Vision impairment: To register or not to register? That is the question

Abstract

For patients to enjoy the benefits of vision impairment registration, they need to be certified by an ophthalmologist. There have been concerns about barriers and a lack of awareness of benefits and certification criteria among ophthalmologists leading to under-registration. The purpose of this study was to gain insight into the certification process in terms of potential barriers, clinical decision-making, and understanding of current guidelines and registration benefits. Ophthalmologists completed a survey on understanding registration benefits and barriers for certification ( n = 22) and a survey on clinical decision-making in certification ( n = 21). Furthermore, visual function and registration data were collected at a hospital Low Vision Clinic in Edinburgh from all new referrals ( n = 89) over a 4-month period from August to November 2020. Our study showed that the main barriers for vision impairment certification were insufficient awareness of registration benefits, uncertainty of when to certify, and a lack of time in clinic. Ophthalmologists were more confident about certification of ocular versus neurological visual impairment. In terms of clinical decision-making, the ophthalmologists’ survey placed most importance on visual-field assessments, followed by visual acuity. Very little importance was placed on contrast sensitivity. Our findings suggest that ophthalmologists would benefit from more education into the benefits of registration and more guidance when registering patients with neurological conditions affecting functional vision in particular. It may be beneficial to highlight the role of contrast sensitivity during the certification process to ophthalmologists.