Certification Of Vision Impairment Research Articles

People with dry age‐related macular degeneration; views on certification of vision impairment in a primary care setting: An explorative qualitative study

Evidence supports the clinical decision-making ability of primary care optometrists with additional qualifications in the identification of eligibility criteria for the certification of vision impairment (CVI). Welsh Government policy is driving pathway change to enable these optometrists to perform CVI. This qualitative study explores the views of people with VI due to dry age-related macular degeneration (AMD) on this pathway change. Nine people with VI due to dry AMD, attending Macular Society support groups, participated. Individual semi-structured interviews were conducted and analysed concurrently using thematic analysis. Five major themes were identified: (1) living with dry AMD, (2) experience of eye care provision, (3) knowledge of CVI, (4) provision of information and (5) CVI in primary care. Participants consistently highlighted the need for the provision of accessible information regarding the certification pathway, dry AMD and the optometrist's role in the provision of eye health care. Information needs to be available prior to the diagnosis of an eye disease, rather than only from the point of diagnosis or where the vision reaches the level required for certification. The findings support the provision of CVI within primary eye care while highlighting areas of importance in pathway development. These include the provision of accessible information prior to, at the point of and following the diagnosis of an eye condition. Information provided needs to extend to the awareness of the role of the optometrist in the provision of eye care, and public health awareness of modifiable risk factors, which will influence the possibility of disease development in later life. The findings provide information that will be useful to those responsible for the provision of CVI within primary care.

Confusion around Certification of Vision Impairment (CVI) and registration processes—are patients falling through the cracks?

BackgroundIn the UK, the Certificate of Vision Impairment (CVI) certifies a person as sight impaired (partially sighted) or severely sight impaired (blind). This is completed by ophthalmologists and passed with the patient’s consent to their GP, their local authority, and The Royal College of Ophthalmologists Certifications office. Once a person is certified, they can be registered by their local authority which is voluntary but enables the person to access rehabilitation or habitation services, financial concessions, welfare benefits and other services provided by local authorities.MethodsWe conducted semi-structured individual interviews with 17 patients with a diagnosed eye condition, 4 Eye Clinic Liaison Officers (ECLO) and 4 referring optometrists around their experiences around CVI and registration processes. Analysis of themes was conducted with results synthesised in a narrative analysis.ResultsPatients reported lack of clarity around the processes of certification and registration, benefits of certification and what happens beyond certification, the type of support that they are entitled to, delays in accessing support. Optometrists appear not to engage with the process much, especially if the patient is being treated by the hospital eye service.ConclusionVision loss can be a devastating experience for the patient. There is a lack of information and confusion around the process. The lack of a joined-up process between certification and registration needs to be addressed if we are to provide the support that patients deserve in order to improve their quality of life and wellbeing.

The certification of vision impairment: A regional 21st century perspective

Certification and registration of those who are sight impaired (SI) provides commissioners, and the providers of health and social care support to those with vision loss, with quantifiable data on the extent of blindness and sight impairment within a community. In this article, we outline the results of a comprehensive review of certification/registration pathways and processes in Northern Ireland and highlight achievements to date. The Developing Eyecare Partnership (DEP) CVI Task Group established by the Health and Social Care Board (HSCB) reviewed all certification/registration processes, pathways and issues that may have contributed to regional under certification/registration. This was undertaken to ensure timely certification/registration of those who may benefit from being certified as either Severely Sight Impaired (SSI) or SI, and in so doing improving patient pathways and access to services. Activity included a review of all available epidemiological data collected in the 2-year periods before and after the introduction of the new pathway (January 1, 2018). This work has resulted in changes to the terminology used in relevant Northern Ireland legislation and other documentation concerning certification/registration. It has also resulted in the creation of more timely and efficient referral pathways and improvements in the quality of information available on certification and the process. Increased awareness of the certification process by health and social care professionals has resulted in a 22.5% increase in certifications over the 2-year period, before COVID-19. Certification rates are now comparable with those from other areas of the United Kingdom. The workings of the DEP CVI group, over a 5-year period, have increased awareness about SI and SSI Certification among patients and Health and Social Care Providers and have improved the quality of local epidemiological data on vision impairment. A patient-based evaluation of the new pathway is planned for 2020.

Trends in diabetic retinopathy screening attendance and associations with vision impairment attributable to diabetes in a large nationwide cohort.

AimsTo investigate diabetic retinopathy screening attendance and trends in certified vision impairment caused by diabetic eye disease.MethodsThis was a retrospective study of attendance in three urban UK diabetic eye screening programmes in England. A survival analysis was performed to investigate time from diagnosis to first screen by age and sex. Logistic regression analysis of factors influencing screening attendance during a 15‐month reporting period was conducted, as well as analysis of new vision impairment certifications (Certificate of Vision Impairment) in England and Wales from 2009 to 2019.ResultsOf those newly registered in the Routine Digital Screening pathway (n = 97 048), 80% attended screening within the first 12 months and 88% by 36 months. Time from registration to first eye screening was longer for people aged 18–34 years, and 20% were unscreened after 3 years. Delay in first screen was associated with increased risk of referable retinopathy. Although 95% of participants (n = 291 296) attended during the 15‐month reporting period, uptake varied considerably. Younger age, social deprivation, ethnicity and duration of diabetes were independent predictors of non‐attendance and referable retinopathy. Although the last 10 years has seen an overall reduction in vision impairment certification attributable to diabetic eye disease, the incidence of vision impairment in those aged <35 years was unchanged.ConclusionsWhilst the majority of participants are screened in a timely manner, there is considerable variation in uptake. Young adults, have sub‐optimal attendance, and levels of vision impairment in this population have not changed over the last 10 years. There is an urgent need to explore barriers to/enablers of attendance in this group to inform policy initiatives and tailored interventions to address this issue.

Agreement between ophthalmologists and optometrists in the certification of vision impairment

Background/objectivesThe certification process to register patients as sight impaired or severely sight impaired is undertaken by consultant ophthalmologists, in the UK. We sought to assess the agreement between optometrists and a consensus panel, in identifying patient eligibility for certification, relative to the agreement between ophthalmologists and the consensus panel.MethodsThe consensus panel (4 consultant ophthalmologists and 3 optometrists with a formal accreditation in low vision), 30 consultant ophthalmologists and 99 low vision optometrists reviewed 40 randomly selected abridged cases. The eligibility outcomes from the ophthalmologists and the optometrists were compared with the consensus panel outcomes.ResultsFor ophthalmologists and optometrists, the median (IQR) number of cases in which there was agreement with the consensus panel was 33.0 (31.0, 33.0) and 36.0 (34.0, 36.5), respectively. In severely sight impaired cases, the probabilities of agreeing on eligibility for certification were 76.0% (95% CIs 71.4%, 80.1%) for ophthalmologists and 61.8% (59.0%, 64.6%) for optometrists. In sight impaired cases, the corresponding values were 51.6% (46.7%, 56.4%) for ophthalmologists and 72.2% (69.8%, 74.5%) for optometrists. In cases of bilateral atrophic age-related macular degeneration (AMD), both groups were more likely to agree with the consensus panel and the differences between optometrists and ophthalmologists were less marked.ConclusionsOptometrists demonstrated a comparable agreement relative to ophthalmologists, with the consensus panel on the eligibility of randomly selected, abridged cases for certification. The findings support the clinical decision-making ability of low vision optometrists in the certification of patients with vision impairment and provide evidence in support of policy change to allow low vision optometrists to certify individuals with atrophic AMD.

Certification of Vision Impairment in Patients with Uveitis Attending a Specialist Clinic

ABSTRACTPurpose: To identify the causes of severe visual loss in a UK uveitis clinic, to suggest means of reducing incidence, and to propose improvement in data collection of vision impairment.Patients and methods: Retrospective case series.Results: Over 128 months, 76 (3.5–4% of patients referred) were certified as vision-impaired or severely vision-impaired. The mean age at registration was 48.4 years, 76% were of working age, and 7% were children. The diagnosis leading most often to registration was sympathetic ophthalmia and the most frequent uveitis complications were secondary cataract (whether or not operated upon) in 62%, chronic cystoid macular edema in 43%, and secondary glaucoma in 28%. Visual loss was often multifactorial.Conclusions: Severe and permanent visual loss in uveitis affects people predominantly of working age. It is probably underreported and a restructuring of the certificate of vision impairment may improve data collection. Early referral to a tertiary center may reduce the incidence of vision impairment.

Retrospective analysis of newly recorded certifications of visual impairment due to diabetic retinopathy in Wales during 2007–2015

ObjectiveThe aim of this study was to analyse the changes in new certifications for both sight impairment (SI) and severe sight impairment (SSI, blindness) in Wales due to diabetic retinopathy...

Leading causes of certifiable visual loss in England and Wales during the year ending 31 March 2013.

The last article on causes of sight impairment (SI) in England and Wales was for April 2007-March 2008. This report updates these figures for April 2012-March 2013. In England and Wales, registration for SI is initiated by completion of a certificate of vision impairment (CVI). The main cause of visual impairment was ascertained for certificates completed April 2012-March 2013. A proportional comparison against April 2007-March 2008 was made. We received 24 009 CVIs of which 10 410 were for severe sight impairment (SSI) and 13 129 were for SI. These numbers were slightly higher than those observed in April 2007-March 2008 (9823 SSI; 12 607 SI). The ratio SI:SSI has remained static with 55% of all certifications being SI. The proportion of certificates without a single main cause has fallen slightly (16.6 to 14%). The proportion of certificates with a main cause of degeneration of the macula and posterior pole (mostly age-related macular degeneration (AMD)) decreased from 58.6 to 50% SSI and from 57.2 to 52.5% SI. Glaucoma remains the second most common cause (11% SSI; 7.6% SI) but hereditary retinal disorders overtook diabetes as third leading cause of SSI. AMD is still by far the leading cause of certifications for sight impairment in England and Wales (both SI and SSI). Proportionate changes have been observed since 2008, but it is important to note that a proportionate increase in one condition will impact on others.

Support for infants and young people with sight loss: a qualitative study of sight impairment certification and referral to education and social care services

ObjectivesTo examine the experience of infants, children and their parents, the role of ophthalmologists and other health, social care and education professionals in the certification and registration processes and examine...

Geographical variation in certification rates of blindness and sight impairment in England, 2008–2009

ObjectivesTo examine and interpret the variation in the incidence of blindness and sight impairment in England by PCT, as reported by the Certificate of Vision Impairment (CVI).DesignAnalysis of national certification...