An individual can have acuity better than the definition of legal blindness and still have significant difficulty functioning due to reduced contrast sensitivity. There are many validated tests that are easy to do during an ocular evaluation.
The Listing of Impairments (listings) describes medical conditions that are severe enough for SSA to consider a person to be disabled. You can find more information about the listings at http://www.ssa.gov/disability/professionals/bluebook
On March 28, 2013, we published the final rule for evaluating cases involving visual disorders in adults and children under titles II and XVI of the Social Security Act. As part of those revisions, we introduced listing 2.04, loss of visual efficiency, or visual impairment, in the better eye, and listing 102.02 loss of central visual acuity.
Since publication of the final rule, there may have been advancements we should consider in medicine, technology, testing, and treatment. We invite the medical community, adjudicators, and members of the public to comment on how we can further enhance our visual disorder listings in these areas. Therefore, we request your input by providing responses to the following questions:
Issues for Comment
- Are there important advancements in medicine, technology, testing, or treatment of visual acuity or visual field loss not currently considered that we should consider in our listings for visual disorders? If so, what are they?
- When a person has corrective surgery such as vitrectomy or refractive laser surgery, how should we evaluate the results of treatment? What is the timeframe post-surgery when visual acuity or visual field loss testing can be conducted?
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Recent changes in disability determination allow for the use of mean deviation from static computerized visual fields as a means of determining disability under 2.03B and 2.04B. This is convenient, as it is a single number readily available from the visual field printout. I'm recommending this be reconsidered, in light of the fact that mean deviation is an age-dependent calculation, and is therefore discriminatory by ...more »
Visual Impairment needs to include: hemianopia field loss, photophobia, diplopia, impaired depth perception, debilitating loss in contrast sensitivity, debilitating glare sensitivity, central/paracentral scotomas, ring scotomas, central visual acuity loss 20/60 or worse, peripheral field limitation (widest diameter of field subtends no greater than 60 degrees)
Quantitative lighting assessment following a standard protocol and used in conjunction with appropriate lighting recommendations may provide significant gains in visual performance for near tasks at low cost. For example, Fletcher et al (ARVO, 2014) showed that AMD patients gain an average of over 2 lines with increased lighting, and those with ring scotomas gain an average of 4 lines. Succar et. al. (ARVO 2015) showed ...more »
Issues for Comment: 1.) Changes in electronic and optical technology over the past decades have led to many significant advances in ophthalmic devices and testing procedures. Laser scanning devices have become common-place. Specifically, Optical Coherence Tomography (OCT) is routinely used to measure central macular thickness (CMT,) image retinal microstructure and to analyze optic nerve cupping and retinal Nerve Fiber ...more »
1. Given the advancements in cataract surgery, we need to speak to the reduced risk of retinal detachment following this surgery. The newest laser surgery treatment does not increase the risk of possible retinal detachment as the older scalpel methods. I would like to see the listings address this issues. 2. I think we should evaluate post vitrectomy and laser surgeries based on the their success. That is to say; does ...more »
This is a follow up to the proposed question about being evaluated post surgically - e.g., what is the timeframe until evaluation can be performed to determine outcome. Answer: It depends on the procedure. For vitrectomy and retinal surgeries (with no additional surgery planned, including secondary cataract extraction), at 9-12 most, impairment finding including VA are typically maximized and function often stabilized. ...more »
Visual Impairment needs to include those debillating sequela from traumatic brain injuries: field loss, photophobia, diplopia, impaired depth perception/binocular dysfunctions, severe oculomotor dysfunctions, impaired visual memory,debilitating glare sensitivity as well as vestibular ocular dysfunctions.
As a practitioner and faculty in low vision rehabilitation, as well as the Chief of Vision Rehabilitation Services, I am submitting points for consideration in regards to your vision standards. A remaining visual field of 20 degrees or less is not, in my clinical experience and based on research, an appropriate cut off for significant functional decline. In clinical research, 40 degrees appears to be the point where ...more »
Please see attachment for ideas regarding DDS Admin Ltr #943 --Evaluating Visual Disorders and SSA's Disability Process. Thank you.
The acuity listings which have been used for many years are based on a Snellen acuity. The Snellen chart has no measurements between 20/100 and 20/200. Thus, anyone with acuity of less than 20/100 has been considered eligible. Many low vision assessments not have many increments between 20/100 and 20/200. If the Administration is going to move away from the Snellen acuity measurement, then the standard for legal blindness ...more »
Issues for Comment Question 1.) Lengthy answer concerning new technologies that should be considered in the listings for visual disorders.