202756854.

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Exam Date: SSN:

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Flow Chart: Laser Worker Surveillance Program WFF Health Unit

Parameter
!nci ental personnel Laser worker

Response
Yes Yes No No

Tests require
Baseline visual acuity Baseline visual acuity; ocular hx; medical hx; Amsler Grid Test; color vision

Comments

In medical surveillance program Maintains minimum safe distance from system Uses protective gear at all times lasers in operation is! classification assigned "y #$ %avelengths of radiation used &list' "cular Histor#

Yes

No

Yes

No

Yes

No

Yes

No

(( eyes #ast )x *am )x (orr lenses #hotosensiti+, ing drug used Apha!ic

No No No No No #henothia+ines psoralens other

No %N%N%N.uadrant/ - upper lo0er - inner outer - upper lo0er - inner outer

$isual %cuit#

Near vision *ar vision

&acular 'unction

Amsler Grid Blan! areas

1cotomata

.uadrant/

Color $ision

Ishihara

%N-

Ref: http/22nodis34gsfc4nasa4gov2display5ir4cfm6Internal7I58N7#

79:;;7;;9B7<page7name8(hapter3 A*$1) 1td4 l=l,l; dated >23;2:;? "Health Hazards Control for Laser Radiation", AN1I @93=49 , 9A:= "Safe Use of Laser."

202756854.doc Name:

Exam Date: SSN:

$ther %NNone

DOB:

Fun uscopic

$pacities

A"normal ocular function only Blurred

$ptic disc $ptic disc color *oveal reflex Macula Retinal )yperpgimt 5epigment 5egenerat Bxudates A2C atio Skin e(amination )x photo sensitivity )x UC laser 0or! )x derm dx (urrent dx Ds "eing ta!en HU rec other e(am:

1harp

#resent A"sent %ell,defined Blurred No No No No %NYes/ exam No/ s!in not nec Not preplacement; only periodic Yes Yes Yes Yes

No

Yes

No No No

Yes Yes Yes #hotosensiti+ing used currently D

Frequenc#/ As determined "y ris! &see "elo0'4 !nci ental Personnel ) e'inition*: Bxposure possi"le "ut unli!ely that they 0ill "e exposed to laser energy sufficient &(lass III" and IC' to cause physical damage? e4g4? custodial? clerical? supervisory personnel4 &e ical surveillance 'or inci ental personnel includes "aseline visual acuity4 Laser Workers ) e'inition*: #ersonnel 0ho 0or! routinely in laser environments 0ith higher po0ered lasers &i4e4?(lass III" and up' and are ordinarily protected "y engineering2procedural protocols4 &e ical surveillance 'or laser workers: ocular and medical histories? visual acuity? Amsler Grid Test? and color vision tests as descri"ed "elo04

Ref: http/22nodis34gsfc4nasa4gov2display5ir4cfm6Internal7I58N7#

79:;;7;;9B7<page7name8(hapter3 A*$1) 1td4 l=l,l; dated >23;2:;? "Health Hazards Control for Laser Radiation", AN1I @93=49 , 9A:= "Safe Use of Laser."

202756854.doc Name:

Exam Date: SSN:

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+e'inition: "cular Histor#, The past e#e histor# and 'amil# histor# is revie0ed4 Any current complaints relate to the e#es are noted4 InEuiry is made into the general health status 0ith a special emphasis upon systemic diseases that may produce ocular pro"lems4 Use of corrective lenses is recorded4 (ertain medical conditions may cause the laser 0or!er to "e at an increased ris! for chronic exposure4 Use of photosensiti-ing me ications? such as phenothia+ines and psoralens? may lo0er the threshold for "iological effects in the s!in? cornea? lens and retina4 %phakic in ivi uals &a"sent lens' 0ould "e su"Fect to additional retinal exposure from "lue light and near ultraviolet and ultraviolet laser radiation4 Unless chronic vie0ing of these 0avelengths is reEuired? there should "e no reason to deny laser operations to these apha!ic individuals4 $isual %cuit#, Cisual acuity for 'ar and near vision is measured according to esta"lished procedure4 Re'raction corrections should "e made if reEuired for "oth distant and near test targets4 If visual acuity does not correct to G;2G; for distance and Haeger 9 for near? an examination is reEuired as listed in section 34G4>4 &acular Function, An %msler gri or similar pattern is used to test macular function for istortions and scotomas4 If any distortions or missing portions of the grid pattern are present? the test is not normal4 Color $ision, (olor vision iscrimination is documented "y !shihara or similar color vision tests4 .(amination o' the "cular Fun us with an "phthalmoscope, This examination is administered to individuals 0hose ocular function tests? 0hich are descri"ed a"ove? are not normal4 The points to "e covered include/ the presence or a"sence of opacities in the media; the sharpness of outline of the optic disc; the color of the optic disc; the depth of the physiological cup? if present; the ratio of the si+e of the retinal veins to that of the retinal arteries; the presence or a"sence of a 0ell,defined macula; the presence or a"sence of a foveal reflex; any retinal pathology that can "e seen 0ith an ophthalmoscope/ hyperpigmentation? depigmentation? retinal degeneration? exudates4 1mall deviations from normal should "e descri"ed and carefully locali+ed4 5ilation of the pupil is reEuired4 Skin .(amination, Bxamination of the s!in is not reEuired 'or preplacement examinations of laser 0or!ers; ho0ever? it is suggested for employees 0ith history of photosensitivit# or 0or!ing 0ith ultraviolet lasers4 Any previous ermatological a/normalities and family history is revie0ed4 Any current complaints concerned 0ith the s!in are noted as 0ell as the history of medication usage? particularly concentrating on those rugs 0hich are potentiall# photosensiti-ing4 "ther .(aminations, *urther examinations are performed as deemed necessary "y the %** )U #hysician4 )0* &e ical Re'erral Following Suspecte or 1nown Laser !n2ur#: Any employee 0ith a suspected laser eye and2or s!in inFury should contact the $ccupational )ealth facility immediately4 The postexposure examination includes items as listed a"ove as deemed necessary "y the %** )U #hysician4 )3* Recor s an Recor Retention: (omplete and accurate records of all laser medical examinations are maintained for all personnel included in the medical surveillance program4 ecords are retained for at least 3; years4 The results of medical surveillance examinations are discussed 0ith the employee4

Ref: http/22nodis34gsfc4nasa4gov2display5ir4cfm6Internal7I58N7#

79:;;7;;9B7<page7name8(hapter3 A*$1) 1td4 l=l,l; dated >23;2:;? "Health Hazards Control for Laser Radiation", AN1I @93=49 , 9A:= "Safe Use of Laser."