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[Problems for ophthalmologists in the certification of blindness ]
1Abteilung für Schielbehandlung und Neuroophthalmologie, Zentrum für Augenheilkunde der Justus-Liebig-Universität, Giessen. michael.h.graef@augen.med.uni-giessen.de
Background:
We compared the medical test results of 117 persons examined by the superintendent for blindness assessment in 2002 with their certificates of blindness (5.5% of the applications, 42% of the testimonial examinations performed in Hessen in 2002).
Methods:
If the ratings as "blind" or "severely visually handicapped" (corresponding to a visual acuity of not more than 0.02 or 0.05, resp.) differed between the medical test and the certificate, visual acuity, visual field, further findings, and the methods of assessment were analyzed on the basis of the medical records.
Results:
The medical test confirmed 75 certificates. Fourteen persons with a certificate of blindness were graded as severely visually handicapped by the medical test. In 8 and 12 cases, respectively, the criteria of neither blindness nor severe visual handicap were fulfilled. Eight persons with a certificate of severe visual handicap were graded as blind by the medical test.
Discussion:
In 29% of the cases, the visual handicap did not reach the certified grade. Striking differences occurred between the certificate and the functions shown in the medical test. In the certificates, the declared visual handicap was regularly judged to correspond to the objective findings, but apparently in these cases symptom validity had not been critically assessed. An improvement of diagnostic validity could be achieved using relatively uncomplicated subjective and objective tests.