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In March 2017 there were 290,475 people registered as either visually impaired or severely visually impaired in the UK [1]. Patients registered as sight impaired benefit from financial support as well as practical help. Practical help is provided by social services in the form of special equipment and training [2].

Examples of financial support includes subsidised council tax bills, free public transport passes, and reduced fees for TV licences. There are some concerns that despite the advantages, not all eligible patients are being certified as sight impaired and are therefore missing out on these benefits [3]. This short article will explain who is eligible for certificates of visual impairment, the process of doing so, and some of the practical help that can be offered to improve the lives of those living with visual impairment.

Eligibility [4]

Patients can either be classified as severely sight impaired or sight impaired. Those registered as severely sight impaired are eligible for greater degrees of support.

 People can be classified as severely sight impaired if they fall into one of the three categories:

Severely sight impaired
  • Group 1 Visual acuity worse than 3/60 (or equivalent)
  • Group 2 Visual acuity better than 3/60 but worse than 6/60 but also have contraction of their visual field
  • Group 3 Visual acuity of 6/60 or better with clinically significant contracted field of vision which is impairing the person, e.g. significant reduction in inferior field or bi-temporal hemianopia

 

People can be classified as sight impaired if they fall into one of the three categories:

Sight impaired
  • Group 1 Visual acuity between 3/60 and 6/60 with full visual field
  • Group 2 Visual acuity between 6/60 and 6/24 with moderate contraction of visual field, e.g. superior or patchy loss, media opacities or aphakia
  • Group 3 Visual acuity of 6/18 or better with marked visual field defect, e.g. homonymous hemianopia 

 

Ultimately it is a matter of professional judgement for the consultant whether the person’s visual loss impairs their functional activities. Contribution from the Eye Clinic Liaison Officer (ECLO) or other clinic staff may be beneficial.

 

 

The process

Once the decision to certify a patient as sight impaired has been made, the process is straightforward. The form was updated in August 2017 to simplify the process and avoid administrative time. Concern around presumed bureaucracy is one reason why clinicians are reluctant to complete the certification of visual impairment.

Figure 1: CVI (Certificate of Visual Impairment).  

The consultant needs to complete part 1 and 2 of the Certificate of Visual Impairment (CVI) (Figure 1). Other eye clinic staff including the ECLO can complete other parts of the form. The patient should be provided with the information booklet ‘Sight Loss: What we need to know.’ This has been written by people with sight loss.

The CVI acts as a formal referral route for someone with sight loss to social services.

Once completed, the form is sent to an ECLO who creates a Royal National Institute of Blind People (RNIB) number. The patient is registered with the local council and is contacted by the sensory team who can arrange an assessment of the home and provide cane training if required. They are able to arrange instalment of handrails, provide mobility training, and give advice about everyday activities including food preparation.

Low vision clinics

Patients can also be seen in low vision clinics. Patients who are not registered as sight impaired are also eligible to access these services. The purpose of these clinics is to give patients a better understanding of their condition, to re-engage them with treatment, and to assess their functional vision.

 

Figure 2: Low vision clinics can provide equipment like lights, magnifiers, filters and telescopes, and train patients to use them.

 

Often patients do not understand their condition and are pessimistic about their future. Having longer appointments where complex concepts can be clearly explained can be very reassuring for patients. Functional visual assessments aim to identify how patients are using their vision and to understand why they are struggling with everyday tasks. Training, like eccentric fixation training where patients are trained to use better areas of their vision, can dramatically improve their visual function.

 

Figure 3: Adaptations like increasing light or reducing glare can significantly improve vision and ultimately quality of life.

 

These clinics can also provide equipment to patients to aid their visual function and train them in their use. These include lights, magnifiers, filters, and telescopes. They have a wide variety of equipment and techniques available as not all equipment will be suitable for every patient. Simple adaptations like increasing light or reducing glare can significantly improve vision and ultimately quality of life.

There are huge benefits of being registered which should be considered for individuals with sight impairment. Becoming registered opens doors which gives them access to support and may well allow them to continue having ongoing useful vision.

 

References

1. Registered Blind and Partially Sighted People, England 2016-17. NHS Digital
https://digital.nhs.uk/data-and-information/
publications/statistical/registered
-blind-and-partially-sighted-people/
registered-blind-and-partially
-sighted-people-england-2016-17

2. Registering as sight impaired. RNIB
http://rnib.org.uk/eye-health/
registering-your-sight-loss

3. Simkiss P, et al. Making certification and registration consistent in England, 2013, RNIB.
4. Department of health, Certificate of Vision impairment, Explanatory notes for Consultant Ophthalmologists and Hospital Eye Clinic Staff in England, August 2017.
(All links last accessed September 2019).

 

Huge thanks to former Specialty Trainee Section Editor Jan Huelle for his brilliant contributions to this section over the years. Congratulations on your consultant post in Munich!

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CONTRIBUTOR
Patrick Hughes

Peninsula Deanery.

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