This factsheet has been produced by the Keratoconus Group. It is designed to assist those with keratoconus in the workplace. It contains information and advice for employers to generate a better understanding of keratoconus.
What is Keratoconus?
Keratoconus is an eye condition affecting the cornea (the clear front surface of the eye) which becomes thin and begins to bulge forward, causing the vision to become distorted. It is a rare condition, affecting about 1 in 1,750 people and is most often diagnosed when the person is in their late teens or early twenties although it can occur later.
Some people are only mildly affected by the condition and their vision can be corrected with spectacles. However if the condition progresses, good vision is no longer possible using spectacles but can be attained with special contact lenses. It is one of the few eye conditions where a person may be able to see normally with contact lenses but NOT with glasses. A small minority of people with keratoconus may eventually need a corneal transplant.
“Occasionally, people with keratoconus experience difficulty with contact lens wear and have to leave one or both lenses out for a short period of time”
How does it affect people?
If glasses can no longer correct the vision, rigid contact lenses are usually prescribed. Because the shape of the eye becomes irregular, contact lens fitting may take longer than normal and often takes place in a hospital. Most people do get good correction of vision with lenses and may go for long periods without experiencing any problems, although they may need changes in the prescription of their lenses if the cornea continues to change shape.
Occasionally, people with keratoconus experience difficulty with contact lens wear and have to leave one or both lenses out for a short period of time. Because the vision through spectacles may be poor, they need assistance to continue working to the same standard as when they are wearing their lenses. People with keratoconus are also likely to be light sensitive, and their vision may be affected by glare so they may benefit from shading from direct sunlight (eg blinds) or changes in computer screen brightness. Some people with keratoconus also experience atopic conditions such as eczema, asthma, hay fever and chronic allergic conjunctivitis, which can make lens wear difficult or painful. Dust, wind, pollen, smoke and air conditioning can also cause discomfort. All these things can reduce daily lens wearing time and consequently the time available with good vision.
How does it affect people at work?
Keratoconus is not a visible condition, so there are no cues for others to pick up on. The quality of vision can vary from day to day, and over the course of a day. So someone may be fine in the morning, but find their vision deteriorates later in the day, as their eyes get tired and a dry atmosphere causes their lenses to dry out and become uncomfortable or painful to wear. People with keratoconus will usually find small print and small fonts difficult and/or tiring to read and they may be quite short sighted even with contact lenses. They may experience ‘ghosting’ of the image or double vision. Certain colour contrasts may also be difficult to cope with. 3D vision may also be affected, making it difficult to see the edges of steps or stairs.
How can the employer help?
Every case of keratoconus is different. You may have an employee with keratoconus and not even be aware of the fact, because they are managing perfectly well. People with the condition often refer to themselves as being ‘part-time partially sighted’, having perfectly adequate vision much of the time, but having periods when it may be difficult to see properly.
If someone is experiencing problems at work, only minor adjustments may be enough to make all the difference. It may be helpful to get an individual assessment through the Access to Work scheme, when a professional advisor will assess the person’s work environment and suggest the most appropriate solutions. If any specialist equipment is needed, Access to Work can cover up to 80% of the costs of this for an existing employee, and 100% for a new employee. Access to Work is available for both new and existing employees by applying online to https://www.gov.uk/access-to-work or by phone 0800 121 7479. The person applying for help through Access to Work does not have to be registered as disabled.
- For computer users, a larger screen will make life easier.
- Modern computers have improved significantly, reducing glare and flicker, and often allowing for the Red/Green/Blue ratio to be customised for reduced eyestrain.
- Some fonts are easier to read (eg Arial) and enlarging font size or altering the colour contrast can help.
- Long hours in front of a computer screen dry out the eyes and affect vision – regular breaks from the screen when a different task can be done are helpful for all.
- Enlargement software, screen readers, speech software may be appropriate for some people.
- Ability to enlarge printed documents to A3 using a photocopier.
- Light levels can be important – natural lighting is best, but where that is not possible, avoiding glare or looking at a light source will help (the person with keratoconus is often the one wearing sunglasses most of the day!). A reading lamp may help some people.
- Working in a centrally heated, air-conditioned environment can cause discomfort and difficulty with dry eyes and lens wear. A humidifier, air exchange or any other way of reducing the dryness and heat will be helpful.
- Dusty conditions will cause problems – some people with keratoconus are prescribed with scleral lenses (which cover the whole of the eye) to help with this. If this is not possible, some eye protection, especially designed for dust conditions may be needed.
- Attending conferences, seminars or workshops may cause difficulty if the person cannot sit close enough to see the presentations. Providing hard copy of any slides would be helpful.
- If driving is part of the job, people with keratoconus may find night driving difficult (due to halo effects around lights) and may need to plan their day to avoid driving after dark.
Just one or two of these suggestions may make all the difference to how well the person with keratoconus manages at work.
People with the condition work successfully in all types of employment including highly paid, responsible positions.
It is important to remember that most people with keratoconus will develop their own strategies for coping with most situations and may only need support and understanding if they go through a bad patch with their vision. Periods of difficulty are likely to be short-term, and once the problem has been dealt with, the employee with keratoconus will be just as effective as other work colleagues. For this reason, many people with keratoconus don’t think of themselves as having a disability, although they do have a long-term eye condition which can at times affect their day to day life.
Like many other long-term medical conditions, keratoconus varies in severity and the effect on the vision can fluctuate. Understanding that the problems are genuine and working with the employee to minimise obstacles to efficient working will benefit both employer and employee.