You are here
Home > Clinical Archive > Expanding the horizons of optometry practice: a visual ergonomics perspective

Expanding the horizons of optometry practice: a visual ergonomics perspective

Jennifer Long is an optometrist, a Certified Generalist OHS Professional and a Certified Professional Ergonomist, specialising in visual ergonomics. Based near Sydney, Australia, Jennifer has been self-employed as a visual ergonomics consultant since 2006. Her primary expertise is visual displays and lighting, particularly as it applies to control room environments. Jennifer is also a conjoint senior lecturer at the School of Optometry and Vision Science, UNSW, where she teaches undergraduate optometry students the subjects Environmental Optometry, Clinical Examination of Colour Vision and Radiometry, Photometry and Colorimetry. Recently she has been involved in research projects at UNSW investigating visual comfort with smartphones. Her website is www.visualergonomics.com.au and she can be contacted by email at jlong@visualergonomics.com.au


Many people seek optometry care to improve their vision, so they can see tasks comfortably and easily. Spectacles and contact lenses may provide a solution – but only if the person has a correctable visual deficit. What if the cause of their difficulties is related to their work environment, such as poor lighting? Or the fact that the font size on their digital device is miniscule?

Visual ergonomics is commonly associated with vision and computers, but it has a much broader scope with applications in transport, mining, healthcare, retail, defence and manufacturing, just to name a few. This article describes some of the ways visual ergonomics can be incorporated into optometry clinical practice to enhance the care you give your patients. It also provides my personal perspective for how I have developed a career as a visual ergonomics consultant and some of the practical issues to consider should you venture down this path.

What is visual ergonomics?

Visual ergonomics is a sub-speciality within ergonomics. It is concerned with “understanding human visual processes and the interactions between humans and other elements of a system” with the purpose of “optimising human well-being and overall system performance” (from the definition of visual ergonomics, International Ergonomics Association Visual Ergonomics Technical Committee, https://www.iea.cc/about/technical.php?id=51df9aa27ebf9).

In other words, visual ergonomics looks at the whole system – the individual, the task and the environment – to improve visual performance.

An imbalance within the system, such as when the visual demands of the task exceed the visual capabilities of the individual, can lead to dissatisfaction, discomfort and poor task performance. A practical example is the design of a road sign: if the font size on the sign is too small for drivers to read, then drivers may miss reading critical information, which in turn could create an inconvenience if they turn down a wrong street, or it may delay their response to reading critical information which in turn could affect their safety.
Visual ergonomics aims to get this balance right. This can be achieved in the consultation room by improving our patient’s visual ability with optical appliances, or by providing advice which our patients can apply to their work or home environment. It can be achieved in workplaces by ensuring that equipment is set up for optimal viewing, or by providing lighting which is appropriate for the task and the environment. Visual ergonomics also has a role in product design (such as digital interfaces and signage), so that products can be used by people with a range of visual abilities.

Visual ergonomics in the consultation room

The traditional office computer consists of a computer tower (containing the hard-drive), monitor, keyboard and mouse, all located on a workstation assigned to an individual.

Fast forward to the 21st century. Desktop computers have given way to a myriad of digital devices such as laptops, smartphones, tablets and watches. There is a trend for activity-based work areas in offices where individuals no longer have their own workstation, but may change their work area according to their work task. There are also increasing numbers of people who use digital devices at home or in transit.

This has put the onus on individuals to ensure that their interaction with digital devices is visually comfortable.

Clinical optometrists are in a prime position for helping patients understand how to improve their visual comfort when using digital devices. Advice could include recommendations for appropriate spectacle lenses, especially for presbyopia, or advice about working distances, management of glare and frequency/duration of rest breaks. Accurate advice is contingent on the optometrist understanding the visual environment in which the patient works. This can be determined by asking patients to describe or draw a diagram of their work environment (for example, number of displays, relative location of displays), or better still, bring in a photograph.

Visual ergonomics in the consultation room – not only for working age patients

Visual ergonomics advice is not the sole province of optometry practices with working-age patients. I have found my visual ergonomics knowledge extremely valuable when working with children and with older aged adults.

Mavis was an independently living, eighty-five- year old lady, who presented for a routine eye examination, because she was having difficulty sewing. She wanted new spectacles.

“What do you sew?” I asked.

Mavis fossicked in her bag and produced an elaborate embroidery project sewn on black fabric. “I take it everywhere. You never know when you will get the opportunity to sew.”

Despite nuclear cataracts, Mavis had exceptional vision: 6/6 in each eye at distance and N5 at near with her current spectacles. This did not explain her visual difficulties while sewing. More telling was her low contrast near acuity (N10) and tritan-type errors on the Standard D15 colour vision test. These results were consistent with her nuclear cataracts and helped explain her difficulty seeing contrast and colours when sewing.

Mavis was not interested in cataract surgery – except for her sewing, she was managing well with her vision and with her current spectacles. Therefore, I took the opportunity to explain to Mavis the visual basis for her difficulties and encouraged her to use lighting which had a good colour rendering index (to help her see the colours more easily) and which provided good illumination (to see the detail in her work).

My journey to become a visual ergonomist

In the 1990s while working in an optometry practice adjacent to an industrial area in Sydney, I had many patients present from local businesses reporting sore eyes, headaches and blurry vision, which they attributed to using a computer at work. To my surprise and frustration, often there was no obvious ophthalmic explanation for their symptoms. Their eyes were healthy, there was minimal refractive error and they had no binocular vision abnormalities.

Curious, I quizzed my patients and discovered that their symptoms were probably not related to their eyes at all, but to the way their work was arranged, the lighting in their workplace or the fact that they did not take rest-breaks during the working day.

This set me on a quest to solve vision problems at their source – in the workplace. I returned to university to study for a Master of Safety Science where I gained useful knowledge about work health safety issues within workplaces and met other professionals working within the health and safety industry. I joined the Human Factors and Ergonomics Society of Australia and the Safety Institute of Australia and attended their professional development events. Although visual ergonomics was not a frequent topic at these events, gaining an understanding and appreciation of the variety of ergonomics and safety issues within workplaces was invaluable for my transition from the optometry consultation room to the workplace. I also became accredited as a Certified Professional Ergonomist (CPE) and a Certified Generalist Occupational Health and Safety (OHS) Professional. This is important for consultants in Australia, because many workplaces prefer to employ external consultants who are accredited by a professional association.

My consultancy work over the past 12 years has included vision screening, assisting individuals with vision problems at work, devising visual ergonomics solutions for existing problems in buildings or on computer interfaces and helping design control rooms so that visual ergonomics problems are not built into a new facility.

Since 2012 I have been the chairperson of the International Ergonomics Association Visual Ergonomics Technical Committee. This has given me the opportunity to build an international visual ergonomics network, which helps people working within visual ergonomics worldwide to connect with each other and keep up-to-date with developments in the field.
So, you would like to work within visual ergonomics?

If you think that consulting to industry is for you, then I suggest that you join your local human factors and ergonomics society and/or safety institute, attend professional development events (even if they aren’t related to visual ergonomics) and get to know the people working within the industry. In South Africa the relevant organisations are the Ergonomics Society of South Africa (http://www.ergonomicssa.com/) which offers competency certification and the South African Institute for Occupational Safety and Health (http://www.saiosh.co.za/) which offers various grades of membership according to your qualifications. I also suggest that you read widely from a range of disciplines (such as lighting, ergonomics, safety, physiotherapy, occupational therapy, computer technology) because not all visual ergonomics research is published in ophthalmic publications. Over time you will discover what specific aspects of visual ergonomics hold more interest for you, and this will help focus your reading.

If your interest is visual ergonomics research, then look within the boundaries of optometry, but also look beyond. Visual ergonomics research is not always labelled “visual ergonomics” and could be nestled within other disciplines such as psychology, occupational therapy, engineering and computer science. Although this may sound daunting, multidisciplinary research can be very satisfying because you are exposed to the perspectives of other people.

Irrespective of whether you apply visual ergonomics knowledge within private optometry practice, in industry or to research, it is important to be within a network of like-minded individuals. This helps reduce professional isolation and it is much easier to keep up-to-date with scientific advances when you interact with others. One such network is the International Ergonomics Association Visual Ergonomics Technical Committee which is free to join (for more information see https://www.iea.cc/about/technical.php?id=51df9aa27ebf9).

Optometrists provide solutions for the visual needs of people. Try looking beyond the individual to the whole system (task and environment). Visual ergonomics can help you provide a more well-rounded solution.

Top