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 Table of Contents  
Year : 2022  |  Volume : 24  |  Issue : 2  |  Page : 171-175

A Cross-sectional survey on workplace-related difficulties among glaucomatous personnel in aviation maintenance tasks

1 Centre for Sight, Delhi, India
2 Executive Director, NHSRC, Delhi, India
3 Classified Specialist, 6 AF Hospital, Coimbatore, Tamil Nadu, India
4 Professor, Department of Community Medicine, AFMC, Pune, Maharashtra, India

Date of Submission10-Feb-2022
Date of Decision02-Mar-2022
Date of Acceptance21-Mar-2022
Date of Web Publication10-Aug-2022

Correspondence Address:
Lt Col (Dr) Arun Kumar Yadav
Department of Community Medicine, AFMC, Pune - 411 040, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmms.jmms_22_22

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Introduction: Quality of life and work are affected in glaucoma patients due to their disease or treatment. Many papers have identified factors that may affect the life of glaucoma patients. There is no assessment of personnel employed in aviation maintenance tasks suffering from glaucoma at the workplace to the best of our knowledge. Methods: A total of 63 personnel working in aviation maintenance tasks diagnosed with glaucoma were requested to fill a pro forma consisting of 20 questions about their vision-related duties. The questionnaire was designed using a standard technique. The data were entered into an excel sheet and statistically analyzed. Results: About 15.9% had visual problems mainly at night, 4.8% had difficulties walking on uneven ground, 7.9% had difficulty viewing objects in the periphery, 1.6% in crossing roads, 6.3% in climbing stairs, none had any problems in color differentiation, and 1.6% had problems while working on aircraft parts. Conclusions: In the present study, the glaucomatous patient might not have any difficulty in carrying out task in aviation industry; however, regular follow-up and close monitoring of the cohort is required to confirm the findings of the study.

Keywords: Aviation maintenance task industry, glaucoma, quality of life

How to cite this article:
Patyal S, Kotwal A, Raina S, Mahapatra B, Yadav AK. A Cross-sectional survey on workplace-related difficulties among glaucomatous personnel in aviation maintenance tasks. J Mar Med Soc 2022;24:171-5

How to cite this URL:
Patyal S, Kotwal A, Raina S, Mahapatra B, Yadav AK. A Cross-sectional survey on workplace-related difficulties among glaucomatous personnel in aviation maintenance tasks. J Mar Med Soc [serial online] 2022 [cited 2023 Mar 26];24:171-5. Available from: https://www.marinemedicalsociety.in/text.asp?2022/24/2/171/353649

  Introduction Top

Glaucoma is a progressive optic neuropathy resulting in defects in the visual field. It is one of the common causes of visual impairment besides cataracts, age-related macular degeneration, and diabetic retinopathy.[1] This disease affects approximately 2% of persons over the age of 40, and its incidence increases with each passing decade. A variety of glaucoma types are found among Indian adults, namely primary glaucoma (both open and closed angles), juvenile open-angle glaucoma, and secondary glaucoma.

Glaucoma patients suffer from various difficulties due to the disease per se, and due to the medications, they are on. To better understand the effects of glaucoma on patients' lives, numerous studies have been carried out.[2],[3],[4]

Problems faced by glaucoma patients such as a disability in tasks requiring good central and near vision; mobility outside the home; difficulty in walking and driving; difficulties related to lighting such as glare; and difficulty in adapting to different levels of light, climbing stairs, face recognition, loss, or impaired balance have been the subject of many researchers.[5],[6],[7]

Despite a wealth of knowledge in literature about difficulties faced by glaucoma patients and their quality of life, a lacuna was felt to understand how glaucoma patients could carry out their tasks, especially in the aviation maintenance industry, where the fine quality of vision was a mandatory requirement. Hence, the study was conducted to identify workplace-related difficulties among glaucomatous patients in aviation industry.

  Methods Top

The study population was defined as the patients diagnosed with glaucoma by an ophthalmologist and working in the aviation industry. A central registry of medical records is maintained. From this central registry, 64 men were identified as being suffering from glaucoma. The contact details of the personnel were extracted, and they were contacted for participation in the study.

Data were collected with the help of a self-administered questionnaire about workplace-related difficulties [Supplementary Table 1]. These questionnaires were sent to concerned individuals, and a local medical officer was requested to ensure the filling and return of the questionnaires. The contact number of the investigator was given in the questionnaire form for any clarification.

Development of questionnaire

A literature search was done for an existing validated questionnaire that could be used, but none was found, which covered all the tasks performed by the aviation industry. Hence, a questionnaire was prepared by two medical officers in aviation, a medical officer (administrator), an ophthalmologist, and a specialist in glaucoma. The questionnaire encompassed duties performed by men in active service at their place of work, the ability to access medicines, instilling them, and difficulties thereof. The questionnaire was sent to experts for content validity. Additions and deletions were made based on the comments received from experts. The final questionnaire consisted of twenty questions. The questionnaire was translated into Hindi by following the steps described by the World Health Organization in the translation and adaption of instruments. The questionnaire was forward translated and then back translated. The questionnaire was pretested among aviation industry workers with cognitive interviewing and further improved upon.[8] Consent was taken from the participants, by the medical officers, for responding to the questionnaire. The study was given ethical clearance from the institutional ethical committee.

The answers to the questionnaire were coded with simple response terms such as “always,” “quite a lot,” “sometimes,” “a little,” and “none.” This method was similar to levels (no problems, some problems, and severe problems) in the five dimensions of EuroQoL-5D[9] and also a health-related questionnaire by Park et al.[10]

The responses given were quantified by a number 4–0 in descending order, highest level provided for the greatest difficulty and 0 for no difficulty. For testing reliability, Cronbach's alpha of response of the first thirty participants was calculated. The calculated Cronbach's alpha was 0.9, which shows an excellent scale inter-item reliability.

The trade of the participants was divided into two categories: technical and nontechnical. Technical included those tasks which involved electronic devices, electronic devices and circuits, panel aircraft systems, and radar systems. These personnel study physics and mathematics till class XII and are trained in working with specialized equipment. While nontechnical persons did not undergo any training and are entrusted with other routine jobs.

Statistical analysis

The quantified responses were entered in an excel sheet. Categorical variables were presented as frequency and percentage. The median difficulty level was calculated for each task. Statistical analysis was carried out using the Statistical Package for the Social Sciences (SPSS) version 23. (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp) P < 0.05 was taken as statistically significant.

  Results Top

All the 64 personnel recorded as glaucoma were approached for the study, and 63 (98.4%) consented. All participants were male. The mean age of participants was 35 ± 10 years (range: 21–53 years). A total of 43 (68.3%) were in technical trades. The types of glaucoma as per available records are shown in [Table 1]. Best-corrected visual acuity (BCVA) was better than 6/12 in 57 individuals. The BCVA of six personnel is shown in [Table 2].
Table 1: Types of glaucoma

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Table 2: Difficulty level (4) and distribution of glaucoma and intervention among those with impaired vision

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As per records, glaucoma medications included prostaglandin analogs, beta-blockers, alpha-adrenergic agonists, and carbonic anhydrase inhibitors in both fixed-dose combinations (Latocom, Combigan, and Travocom) and individual drug forms. Intraocular pressures were maintained below 18 ± 2 mmHg in all eyes with medication or surgery.

Interventions performed included YAG laser peripheral iridectomy in four patients and trabeculectomy in ten eyes of six patients (one – juvenile open-angle glaucoma, two – primary open-angle glaucoma, two – angle-closure glaucoma, and one – steroid-induced glaucoma). Ahmed glaucoma valve was found to be implanted in seven eyes.

The responses to the questionnaire are given in [Table 3]. A total of 10 (15.9%) participants expressed (level 4) difficulty in firing and adjusting to bright/dim lights. Responses to the number of road traffic accidents and difficulties crossing roads are minimal (only one person has expressed difficulty crossing roads with no history of road traffic accidents among all responders). The highest number of level 4 difficulty was the procurement of glaucoma medicines (50.8% personnel). Fourteen of 63 (22.2%) personnel in our study reported level 4 of fear of blindness. Overall, the median for nine items (45%) was zero. A comparison of the level of difficulty between technical trade personnel and nontechnical trades was also made to assess the difference in the level of difficulties, but no statistical difference was found (P > 0.05) [Supplementary Table 2].
Table 3: Distribution of difficulty score on questionnaire

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  Discussion Top

Glaucoma causes visual disability, which may affect the functionality and quality of life. Various studies using questionnaires, such as Glaucoma Quality of Life-15, Glaucoma Activity Limitation-9, SF-36, EQ-5D, and others, have been conducted.[2],[9],[11] Self-reported disabilities due to glaucoma have been used in many multicenter studies and clinical trials to study the effect of glaucoma in the life of patients.[5] However, we could not find any study being conducted on workers of the aviation industry.

Patients with early or moderate glaucomatous visual loss need more light, suffer from blurry vision and glare, and have a significant visual disability and difficulty in performing tasks such as reading and driving.[12] In our study, out of six individuals with impaired BCVA, three reported no level 4 difficulty in any sphere/task, but two had level 4 difficulty at night (night duty, guard duty at night), etc. Three individuals had difficulty viewing objects in the far periphery, various parades, and obtaining medicines and were affected by dust. We did not find difference in difficulties among technical and nontechnical groups.

Various aspects of vision that may be affected in glaucoma include detecting motion, recognizing patterns (acuity), discriminating borders (contrast), determining color, and observing objects in different parts of the visual field.[13] Loss of blue-yellow sensitivity (early glaucoma) and red-green sensitivity (advanced glaucoma) has also been reported in the literature.[14] All the above difficulties may impact personnel in performing tasks in aviation industry such as walking on uneven ground in airfields, bird hazard team duties, new object detection parade, facial recognition especially at night, crossing roads, and working on small aircraft parts, but our study shows that these have been minimally affected by glaucoma.

Projectile throwing and adjusting to bright/dim lights are most difficult (15.9% personnel), with level 4 difficulty. This may be due to hand–eye coordination required for the task. In that case, we can extrapolate findings of a study by Zwierko et al., where hand–eye coordination tasks of glaucoma patients were compared to normals. Glaucoma patients were found to have slower aiming tests and made more errors of longer duration (linear tracking test).[15]

Responses to the number of road traffic accidents and difficulties crossing roads are minimal (only one person has expressed difficulty crossing roads, and there is no history of road traffic accidents among all responders). This response is quite contrary to the finding by Schultz, where a 65% higher accident rate in glaucoma patients over 5 years was found.[16] Age of the responders (>70 years) in this study was much higher than in our study, and field defects perhaps were larger and deeper in the study group, which may have caused a greater number of accidents.

Procurement of glaucoma medicine is the most common level four difficulty (50.8% personnel). This response is of concern, as many of the medicines are supposed to be available in pharmacy. Fear of blindness is of paramount importance to the patient and can affect his mental well-being. The collaborative initial treatment study found that 34% of glaucoma patients reported at least a moderate amount of fear of blindness. Fourteen of 63 (22.2%) personnel, in our study, reported level 4 of fear of blindness, a significantly lesser number than reported, perhaps due to the fact that they had been counseled about their disease and as they were still able to perform all their duties comfortably, despite their disease.

One of the study's limitations was that since the data on glaucoma were collected from records wherein multiple ophthalmologists have recorded findings, there was a lack of standardization of form, and data on patients' visual fields were not available, and the severity of glaucoma could not be graded. Secondary glaucomas were also included in the study material, wherein visual fields could have been affected by the primary disease. There may also be bias in self-reporting of the difficulties faced due to glaucoma. Another limitation is that the subjective findings of the participants could not be correlated with objective findings.

The responses to the different questions relating to the tasks performed by aviation industry staff convey that overall, their vision and field defects do not hamper their ability to work in conditions. The novel study also opens an area of further research for optimal utilization of the workforce. The registry provides the opportunity to follow up on these patients for outcomes and further research.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Bourne RR, Stevens GA, White RA, Smith JL, Flaxman SR, Price H, et al. Causes of vision loss worldwide, 1990-2010: A systematic analysis. Lancet Glob Health 2013;1:e339-49.  Back to cited text no. 1
Gupta V, Dutta P, Mary OV, Kapoor KS, Sihota R, Kumar G. Effect of glaucoma on the quality of life of young patients. Invest Ophthalmol Vis Sci 2011;52:8433-7.  Back to cited text no. 2
Gupta V, Srinivasan G, Mei SS, Gazzard G, Sihota R, Kapoor KS. Utility values among glaucoma patients: An impact on the quality of life. Br J Ophthalmol 2005;89:1241-4.  Back to cited text no. 3
Onakoya AO, Mbadugha CA, Aribaba OT, Ibidapo OO. Quality of life of primary open angle glaucoma patients in Lagos, Nigeria: Clinical and sociodemographic correlates. J Glaucoma 2012;21:287-95.  Back to cited text no. 4
Ramulu P. Glaucoma and disability: Which tasks are affected, and at what stage of disease? Curr Opin Ophthalmol 2009;20:92-8.  Back to cited text no. 5
Friedman DS, Freeman E, Munoz B, Jampel HD, West SK. Glaucoma and mobility performance: The Salisbury Eye Evaluation Project. Ophthalmology 2007;114:2232-7.  Back to cited text no. 6
Lombardi M, Zenouda A, Azoulay-Sebban L, Lebrisse M, Gutman E, Brasnu E, et al. Correlation between visual function and performance of simulated daily living activities in glaucomatous patients. J Glaucoma 2018;27:1017-24.  Back to cited text no. 7
WHO | Process of Translation and Adaptation of Instruments. WHO. Available form: https://www.who.int/substance_abuse/research_tools/translation/en/. [Last accessed on 2021 Jun 06].  Back to cited text no. 8
Quaranta L, Riva I, Gerardi C, Oddone F, Floriani I, Konstas AG. Quality of life in glaucoma: A review of the literature. Adv Ther 2016;33:959-81.  Back to cited text no. 9
Park S, Kho YL, Kim HJ, Kim J, Lee EH. Impact of glaucoma on quality of life and activities of daily living. Hong Kong J Occup Ther 2015;25:39-44.  Back to cited text no. 10
Goldberg I, Clement C, Chiang TH, Walt JG, Ravelo A, Graham S, et al. Assessing quality of life in glaucoma patients using the glaucoma quality of life – 15 (GQL–15) Questionnaire. Invest Ophthalmol Vis Sci 2005;46:1902.  Back to cited text no. 11
Hu CX, Zangalli C, Hsieh M, Gupta L, Williams AL, Richman J, et al. What do patients with glaucoma see? Visual symptoms reported by patients with glaucoma. Am J Med Sci 2014;348:403-9.  Back to cited text no. 12
Gothwal VK, Reddy SP, Bharani S, Bagga DK, Sumalini R, Garudadri CS, et al. Impact of glaucoma on visual functioning in Indians. Invest Ophthalmol Vis Sci 2012;53:6081-92.  Back to cited text no. 13
Niwa Y, Muraki S, Naito F, Minamikawa T, Ohji M. Evaluation of acquired color vision deficiency in glaucoma using the Rabin cone contrast test. Invest Ophthalmol Vis Sci 2014;55:6686-90.  Back to cited text no. 14
Zwierko T, Jedziniak W, Lesiakowski P, Śliwiak M, Kirkiewicz M, Lubiński W. Eye-hand coordination impairment in glaucoma patients. Int J Environ Res Public Health 2019;16:4332.  Back to cited text no. 15
Glaucoma Patients at Higher Risk of Car Accidents. American Academy of Ophthalmology; 2017. Available from: https://www.aao.org/editors-choice/glaucoma-patients-at-higher-risk-of-car-accidents. [Last accessed on 2021 Jun 06].  Back to cited text no. 16


  [Table 1], [Table 2], [Table 3]


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