; Sunflower Cataract
366.41 - Diabetic Cataract
366.42 - Tetanic Cataract
366.43 - Myotonic Cataract
366.44 - Cataract Associated with Other Syndromes
366.45 - Toxic Cataract; Drug-induced Cataract
366.46 - Cataract Associated with Radiation and Other Physical Influences
366.8 - Cataract, Other; Calcification of Lens
366.9 - Cataract, Unspecified

Overview

© Reed Group
A cataract is a cloudy (opaque) area that forms in the normally clear crystalline lens of the eye. Vision deteriorates when cloudiness obstructs light passing through the lens to the inner lining of the back of the eye (retina) where images are received and transmitted to the optic nerve. Cataracts manifest first as small, scattered cloudy areas. They are painless and develop over a period of a few months to several years.

Cataracts are the leading cause of blindness worldwide (WHO). Aging and accompanying biochemical changes within the lens are the most common cause of cataracts (senile cataracts). Other causes include injury (trauma), hypertension, connective tissue diseases, ocular infection, exposure to x-rays, certain drugs (e.g., corticosteroids, diuretics, thiamine), and diseases such as diabetes mellitus. Drugs used for treatment of a disease that damages the optic nerve (glaucoma) also have been implicated, as has the herb St. John's wort (Carroll). Smoking and alcohol use have been found to increase cataract occurrence. High levels of uric acid and low levels of riboflavin, vitamin E, iron, and protein also are thought to contribute to cataract formation. Recent research indicates that ultraviolet radiation from sunlight may be a major factor in development of the condition; it is estimated that 20% of cataracts are caused by ultraviolet radiation from sun exposure (WHO).

An early stage of cataract development can produce increased hardness and density at the center of the lens (nuclear sclerosis). In an advanced stage, a cataract may cause the lens to appear brownish. Cataracts in adults can occur in the outer covering around the lens (capsule), the center (nucleus), or the area around the center (cortex). Cataracts may stop developing in the early stages and cause only minor or no vision loss. If growth continues, vision will worsen, and treatment will be needed. When cataracts significantly impair vision, surgical removal of the lens and its replacement with an artificial plastic lens is the only remedy.

Incidence and Prevalence: Between 300,000 and 400,000 new visually disabling cataracts are diagnosed each year, with about 7,000 resulting in blindness after surgery (Ocampo). Incidence of congenital cataracts is 12 to 16 cases per 100,000 (Bashour).

Worldwide, 16 million new visually disabling cataracts are diagnosed each year (WHO), with up to 200,000 resulting in blindness after surgery (Ocampo). In Africa, 1.2% of the population is blind, with 36% of cases caused by cataracts (Ocampo). In Scotland, 25% of all cases of blindness are caused by cataracts (Ocampo).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The most significant risk factor for developing cataracts is aging; more than half of people aged 65 or older have cataracts (Carroll). Individuals who work outdoors for more than 7 hours per day and those exposed to infrared radiation are at increased risk as they age, as are those who smoke and/or drink alcohol (Ocampo). Other risk factors include hypertension, trauma, long-term steroid use, pneumonia, heart disease, allergies, and systemic illnesses such as diabetes (Ocampo). A small percentage of cataracts are present at birth (congenital). Women have a slightly higher incidence of developing cataracts than men. Unoperated cataracts are responsible for a higher percentage of blindness in blacks than whites (Ocampo).

Source: Medical Disability Advisor



Diagnosis

History: Individuals report a progressive deterioration in visual acuity. Symptoms include blurred or cloudy vision and the inability to see properly at night due to low contrast or glare. Individuals also may report difficulty perceiving light sources, which can produce a halo effect. Monocular double vision (diplopia) may occur continually or sporadically. An individual may report a new, though temporary, ability to read without glasses. Vision may lack subtle variations in shading. Pain typically is absent unless the cataract swells and causes increased pressure in the eyes (acute secondary glaucoma). Vision loss can be sudden but usually is gradual.

Physical exam: An eye exam with dilation of the pupil using an ophthalmoscope and slit lamp will reveal a cataract. Visual acuity at a distance is measured using high and low lighting with the Snellen chart. Impairment of ability to see letters or shapes at a distance may be detected. Cataracts are staged based on visual acuity. Cataracts are designated as immature if the individual is able to read at a level better than 20/200; they are designated as mature if vision is worse than 20/200. Incipient cataracts occur when the individual can read at 20/20 but has a significantly opaque lens as observed on slit lamp examination (Ocampo).

Tests: An examination (refraction) using various lenses is performed to see if glasses or contact lenses can improve vision. Eyedrops to dilate the pupil enable a thorough examination. A type and grade then are assigned to the cataract. Cataracts are commonly classified according to the color, location, and severity of the cloudiness. A central (nuclear) cataract is graded according to the percentage of area affected. In cases of cataracts found in the periphery (cortical) or outer covering (posterior subcapsular), grades range from 1 (least affected) to 4 (most affected). The pressure inside the eye (intraocular pressure) can be measured (tonometry) to rule out glaucoma. Tests that measure the individual's ability to see different shades of color and to measure contrast sensitivity and glare may be performed.

In certain cases, tests are done to predict the increase in vision that may be expected to occur after cataract removal (potential acuity meter or laser interferometer testing). When an artificial lens insertion is planned, the length of the eye is measured, and the curvature of the cornea is evaluated. If the eye is obscured by a dense cataract, ocular studies with computed tomography (CT) scan, magnetic resonance imaging (MRI), or ultrasound are performed to adequately view the back of the eye prior to surgery.

Source: Medical Disability Advisor



Treatment

When glasses or contact lenses no longer improve impaired vision, surgery is strongly considered. Cataract removal under an operating microscope usually involves techniques of phacoemulsification or of extracapsular cataract extraction (ECCE), both allowing the outer covering (capsule) of the lens to remain in place. The most common procedure is phacoemulsification, which involves inserting a small probe through a tiny incision and using ultrasound vibration to break apart the lens, which is then suctioned out of the eye (“Phacoemulsification"). An artificial lens usually is inserted (intraocular lens implantation [IOL]). The lens is most commonly placed behind the colored portion of the eye (iris), but also may be placed in front of the iris. Less commonly, ECCE is performed to remove very large cataracts. With ECCE, a larger incision is made at the side of the eye to remove the cataract and natural lens in a single piece; following cataract removal, IOL is performed and the incision is closed with tiny sutures (“Extracapsular Cataract Extraction"). Laser surgery, in which concentrated light (laser) is used to dissolve the cataract instead of ultrasound vibration, is not currently used to remove cataracts, as it is considered an experimental form of treatment.

Eyedrops and oral medication may be used before, during, and after surgery to reduce eye pressure. Antibiotics may be used for the first 1 to 2 weeks to prevent infection (Ocampo). Anti-inflammatory agents, including topical steroids, also may be administered to prevent further damage caused by the eye tissue's reaction to injury. The eye may then be covered with a shield for the first postoperative day. If an artificial lens is not inserted, thick glasses (aphakic) or contact lenses will be needed and are prescribed when the eye is fully recovered. Glasses or contact lenses may be needed even if an artificial lens was inserted. Newly developed implantable lenses now offer options for correcting certain types of pre-existing vision deficiencies, such as hyperopia, myopia, presbyopia, or astigmatism.

Source: Medical Disability Advisor



Prognosis

If surgery is not performed, cataracts usually continue to develop causing vision to worsen. Most individuals experience improved vision following surgical removal with artificial lens insertion, along with improved quality of life and mental status. Following cataract surgery, ocular inflammation will slowly resolve over 2 weeks, and vision is considered stable at 6 to 8 weeks (Ocampo). In some cases, additional treatment (YAG laser capsulotomy) will be required if an after-cataract or secondary cataract forms. In rare cases, retinal detachment or other serious complications of surgery may cause blindness in the affected eye.
Because cataracts may be present in only one eye or may develop at different rates in both eyes, attempts to improve vision with glasses or contact lenses may result in objects being seen as larger or smaller than actual size. The eyes may resist working together to gauge distance or depth perception. Different lens prescriptions may need to be used for each eye and finely tuned until the best possible vision is obtained.

Source: Medical Disability Advisor



Complications

Problems during surgery or the pre-existence of other eye disease may rule out insertion of an intraocular lens. Following surgery, an after-cataract or secondary cataract can form when the back portion of the lens capsule clouds over (posterior capsular opacification or secondary cataract). A YAG laser capsulotomy then might be required to incise this membrane, allowing for improved vision. Other postsurgical complications include dislocation of the intraocular lens (0.2% to 1.8% of cases) (Wu), swelling (edema), retinal detachment (0.5% of cases), bleeding (hemorrhage), and infection inside the eye (1 in 3,000 cases) (“Complications”).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Lighting may need adjustment, or a hat or visor may be required to reduce glare. Performance of tasks that require reading, driving, or operation of machinery should be evaluated following cataract surgery and may be problematic depending on the extent of postoperative visual acuity. The individual may need to wear glasses, filtered glasses, or contact lenses. Eyestrain may result in the need of rest breaks to close their eyes. Sunshine and strong light may need to be avoided. Physical activity, lifting, and bending may be restricted for a short period following surgery.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was individual properly tested to confirm cataract diagnosis and rule out the possibility of an eye injury or other diseases?
  • Were appropriate methods and tests been applied to determine the extent of the cataract condition?
  • Is cataract immature, mature, or incipient?

Regarding treatment:

  • Was phacoemulsification or extracapsular cataract extraction required?
  • Was intraocular lens inserted?
  • Was artificial lens properly positioned?
  • Is healing taking place as expected or has the process been complicated by an infection or injury?
  • If surgery was performed, did individual receive topical antibiotics? Anti-inflammatory medications?
  • Has individual achieved optimal visual results following cataract removal?
  • Have prescriptive lenses been finely tuned until the best possible vision is obtained?

Regarding prognosis:

  • If vision was not significantly improved with cataract removal, can vision be further corrected with prescription glasses or contact lenses?
  • Has posterior capsular opacification occurred? Eye infection? Retinal detachment?
  • Did individual undergo YAG laser capsulotomy to clear up an after-cataract or secondary cataract? Was procedure effective?
  • Has surgically inserted artificial lens provided adequate vision correction? Does it need to be replaced with a different type of lens?
  • Has individual experienced complications, related to either the cataract or its treatment, that may affect recovery?
  • Are further corrective procedures warranted?

Source: Medical Disability Advisor



References

Cited

"Complications." Cataract.com. 2009. 6 Oct. 2009 <http://www.cataract.com/complications.html>.

"Extracapsular Cataract Extraction." Eyesurgeryeducation.com. 2003. Eye Surgery Education Council. 6 Oct. 2009 <http://www.eyesurgeryeducation.com/Extracapsular_Extraction.html>.

"Phacoemulsification." Eyesurgeryeducation.com. 2003. Eye Surgery Education Council. 6 Oct. 2009 <http://www.eyesurgeryeducation.com/Phacoemulsification.html>.

Bashour, Mounir, Johanne Menassa, and C. Corina Gerontis. "Cataract, Congenital." eMedicine. Eds. Richard W. Allinson, et al. 8 Jun. 2009. Medscape. 6 Oct. 2009 <http://emedicine.medscape.com/article/1210837-overview>.

Carroll, Nick. "Cataracts Caused by St. John's Wort: Overview." injuryboard.com. 11 Sep. 2009. 12 Nov. 2009 <http://www.injuryboard.com/topic/cataract-surgery-overview.aspx>.

Ocampo, Vincente Victor D., and Stephen C. Foster. "Cataract, Senile." eMedicine. Eds. Richard W. Allinson, et al. 20 May. 2009. Medscape. 12 Nov. 2009 <http://emedicine.medscape.com/article/1210914-overview>.

WHO. "What Are the Effects of UV on the Eye?" WHO. 2009. World Health Organization. 6 Oct. 2009 <http://www.who.int/uv/faq/uvhealtfac/en/index3.html>.

Wu, Lihteh, and Teodoro Evans. "Intraocular Lens Dislocation." eMedicine. Eds. Brian A. Phillpotts, et al. 25 Jul. 2007. Medscape. 6 Oct. 2009 <http://emedicine.medscape.com/article/1211310-overview>.

Source: Medical Disability Advisor






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