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.

Diabetic Retinopathy


Related Terms

  • Background Retinopathy
  • Diabetic Maculopathy
  • Malignant Retinopathy
  • Nonproliferative Retinopathy
  • Proliferative Retinopathy
  • Simple Retinopathy

Differential Diagnosis

  • Cataract(s)
  • Glaucoma
  • Hypertensive retinopathy
  • Radiation retinopathy
  • Retinal vitreous obstruction
  • Retinitis pigmentosa
  • Senile macular degeneration

Specialists

  • Ophthalmologist

Comorbid Conditions

  • Cardiovascular disease
  • Endocrine disorders
  • Immune system disorders
  • Neurologic conditions
  • Renal disease

Factors Influencing Duration

Age, presence of complications, severity of the disease and the individual's overall health might impact duration of disability.

Medical Codes

ICD-9-CM:
249.50 - Secondary diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled, or unspecified
362.01 - Background Diabetic Retinopathy; Diabetic Macular Edema; Diabetic Retinal Edema; Diabetic Retinal Microaneurysms
362.02 - Proliferative Diabetic Retinopathy
362.04 - Retinal Disorders, Other; Mild Nonproliferative Diabetic Retinopathy
362.05 - Retinal Disorders, Other; Moderate Nonproliferative Diabetic Retinopathy
362.06 - Retinal Disorders, Other; Severe Nonproliferative Diabetic Retinopathy
362.07 - Retinal Disorders, Other; Diabetic Macular Edema; Diabetic Retinal Edema

Overview

Diabetic retinopathy refers to progressive damage to the blood vessels in the inner eye (retina) caused by high blood sugar levels (hyperglycemia). As a common complication of diabetes mellitus, the disease is a leading cause of blindness and accompanying disability among workers. Diabetic retinopathy occurs in different forms, including nonproliferative (background) retinopathy, diabetic maculopathy and proliferative retinopathy.

Nonproliferative or background retinopathy occurs in early stages of the disease. Small capillaries in the retina may weaken or break, leaking blood that then forms small, dot-like hemorrhages. Maculopathy may develop when fluid accumulation in the central portion of the retina (macula) causes thickening of the tissue, swelling (macular edema) and possible extensive hemorrhages, leading to blurred, distorted or diminished vision.

As diabetic retinopathy progresses, new blood vessels develop (neovascularization). This stage is called proliferative diabetic retinopathy. These new, weaker vessels hemorrhage more easily into the clear, jelly-like substance that fills the eye (vitreous humor). There can also be neovascularization of the iris or the filtering mechanism of the eye (trabecular meshwork). Oxygen loss (ischemia) also occurs within the retina. The abnormal blood vessel growth may cause spots (floaters), vitreous hemorrhage, retinal detachment, or glaucoma.

Incidence and Prevalence: Proliferative diabetic retinopathy is found in more than 700,000 US residents at any given time (Weiland 29). About 8% of all cases of legal blindness in the US, involving about 12,000 to 24,000 individuals annually, are due to diabetes and vision complications ("Diabetes").

Source: Medical Disability Advisor



Causation and Known Risk Factors

The effects of hyperglycemia add up over time (cumulative). This puts individuals who have had uncontrolled diabetes mellitus for many years at a higher risk of developing diabetic retinopathy. Individuals with Type I diabetes mellitus have a 75% to 95% chance of developing diabetic retinopathy after 15 years, and a more than 95% chance after 30 years. Individuals with Type II diabetes have a 40% chance of developing diabetic retinopathy after 15 years, and a 60% chance after 20 years (Lightman).

Poor blood sugar control (glycemia), pregnancy, kidney complications, high blood pressure (hypertension), and smoking all increase the risk of developing diabetic retinopathy.

Source: Medical Disability Advisor



Diagnosis

History: The individual has a history of diabetes and may report seeing floaters or flashes. Blurred or cloudy vision, inability to see fine details, or a sudden total loss of vision may be mentioned. Other possible symptoms include distorted vision or pain due to increase ocular pressure. Individuals with nonproliferative diabetic retinopathy may report only a decrease in visual acuity. Early on, during the preventable stage, symptoms may not be present.

Physical exam: An eye exam involves dilating the pupil and using an instrument that allows the eye doctor to view the retina (ophthalmoscope or slit lamp). The examination may reveal tiny ballooned-out areas of blood vessels (microaneurysms), dot hemorrhages, and/or white to yellow fat (lipid) deposits (hard exudates) on the retina. Swelling of the area of the retina that absorbs light and relates to color vision (macula) may be noted. In proliferative diabetic retinopathy, neovascularization, hemorrhage, scarring, and physical detachment of the retina from the eye wall may be noted. A standard vision test with an eye chart (Snellen chart) may reveal loss of vision. In advanced cases, eye pressure may be elevated.

Tests: Tests may include ocular ultrasound (ultrasonography), rapid sequence of photographs that visualize the passage of a dye through the blood vessels of the eye (fluorescein angiography), and measuring eye pressure (glaucoma testing).

Source: Medical Disability Advisor



Treatment

Other conditions accompanying diabetic retinopathy should be considered and possibly treated. Levels of blood sugar and lipids should be monitored, along with possible hypertension or kidney (renal) disease. While research is being done on possible drugs to help control diabetic retinopathy, no direct medical intervention is indicated at this time.

The standard treatment for proliferative diabetic retinopathy is laser surgery (laser panretinal photocoagulation, or PRP). The individual is placed in a darkened room, and a contact lens is inserted before the laser is used. While the laser can create blind spots in the peripheral vision, this procedure reduces the risk of severe vision loss. During PRP, the laser seals retinal tears and leaking blood vessels. PRP destroys hemorrhage and oxygen-deprived retinal tissue outside the area of central vision. The laser can also be aimed along the sides of the retina to prevent growth of abnormal new vessels or seal the retina to the wall of the eye and prevent retinal detachment.

In some cases, a procedure called cryoretinopexy can be performed instead of laser photocoagulation. The purpose is the same but instead of a laser, extreme cold is used to freeze the areas of abnormal vessel growth.

Advanced cases of proliferative diabetic retinopathy may also be treated by a microsurgical procedure to remove the bloody, fibrous, vitreous humor (vitrectomy). In order to maintain the shape of the eyeball, the removed vitreous humor is then replaced with either a thick, gel-like substance similar to the natural vitreous humor or a clear salt solution (saline). If the retina has become detached, it can be surgically reattached to the back of the eye.

Source: Medical Disability Advisor



Prognosis

When diabetic retinopathy is diagnosed and monitored closely from the early stages, the outlook is good. Regular ophthalmic examination increases the likelihood of catching complications early and treating them promptly, thereby improving the prognosis. The presence of white spots on the retina (cotton wool spots) is an ominous sign and usually indicates rapidly progressing retinopathy. If treatment is delayed, proliferative diabetic retinopathy can result in blindness.

Laser photocoagulation and cryoretinopexy can be effective in reducing risk of serious vision loss, depending on how far the disease has progressed. Cryoretinopexy has a higher incidence of complications such as inflammation.

Vitrectomy is generally reserved for advanced cases of proliferative diabetic retinopathy. The outcome depends on the extent of damage or vision loss prior to the procedure. If preoperative vision loss was due primarily to a cloudy vitreous, the procedure will be more successful than if significant damage to the retina has occurred.

Vision loss that has already occurred cannot always be restored.

Source: Medical Disability Advisor



Complications

Complications include separation of the retina from the back of the eye (detached retina), glaucoma, and/or blindness.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Any restrictions or accommodations must be tailored to the degree of visual impairment. Larger computer screens may be helpful to individuals with only mild to moderately impaired vision. A visual functional capacity evaluation may help to identify necessary requirements for job modifications. Individuals whose jobs require fine detail and driving or operating heavy machinery may require alternative work assignments.

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:

  • How long has the individual had diabetes?
  • Does the individual also have kidney complications, hypertension, or poor blood sugar control? Is the individual a smoker?
  • Does the individual report areas of vision that are blocked by floaters or flashes, blurred or cloudy vision, inability to see fine details, or a sudden total loss of vision?
  • Does the individual have ophthalmic pain?
  • On exam did the eye doctor find microaneurysms, dot hemorrhages, and/or lipid deposits on the retina?
  • Is there swelling of the macula?
  • Did the physician find neovascularization, hemorrhage, scarring, or retinal detachment?
  • Did the individual have a visual acuity test?
  • Did the individual have an ultrasound, fluorescein angiography, and glaucoma testing?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has the individual been treated with laser surgery or cryoretinopexy?
  • Did it become necessary to perform a vitrectomy or surgically reattach the retina?

Regarding prognosis:

  • Is the individual's employer able to accommodate any necessary restrictions?
  • Does the individual have any conditions that may affect ability to recover?
  • Has the individual had any complications such as detached retina, glaucoma, and/or blindness?

Source: Medical Disability Advisor



References

Cited

"Diabetes and Retinopathy (Eye Complications)." American Diabetes Association. 15 Dec. 2004 <http://www.diabetes.org/diabetes-statistics/eye-complications.jsp>.

Lightman, S., and H. M. Towler. "Diabetic Retinopathy." Clinical Cornerstone 5 2 (2003): 12-21.

Weiland, David A., and Russell D. White. "Diabetes Mellitus." Clinics in Family Practice 4 3 (2002): 1-42.

Source: Medical Disability Advisor






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