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.

Retinal Detachment


Related Terms

  • Detached Retina
  • Retinal Break
  • Retinal Tear
  • Rhegmatogenous Retinal Detachment
  • Serous Retinal Detachment
  • Traction Retinal Detachment

Differential Diagnosis

Specialists

  • Ophthalmologist

Comorbid Conditions

  • Blood dyscrasias
  • Cardiovascular disease
  • Connective tissue disorders
  • Diabetes
  • Endocrine disorders
  • Neurologic conditions

Factors Influencing Duration

The underlying cause of the condition, speed of intervention, method of treatment, individual response to treatment, and presence of complications, may influence length of disability.

Medical Codes

ICD-9-CM:
361 - Retinal Detachments and Defects
361.0 - Retinal Detachment with Retinal Defect; Rhegmatogenous Retinal Detachment
361.00 - Retinal Detachment with Retinal Defect, Unspecified
361.01 - Retinal Detachment with Retinal Defect; Recent Detachment, Partial, with Single Defect
361.02 - Retinal Detachment with Retinal Defect; Recent Detachment, Partial, with Multiple Defects
361.03 - Retinal Detachment with Retinal Defect; Recent Detachment, Partial, with Giant Tear
361.05 - Retinal Detachment with Retinal Defect; Recent Detachment, Total or Subtotal
361.06 - Retinal Detachment with Retinal Defect; Old Detachment, Partial; Delimited Old Retinal Detachment
361.07 - Retinal Detachment with Retinal Defect; Old Detachment, Total or Subtotal
361.2 - Serous Retinal Detachment; Retinal Detachment without Retinal Defect
361.8 - Retinal Detachment, Other Forms; Traction Detachment of Retina
361.81 - Traction Detachment of Retina; Traction Detachment with Vitreoretinal Organization
361.89 - Retinal Detachment, Other Forms; Traction Detachment of Retina, Other
361.9 - Retinal Detachment; Unspecified

Overview

© Reed Group
Retinal detachment occurs when the light-sensitive, multi-layered tissue at the inner back surface of the eyeball (retina) tears or is pushed away from supporting layers that contain nourishing blood vessels (choroid). A break, tear, or hole in the retina usually precedes detachment. Detachment may occur suddenly as gel-like fluids within the eye (vitreous humor) leak beneath the retina (rhegmatogenous detachment) separating it from the choroid. Retinal detachment also can result when the vitreous gel inside the eye degenerates, contracts, and liquefies with aging, causing it to pull on the retina and tear it away from the choroid (traction retinal detachment). The retina also may detach if there is an increase of fluid in the space behind the retina (subretinal space) that forces the retina away from the choroid (serous detachment) (Garg).

Because retinal cells degenerate and die if separated from oxygen and nutrients provided by the choroid, treatment must begin as soon as possible to restore and preserve vision. Central vision may be affected if the center portion of the eye responsible for detailed vision (macula) becomes detached. Without prompt reattachment of the retina through surgery, vision loss will be permanent.

Incidence and Prevalence: Retinal detachment occurs in 10 to 12.5 of 100,000 population annually (Larkin). In younger individuals, the male: female ratio for retinal detachment is 3:2 (Larkin).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals between the ages of 40 and 70, those who are very nearsighted (myopic), and those who have undergone cataract removal surgery are most likely to develop retinal detachment (Larkin). Retinal detachment may be associated with direct eye trauma. Individuals between the ages of 25 and 45 who participate in certain sports (e.g., bungee jumping, boxing) are at higher risk for retinal trauma that can result in detachment (Larkin). Retinal detachment also is associated with diabetes, metabolic disorders, abnormal eye structures, vascular disease, intraocular inflammation (sarcoid uveitis), and eye tumors.

Source: Medical Disability Advisor



Diagnosis

History: Individuals report a sudden onset of symptoms that may include flashes of bright light (photopsia) seen with eye movement at the edge of the field of vision (peripheral vision), particularly in dim lighting. The visual field may be flooded with dark, floating cobweb-like shapes (floaters) or translucent specks of various shapes. Flashes may occur only once and then return hours, days, or weeks later. Wavy distortion also may be experienced in the visual field (metamorphopsia). One or both eyes may have symptoms, but usually only one eye is affected at a time. Generally, pain is not present.

Preliminary symptoms may not precede a detachment. The individual may instead report direct symptoms of a detachment, such as blurring or a shadow or black drape that obscures part of the visual field in one eye. Visual blurring appears in the field of vision opposite to the area of detachment. If the lower part of the retina is detached, the drape descends from the top. In an upper detachment, the drape ascends from the bottom. In a left detachment, the drape enters from the right. In a right detachment, the drape enters from the left.

Physical exam: The pupil is widely dilated with eyedrops (mydriatics). The retina is examined with an ophthalmoscope, while gentle pressure is applied to the eyeball to bring all parts of the retina into view. A microscopic examination with a slit lamp (biomicroscopy) may also be conducted.

Tests: If a cataract or other lens cloudiness (opacity) prevents a visual view of the retina, high frequency sound waves (ultrasound) are employed to detect detachment. A visual acuity assessment is performed to determine the extent of vision loss. Additional investigations may include a refraction test, intra-ocular pressure test, testing for defects in color vision, pupillary reflex response, and retinal photography. A study of vascular integrity may be done by intravenously injecting a dye (fluorescein angiography). Magnetic resonance imaging (MRI) and computed tomography (CT) scanning may be performed to detect underlying tumors or foreign bodies.

Source: Medical Disability Advisor



Treatment

Immediate intervention is needed to prevent a retinal tear from becoming a detachment. Treatment of a tear usually involves using a laser to make small burns around the tear (photocoagulation) to create scarring that helps the retina adhere to the choroid. The scars that are created seal the edges of the tear and prevent fluid from leaking under the retina and causing detachment. Alternatively, a cold probe may used to create scaring (cryopexy). In some cases, short-wave electromagnetic energy (diathermy) is used to apply heat to the retinal tissue, sealing the tear (Wu).

If a detachment has occurred, the retina will not heal without surgical intervention. Treatment is aimed at reattaching the retina to the choroid layer of the eye (retinal detachment surgery) within 24 hours (Larkin). The procedure chosen varies depending on the extent and type of detachment. With pneumatic retinopexy, the subretinal fluid is drained, and expandable gas is added into the vitreous cavity, gently pressing the retina back into place against the choroid. This procedure may require the individual to hold their head in a specific position for several days. With scleral buckling, cryopexy is performed then a soft silicone rubber sponge may be sewn in place on the outside of the layer of eye (sclera) overlying the tear. This indents the sclera and allows the retina to settle back into place against the choroid. Sometimes, the vitreous humor between the retina and the lens must be partially removed (vitrectomy) to reduce retinal scar tissue that may be causing tension on the retinal tear and to improve the outcome of scleral buckling surgery. The vitreous may be replaced with gas or fluid to help hold the retina in place while it heals. Any underlying medical problem that may have caused the retinal detachment also is addressed.

Following surgery for retinal reattachment, topical antibiotics are given for 7 to 10 days, and steroids and medications to inhibit lens movement and eye accommodation (cycloplegic agents) may be used for up to 1 month (Wu).

Source: Medical Disability Advisor



Prognosis

Approximately 15% of individuals with retinal detachment in one eye will go on to experience the same condition in the other eye (Larkin). Surgical techniques for repairing retinal detachment are effective in up to 90% of individuals ("Retinal Detachment"); however, some individuals may need more than one procedure to reattach the retina. Some permanent loss of vision is common; however, half of those undergoing successful reattachment will achieve postoperative visual acuity of 20/50 or better (Wu). Several months may be required for visual acuity to return following a procedure. Vision may be worse following a procedure, and glasses or contact lenses may be required to restore acuity.

Reattachment of the retina may not be achieved in some cases. If treatment is delayed until the macula is affected, the individual likely will have permanent blurring in the central visual area and lens magnification will be required to aid vision, particularly during reading. Lack of treatment will result in retinal shrinkage and blindness in the affected eye. Overlooked breaks or tears in the retina not repaired during the first procedure may cause recurrence of the detachment. Once detachment has occurred, it may not be possible to restore normal central vision.

Source: Medical Disability Advisor



Complications

If treatment is delayed, a partial retinal detachment may progress until the entire retina is detached. When this happens, it may be impossible to restore normal vision, and there may be permanent loss of visual acuity or complete blindness in the affected eye. Other complications can include bleeding into the center of the eye (vitreous hemorrhage), glaucoma (angle closure), inflammation, infection, and scarring following surgery. Loss of light and depth perception also may occur. Some retinal detachments may require additional treatment. If gas is injected into the vitreous space, a gas cataract may form that must be removed surgically when retinal healing is complete. Others detachment may never be resolved.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Following retinal detachment and reattachment, the individual must be allowed sufficient time off for frequent eye examinations to evaluate recovery and monitor the eyes for recurrence. Vision should be evaluated and compared to the visual requirements of the job. Work duties may temporarily need to be changed if clear vision in both eyes is essential to the individual's work or safety. If permanent partial visual loss occurs, the individual may need accommodations such as large and high-contrast print or extra illumination at workstations. Additional accommodations are needed if blindness results.

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:

  • Did individual have symptoms consistent with diagnosis of retinal tears or detachment, such as flashes of bright light, floaters, or wavy sensation in the visual field?
  • Did individual report direct symptoms of a detachment, such as blurring or a shadow or black drape that obscures part of the visual field in one eye?
  • Was diagnosis confirmed through an examination with an ophthalmoscope and/or slit lamp?
  • If a cataract or other lens opacity prevented a visual view of the retina, was ultrasound used?
  • Was a visual acuity test performed to determine the extent of vision loss?

Regarding treatment:

  • Did individual seek and receive treatment within 24 hours after the first signs of visual deterioration?
  • What type of treatment was used to reattach the detached portion of the retina to the choroid layer of the eye and seal retinal tears?
  • Were underlying medical problems that may have caused the retinal detachment also addressed?

Regarding prognosis:

  • Did individual receive timely treatment? Were efforts to reattach the retina successful?
  • Was full visual acuity restored after procedures were undertaken to correct the retinal detachment?
  • Has individual experienced complications such as hemorrhage, glaucoma, inflammation, gas cataract, or infection that may affect recovery and prognosis?
  • Was there recurrence of retinal detachment? Did individual require a second procedure?
  • Is there evidence that a break or tear in the retina may have been overlooked during the first surgical intervention?
  • Has individual been provided with the glasses or contact lenses necessary to compensate for decreased visual capacity?
  • Does individual have an underlying condition that may affect recovery?

Source: Medical Disability Advisor



References

Cited

"Retinal Detachment." National Eye Institute. Oct. 2009. U.S. National Institutes of Health. 13 Oct. 2009 <http://www.nei.nih.gov/health/retinaldetach/index.asp>.

Garg, Sunir J. "Retinal Detachment." The Merck Manual for Healthcare Professionals. Merck and Company, Inc., 2008. The Merck Manuals Online Medical Library. Dec. 2008. Merck & Co., Inc. 13 Oct. 2009 <http://www.merck.com/mmpe/sec09/ch106/ch106g.html>.

Larkin, Gregory L. "Retinal Detachment." eMedicine. Eds. Joseph A. Salomone, et al. 7 May. 2008. Medscape. 13 Oct. 2009 <http://emedicine.medscape.com/article/798501-overview>.

Wu, Linteh, and Teodoro Evans. "Retinal Detachment, Rhegmatogenous." eMedicine. Eds. Vytautas A. Pakainis, et al. 2 Aug. 2007. Medscape. 13 Oct. 2009 <http://emedicine.medscape.com/article/1224737-overview>.

General

Mayo Clinic Staff. "Retinal Detachment." MayoClinic.com. 6 Nov. 2008. Mayo Foundation for Medical Education and Research. 13 Oct. 2009 <http://www.mayoclinic.com/health/retinal-detachment/DS00254>.

Source: Medical Disability Advisor






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