Deciding whether or not a patient qualifies for a vision-related disability is not as straightforward as it may seem. In fact, you start to enter murky waters when you begin exploring this question. Mark E. Wilkinson, OD, FAAO, walked attendees of his session, “Your Role in Rating Visual Impairments/Disabilities,” through this process to get the ball rolling on day two of the Academy’s virtual meeting.
Back in 2004, the case that got Dr. Wilkinson started with visual impairments and disabilities fell into his lap. A 17-year-old student had been rejected by both Stanford and Northwestern because of his testing scores. He requested a 50% increase in the time he was allotted on assessments due to his visual disorder, nystagmus. It was ultimately decided that he was not impaired and, therefore, did not have a disability.
Although this Stargardt’s patient demonstrates relative central scotomas, their presence did not prevent her from driving safely. In this regard, she experienced an impairment but not a disability. Click image to enlarge.
A 38-year-old female presented with a history of reduced vision for the past 20 years secondary to Stargardt disease. Her best-corrected visual acuity (BCVA) was 20/160-2 OD, 20/160-1 OS and 20/125-2 OU. She had small bilateral central scotomas consistent with her central acuity. A discretionary review request was made to the Iowa DOT, and she received unrestricted driving privileges following several behind-the-wheel tests that took place during the day and at night. She has maintained full driving privileges, without incident, for the past 17 years.
Definitions of Key Terms
Dr. Wilkinson presented several amendments designed to protect those who fall under any one of these four categories. The first was the Americans With Disabilities Act (ADA) of 1990, which works to eliminate employment discrimination against workers with disabilities. The ADA defines a disability as a physical or mental impairment that limits a person’s ability to perform one or more major life activities—such as seeing, reading, speaking, writing or learning—as compared with the majority of the general population. The ADA Amendment Act of 2008 broadened the qualifying factors of a disability, making it easier for someone to establish that they are disabled and entitled to protection under the ADA. These Acts raised the need for educational-based testing to support continued requested accommodations.
As far as prevalence of disability in the United States goes, approximately one in five Americans are disabled and about 15 million Americans get monthly disability checks that total $260 billion each year when combined with health care costs, according to Dr. Wilkinson. Under the federal definition, someone is disabled if they have a medical condition that makes it impossible for them to work.
Concerning vision specifically, Dr. Wilkinson uses the AMA Guide to the Evaluation of Permanent Impairment to evaluate the extent and severity of the problem and assess functional impairment of the visual system as a whole as it affects a patient’s ability to perform daily activities. He emphasized that while practitioners want to advocate for and help their patients, they must remain objective and give diagnoses that are warranted, even if they are not always wanted. Not doing so and deceiving an insurance company by providing false, misleading or incomplete information could result in legal action against the practitioner. The practitioner’s job is to use the tools and tests available to them to determine if a patient has a limiting physical or mental impairment that would require reasonable accommodations and provide the appropriate care if deemed necessary.
Educationally, the Individuals With Disabilities Educational Act mandates that each student suspected of having a disability be assessed in all relevant areas. Based on the results and required modifications, students are accommodated and monitored accordingly, all the while receiving meaningful opportunities to participate in all aspects of school on an equal basis with their nondisabled peers.
There must be “formal, educationally-based testing information that supports the claim that the individual has a visual problem that requires educational accommodations to accurately demonstrate their educational potential, before such accommodations are provided,” Dr. Wilkinson said as he concluded the course.