Blindness and social security in Italy: critical issues and proposals.

Abstract

In Italy, blindness and low vision are ruled by Law 138/2001: two categories of blindness (corresponding to the one in the current WHO classification), receiving economical remuneration, and three categories of low vision, not directly remunerated. The problem ensues that low vision patients, who better gain from rehabilitation, have no economical contribution to undergo such care pathways; moreover, in Italy the evaluation has not yet shifted from "visual function" to "functional vision", thus lacking a holistic evaluation of visual dysfunction impact on the patient's daily life skills. To quantify the visual function of the examinee, only subjective performance (visual acuity and/or visual field) is evaluated in accordance with Law 138/2001, thus paving the way to malingerers: the "false blinds" phenomenon has recently reached the media. The Authors suggest that a correlation between the individual anatomical picture of the pathology/ies and the visual performance, obtained in patients with similar lesions undergoing controlled clinical studies reported in the ophthalmological literature, could offer more objective values to quantify the visual function.