Ophthalmological standards in ocupational medicine – comparison of the Polish and British models based on selected current examples

INTRODUCTION

Every country is unique. Admittedly, all countries have their own territory and population, their own authorities, and their distinctive laws and practices. Country-specific customs cover many areas of life: from what is regarded as culturally acceptable behavior to heroic deeds, from a complex legislative system to simple health requirements applicable to employees. Indeed, each country also has its specific guidelines for the minimum health criteria (including the field of ophthalmology) that must be demonstrated by employees in certain positions [1-5]. In Poland, these standards are frequently set out in ministerial regulations [6-9]. Accordingly, the minimum eyesight requirements which must be met by firefighters are laid down in the Regulation of the Minister of the Interior and Administration of 11 October 2018 on the list of diseases and disabilities along with the categories of fitness to serve in the Police, Border Guard, Marshal's Guard, State Fire Service, and State Protection Service. Similar requirements applicable to train drivers are included in the Regulation of the Minister of Infrastructure and Development of 10 February 2014 on the train driver's license; and to seafarers – in the Regulation of the Minister of Health of 9 December 2015 on the health conditions required from seafarers to perform work on seagoing vessels [6-8]. In the UK, the certification system appears to be far simpler. Occupational visual standards for the professions listed above (and many others) can be found in relevant publications of the Royal College of Ophthalmologists [10, 11].

DISCUSSION

Poland’s current legislation includes the Regulation of the Minister of the Interior and Administration of 11 October 2018 on the list of diseases and disabilities along with the categories of fitness to serve in the Police, Border Guard, Marshal’s Guard, State Fire Service, and State Protection Service (Journal of Laws 2018, item 2035) (6). Pursuant to the Regulation, three categories of fitness to work in the State Fire Service are identified:
Category A – fit for service,
Category B – fit for service with restriction,
Category C – unfit for service.
A detailed list of diseases and disabilities which are taken into consideration in the assessment of physical and mental fitness to work in the State Fire Service is given in Table I [6, 12]. The visual standards required of firefighters in the UK in line with the recommendations of the Royal College of Ophthalmologists are listed in Table II [10, 11, 13]. The visual standards applicable to firefighters in Poland are considerably more elaborate and, with a degree of simplification, they can also be assumed to be more restrictive than the corresponding requirements in place in the UK. For example, a person with corrected visual acuity of 0.7 in the better eye (measured by Snellen chart) cannot be a firefighter in Poland, whereas in the UK they would face no obstacles in pursuing this profession. In addition, Polish firefighters must have normal mesopic vision, and the majority of choroidal and retinal conditions, as well as glaucoma [6, 10-13], are considered as disqualifying factors. The health requirements which are currently enforced with regard to train drivers in Poland are laid down in the Regulation of the Minister of Infrastructure and Development of 10 February 2014 on the train driver’s license (consolidated text: Journal of Laws 2019, item 2373). The detailed vision requirements that should be satisfied by individuals applying to receive or renew their train driver’s license are shown in Table III [7]. The visual standards required of train drivers in the UK in accordance with the guidelines elaborated by the Royal College of Ophthalmologists are listed in Table IV [10, 11]
The minimum visual standards required of train drivers in Poland are less liberal than in the UK, and the visual examination itself is more thorough. Again, an individual with corrected visual acuity of 0.7 in the better eye (measured by Snellen chart) in the UK may be a train driver (also an underground train driver), whereas in Poland this would not be permitted. Additionally, train drivers in Poland must demonstrate normal contrast sensitivity and perform the glare test correctly [7, 10, 11]. The eyesight requirements applicable to working on ships in Poland are set out in the Regulation of the Minister of Health of 9 December 2015 on the health conditions required from seafarers to perform work on seagoing vessels (Journal of Laws 2015, item 2105) [8]. In order to facilitate medical certification, workers on seagoing vessels have been divided into three groups:
group I – masters, deck officers and ratings who are required to assume watch-keeping duties;
group II – all mechanical engineers, marine electro automation officers, marine electricians, ratings and other crew members forming part of the engineering watch;
group III – radio operators.
The detailed conditions for the visual medical examination in seafarers are shown in Table V [8, 14]. The visual standards required of seafarers in accordance with the guidelines recommended by the Royal College of Ophthalmologists are listed in Table VI [10, 11, 15]. On the other hand, the visual standards applicable to seafarers in the UK are more restrictive than in Poland. Let us again consider an individual with corrected visual acuity of 0.7 in the better eye (measured by Snellen chart). In Poland, such a person may become a deck officer, while in the UK this will not be permitted. Even though the ophthalmic examination performed in seafarers in Poland seems more detailed in scope, it needs to be added that mesopic vision and glare tests are required only in specific situations, e.g. in individuals with implanted intraocular lenses, after laser vision correction surgery or for other reasons related to medical examination [8, 10, 11, 14, 15].

CONCLUSIONS

Firefighters, seafarers, train drivers – the development of occupational visual standards applicable to these professions in Poland requires as many as three different regulations and the involvement of as many government ministers. This is a lot – in fact, way too many. In the UK, a single set of guidelines has been proposed by the Royal College of Ophthalmologists to address this problem. Is this insufficient? No, clearly it is perfectly enough. Perhaps it would be worthwhile to take a leaf out of the book of proven methods? Maybe some of the solutions should be communicated to the Polish Ophthalmological Society? As Antoine de Saint-Exupéry used to say: “We often come up with ideas, but far less commonly with solutions”.

Disclosure

The authors declare no conflict of interest.

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