A
more thourough study of this aspect is presented
in the French section of this website.
French disability laws and specific evaluation of the legislation is
considered in the scope of severe ocular surface disease. We would very
much welcome similar analysis of disabilities evaluation rules from
other countries. While legislative situations may differ signicantly, we
are certain that there are many analogies due to the poor understanding
of the disabilities caused by OSD and dysfunctional tear syndromes (DTS)
generally. Too many situations remain overlooked or ignored, there are
too many incoherences to consider that a proper evaluation of these
disabilities are possible. Here are some obvious conclusions of our
evaluation in France that may be applicable to most countries worldwide.
1. All eye disabilities problems are seen solely through
their visual aspect and chronic eye pain is totay disregarded. While OSD
and DTS may have very serious visual implications, severe ocular pain is
not at all considered as disabiling. Science, however, has clearly
demonstrated that the cornea is the most sensitive tissue of the human
body. Besides that, corneal sensivity pain is obvious for anyone who's
had the smallest grain of sand or just a drop of limon in their eyes
once in their lives, but that still not the case for the French
disability evaluators... Constant pain in an organ that is used in 80%
of our activities is not seen a disabiling in France... We were told
that pain is subjective and therefore pain cannot lead to indemnisation.
This argument is falacious in our opinion for several reasons incduing
that: pain is clearly related to the sensivity of a giving tissue and
the cornea is the most sensitive one, severe ocular pain is most that
likely in corneal erosions; subjective consideration of pain and
disabilities are considered elsewhere for instance any mental handicap
will rely on the professional judging it, not in an objective
measurement of the said disability, the French relevant legislation
clearly considers pain as being part of many disabilities (back pain for
instance and some neurological disorders) then why not consider at the
same level for the MOST SENSITIVE ORGAN OF THE HUMAN BODY! Yet
another mystery...
2. Visual acuity of OSD sufferers and particularly those
with DTS may differ significantly due to many factor including
environemental factors, lack of tears, artificial drops, corneal
erosions, cicatricial astigmatism etc. These factors may explain why the
sight of dry eye patients is constantly changing, carrying other
consequences such as headaches, difficulty in concentration and focus,
etc.
3. Environmental factors are disregarded - The awareness
of the well known impact of air conditioner, computer use, over-heating
and such other environmetal factors common in our professional
environnement has clearly not reached the French disability evaluation
committees.
4. Two similar commissions in different places of the
French territory may have very different understanding of the ocular
surface handicap. Some of our members are been well evaluated for rather
mild conditions whereas some severe cases were considered as not very
disabiling. By confronting several cases personnally we were able to
demonstrate there is no uniformity in the treatment of these matters and
all relies on the subjective judgement of one specific group of
individuals in charge of disability in a giving place. Hopefully DTS
sufferers will be "judged" by a commission where one of the members has
been confronted himself to severe eye pain once in his life or has met
someone who did so.
5. Photophobia although present in the evaluation is
considered as a minor issue, whereas for some OSD opening the eye is
clearly a challenge. Isn't a closed eye a disability in modern world. We
believe it's not worth commenting any further...
6. Loss of transprence is not considered in the
evaluation, however, this affect seriously corneal erosions sufferers.
While they may be albe to see under perfect conditions, such as an
iluminated eye chart in a dark environment they may be unable to see at
they same distance when the light is pointed on the eye and not at
the object.
7. Cicatricial astigmatism and its consequences are
totally disregarded (troube reading, headaches, visual aberrations,
etc).
8. Frequent corneal erosion sufferers are not considered
when these may have to close their eye shut many weeks per year during
those episodes. Visual problem are not analysed throught their chronic
aspect but just through one pucntual exam.
9. OSD imposes constant care (even nightime care) on
their sufferers and yet this aspect is not considered as disabiling when
such treatments are either unpractical in daily life professional
activities or totally impossible. Eye care logistics is also an
important issue and some dry eye sufferers need a humidifier, drops,
medications, sometimes a fridge for cyclosporine or autologuos serum
constantly.
10. Last but not least... The evaluation mentions watery
eyes as a criteria for disability WHEN THE ABSENCE OF TEARS OR LOW TEAR
QUALITY IS TOTALLY UNADDRESSED. How logic does that seem to you
considering that watery eyes is a reaction to limited lack of tears,
which certainly is less serious than having no tears or having toxic
tears for the ocular surface? Not worth commenting any further most
probably.
This internal study was made based
on French law and the experience of all participating members of
Keratos. While this may not be relevant for mild dry eye sufferer, it
clearly identifies huge gaps in French disability legislation and
indicates us obvious leads for future DTS awareness work ahead of us!
Please send us relevant
information on DTS disability evaluation issues from your country or any
other study of the impact on the quality of life.
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