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 Repair


Related Terms

  • Cryoretinopexy
  • Cryotherapy
  • Laser Photocoagulation
  • Photocoagulation
  • Pneumatic Retinopexy
  • Retinal Attachment
  • Retinal Attachment by Cryotherapy
  • Scleral Buckle
  • Scleral Buckling

Specialists

  • Ophthalmologist

Comorbid Conditions

Factors Influencing Duration

The extent of treatment necessary, the individual's response to treatment, recurrence of the condition, presence of complications, and underlying conditions can extend length of disability.

Medical Codes

ICD-9-CM:
14.41 - Sclera Buckling with Implant
14.49 - Other Scleral Buckling; Sclera Buckling with: Air Tamponade, Resection of Sclera, Vitrectomy
14.51 - Repair of Retinal Detachment with Diathermy
14.52 - Repair of Retinal Detachment with Cryotherapy
14.53 - Repair of Retinal Detachment with Xenon Arc Photocoagulation
14.54 - Repair of Retinal Detachment with Laser Photocoagulation
14.55 - Repair of Retinal Detachment with Photocoagulation of Unspecified Type
14.59 - Repair of Retinal Detachment, Other

Overview

Retinal detachment repair is a procedure that reattaches the light-sensitive area of the inner back surface of the eye (retina) to the layer of tissue underneath it (choroid). Reattachment is essential to maintaining vision because the choroid contains the blood vessels that nourish the retina. Repairing a detached retina generally is a two-step process. First the retina is brought back into direct contact with the choroid. Next, the retina is reattached to the choroid using one of several methods depending on the severity and complexity of the tear or detachment.

Retinal detachments occur when a tear, break, or hole forms in the retina (rhegmatogenous detachment); when the gel-like substance of the eye's interior (vitreous) begins to liquefy with aging and pulls away from the inner back lining of the eye peeling the retina off the choroid (traction detachment); or when increases fluid in the space behind the retina that pushes it away from the choroid (serous detachment) (Garg).

Source: Medical Disability Advisor



Reason for Procedure

Retinal detachment repair is indicated when all or a portion of the retina disconnects from the choroid. Once the retina becomes detached, it does not spontaneously heal or reattach, and vision loss results. Prompt treatment with retinal detachment repair is necessary to preserve eyesight.

Source: Medical Disability Advisor



How Procedure is Performed

Several procedures are used for repair of a detached retina depending on the size, location, and complexity of the detachment. In cases of retinal tears with or without small retinal detachment, a laser is used 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 further detachment. Laser photocoagulation is the least invasive retinal detachment repair and does not require anesthesia or a surgical incision. The procedure typically is performed in the ophthalmologist's office. In larger retinal detachments, a special fluid (perfluorocarbon liquid, silicone oil) also may be injected into the eye to help press the retina against the choroid and promote reattachment. Alternatively, a probe (cryoprobe) may be used to create scarring through extreme cold (cryotherapy) to achieve the same results. The procedure is over within minutes, and the individual often can resume normal activity almost immediately. However, if fluid has been injected into the eye, vision in that eye will be affected until the fluid is resorbed or removed.

Pneumatic retinopexy, usually an office procedure done under local anesthesia, involves injection of a gas bubble that presses against the retina and holds it in place against the choroid, allowing reattachment. Photocoagulation or cryotherapy then may be used to seal any retinal tears or holes. Pneumatic retinopexy tends to work only when detachments occur in the top (superior) portion of the retina. Individuals who undergo pneumatic retinopexy may be required during the following 1 to 2 weeks to keep their face pointed down toward the floor and avoid certain positions, such as reclining on the back so that the gas bubble maintains position and holds the retina in place (Williamson). Airplane travel also is not permitted until all the gas is resorbed because if cabin pressure is reduced, the gas bubble may expand during flight and increase eye pressure, causing damage to the eye. Gas may dry the cornea, causing a gas cataract that impairs vision and may need to be removed when healing is complete.

Surgical procedures are performed under local or general anesthesia depending on the extent of intervention needed. These procedures take place in an outpatient center or hospital, and overnight stays usually are not required. Once the individual is anesthetized, a small incision is made in the eye. If fluid has collected under the retina, it will be drained. A scleral buckle procedure involves placing a silicone band around the eyeball or fastening a small silicone implant to the outside of the eye near the area of retinal detachment. The silicone implant or band provides pressure, pushing the wall of the eye onto the retina from the outside in the specific area of the retinal tear. In some cases, small surgical instruments may be needed to remove scar tissue from the retina. If the retina is successfully returned to its normal position against the choroid, the incision in the overlying conjunctiva will be stitched together, and the procedure will be complete.

If debris from bleeding or scarring obscures the surgeon's view of the eye's interior, a vitrectomy may be required. The surgeon will remove the gel-like substance (vitreous) from the eye. Vitrectomy may be required in combination with scleral buckling. If necessary, the removed vitreous will be replaced temporarily with substances such as liquid silicone, perfluorocarbon liquid, or mixtures of gases to make sure the retina stays attached to the choroid. The surgeon will remove scar tissue and complete necessary repairs before stitching the incision closed. Depending on the location of the retinal detachment, individuals who have received an injection of gas may be required to lay face down (prone) for several days to encourage the retina to reattach. Injected gas will gradually be absorbed by the body over three to six weeks and replaced with fluid secreted by the eye. Other substances may be resorbed or replaced with saline solution similar to the composition of the eye's original vitreous.

Following photocoagulation or cryoprobe treatment, individuals usually are able to resume normal activity within a short period (generally 3 to 7 days). Medication usually is limited to topical eye drop medicines to prevent inflammation and infection. Individuals who undergo scleral buckling and vitrectomy will take longer to resume normal activities (up to one month). Some individuals may require pain medications for a few days following repair of a retinal detachment, especially when surgical repair was required.

Source: Medical Disability Advisor



Prognosis

If the retina is reattached, vision will be restored to some extent, and blindness in the affected eye will be prevented. However, the degree of restored vision will vary significantly. Scleral buckling techniques successfully preserve vision in about 90% of cases, while procedures involving vitrectomy are successful in about 75% to 90% of cases (Gariano). A small percentage of individuals will not achieve reattachment of the retina, resulting in blindness in the affected eye. The longer a detachment is left untreated, the more damage to the retina and the less vision that is recovered. Fibrous scar tissue growths on the retina are also related to a poor visual outcome.
The initial procedure may fail, or the retina may spontaneously detach several weeks following an apparently successful reattachment; late re-detachments can occur up to 1 year following the surgery in 2% of cases (Williamson). Prolonged inflammation, infection, or bleeding also may occur and prolong recovery. Scar tissue may grow on the retina after a procedure, and reduce visual acuity after recovery in 5% to10% of cases (Gariano). Individuals who have gas injected into the eye to hold the retina in place often develop a cataract that must be surgically removed.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Following retinal reattachment, the individual may require time off from work to attend frequent eye examinations to evaluate recovery and watch for recurrence of a retinal detachment. Bending, lifting, and strenuous activity may be restricted for several weeks, and job reassignment may be necessary if the individual is required to perform these movements. Vision in the involved eye will be impaired for several weeks, so driving may need to be restricted, depending on the individual's binocular function and position. Work duties may need to be temporarily changed if clear vision in both eyes is essential to the individual's work or safety. As the eye heals, eye protection may be required. For a few weeks after surgery, some individuals may be required to hold their head in a certain position for many hours of the day, especially if a gas bubble was used to help repair the detachment. The requirement for maintaining a specific head position may delay return to work. If a gas bubble procedure was used, the individual cannot travel by air until the surgeon gives clearance. If pain medication is needed, company policy on medication use should be reviewed to determine if medication usage is compatible with job safety and function.

Source: Medical Disability Advisor



References

Cited

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

Gariano, R. F., and Chang-Hee Kim. "Evaluation and Management of Suspected Retinal Detachment." American Family Physician 69 7 (2004): 1691-1698. American Academy of Family Physicians. 13 Oct. 2009 <http://www.aafp.org/afp/20040401/1691.html>.

Williamson, Thomas H. "Rhegmatogenous Retinal Detachment: Chapter 5." Vitreo-retinal Surgery. Eds. Marion Philipp, et al. 1st ed. Springer, 2007.

General

Curtis, Jeanette. "Retinal Detachment--Surgery." WebMD. Ed. Kathleen M. Arris. 14 Sep. 2007. 13 Oct. 2009 <http://www.webmd.com/eye-health/tc/retinal-detachment-surgery>.

Hersch, Peter S,, Bruce M. Zagelbaum, and Sandra L. Cremers. "Retinal Detachment Repair: Chapter 64." Ophthalmic Surgical Procedures. 2nd ed. Thieme Medical Publishers, 2009. 335-346.

Source: Medical Disability Advisor






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