‘All the doctors did, was doing the medical bit. They are not interested in daily living.’
‘I was never offered certification for my sight impairment.’
‘I would have liked certification 4 years ago.’
These are some of the comments from patients from my local Macular Society support group, who I interviewed about certification and registration.
Why are so many patients not offered certification for their sight impairment from the moment they are eligible?
Are we assuming that someone else will have offered it, only to find out that that ‘somebody’ is called ‘nobody’?
Are we too busy to consider our patients’ practical needs?
Are we unfamiliar with the criteria for certification?
In this blog, I will explain certification criteria for Scotland, England and Wales.
Eligibility criteria differ slightly between nations. It is worth noting that the criteria for certification are provided as a guide, not as a strict set of rules. The purpose of certification is ultimately to offer appropriate support for the level of visual difficulties affecting a person’s everyday life, and this depends on visual parameters, as well as personal circumstances.
The following sections provide a summary of the eligibility criteria for Scotland, England and Wales, based on the ‘Explanatory Notes for Eye Care Professionals’ for each nation.
Eligibility criteria for certification of Severe Sight Impairment
Snellen acuity worse than 3/60 and a full visual field
If a person’s vision is below 3/60 Snellen (1.3 LogMAR) they are entitled certification for severe sight impairment, even when their visual field is full.
Snellen acuity 3/60-6/60 with severely reduced visual field
Patients with a Snellen acuity between 3/60 and 6/60 (1.0-1.3 LogMAR) are entitled severe sight impairment certification, provided that they have a severely reduced or contracted visual field, such as tunnel vision. In Scotland, the Explanatory notes add that this does not include long-standing visual defect without field restriction such as congenital nystagmus, albinism or myopia.
Snellen acuity 6/60 or better with very reduced/ functional impairment
Patients with a Snellen acuity of 6/60 (1.0 LogMAR) or better are entitled certification, provided that they have a very reduced visual field or functional impairment, particularly if this includes a lower field impairment. In England and Wales, this also includes bi-temporal hemianopia. In Scotland, a bi-temporal or homonymous hemianopia is only included if the Snellen acuity is below 6/18 (0.5 LogMAR).
Eligibility criteria for certification of Sight Impairment
Snellen acuity 3/60-6/60 and a full visual field
If a person’s vision is 3/60-6/60 Snellen (1.0-1.3 LogMAR) they are entitled certification for sight impairment, even when their visual field is full.
Snellen acuity of 6/24 or worse with a moderate reduction of central field
If a person has a vision of 6/24 Snellen or worse (0.6 LogMAR) with moderate reduction of their central visual field, they qualify for certification of sight impairment. In the English Explanatory Notes, this includes cloudy or blurry, superior or patchy fields. In Scotland and Wales, this includes media opacities or aphakia.
Snellen acuity of 6/18 or better with a severe field defect
If a person has a vision of 6/18 or better (0.5 LogMAR) and a large part of their visual field is missing, they are entitled certification for sight impairment. Examples are homonymous hemianopia and peripheral field impairment, or marked contraction of the visual field.
Further information
Overview of criteria (visual parameters) for England, Scotland and Wales:
Article about certification and registration, presenting a survey amongst ophthalmologists:
Educational articles about certification and registration:
