Sightloss certification and registration and the Disabled Children’s Register

Consider sight loss certification and registration and also registering with your local authority’s Disabled Children’s register.

Certification and Registration of Sight Impairment

Your child’s consultant ophthalmologist can certify your child as sight impaired (partially sighted) or severely sight impaired (blind) if certain criteria are met. Referrals for certification of visual impairment can be made by an optician or a GP and parents can also ask their child’s consultant ophthalmologist themselves.

Registering sight loss then follows if you give permission for your child to be registered as sight impaired or severely sight impaired with your local social services. Registration is entirely voluntary and you also have the choice of taking your child off the register at any time if you wish. 

If you consent to your child being placed on the register, you will be asked to sign a Certificate of Vision Impairment.  In England and Wales the certificate is called the Certificate of Vision Impairment (CVI). In Scotland it’s called BP1, in Northern Ireland it’s called A655. Copies of this form will be sent to you, your GP and your local social services department.

Since August 2017, eye health professionals are using a new Certificate of Vision Impairment (CVI) form when certifying people as sight impaired or severely sight impaired in England.

What is Visual Acuity? What is Visual Field?

RNIB describes visual acuity and visual field as below. This and further information can be found in the RNIB Criteria for Certification Guide.

  • Visual acuity – your central vision, the vision you use to see detail
  • Visual field – how much you can see around the edge of your vision while looking straight ahead

RNIB explanation of criteria for certification:

Steps to sight loss registration and its advantages

RNIB gives the following information on the steps to sight loss registration and its advantages:

www.rnib.org.uk/eye-health/registering-your-sight-loss

IMPORTANT – The RNIB points out in its guide on benefits concessions and on registering sight loss, that the consultant ophthalmologist may not realise how important certification and registration can be in getting you the help you need. You may need to bring up registration with the consultant, to make it clear that you would like your child to be certified and registered, provided criteria are met.

Call or email RNIB Helpline if you are having a problem getting your child certified as sight impaired or severely sight impaired

If you are having a problem getting your child certified as sight impaired or severely sight impaired you can call the RNIB helpline for advice on 0303 123 9999 or email: helpline@rnib.org.uk

Nystagmus – The problem with Certification using Visual Acuity Readings and the issue of Variability of Vision caused by Nystagmus

It is important to remind your child’s consultant ophthalmologist that for children with nystagmus, visual acuity measured in a clinical setting can be very different from visual acuity in the real world, where conditions cannot be controlled.

People with nystagmus are also likely to have variable levels of vision according to stress, anxiety, high emotion, tiredness or illness. Lighting conditions can affect vision, as can time of day. This is one reason why people with nystagmus who may achieve good visual acuity scores in the clinic, can be registered sight impaired.  Any official reports on nystagmus should always refer to the variability of vision.

The RNIB has a good explanatory paragraph on measuring vision in their booklet on nystagmus (below) which can be useful to show the consultant if you are considering sight loss certification for your child.

Measuring vision at the eye clinic (from RNIB booklet on nystagmus)

The eye clinic can investigate your child’s vision in a number of ways. Different tests are used to assess how well we see detail, faint edges, peripheral detail and colour. There are specially adapted tests for children of different ages. 

The most common test is the visual acuity test which is the familiar set of letters on a chart held 6 metres away. Many people with nystagmus manage to read down quite far on this test, especially if they are calm and can use their null point. They then feel that the result gives a false impression of how well they can see. This is because the test does not reflect well the real world where objects move, lighting changes and we can become anxious. All of these factors make vision worse. 

If your vision is variable, make this clear to the specialists testing you. Give examples of situations when your vision is at its worse such as trying to find the right platform for a train if you are running late. Any official reports on your vision need to reflect the fact that your vision is variable.

Eligibility Framework for Scoring Support Levels and the use of Visual Acuity Criteria

NatSIP, the National Sensory Impairment Partnership is a partnership of organisations working together to improve outcomes for children and young people with sensory impairment.

NatSIP publish The Eligibility Framework for Scoring Support Levels’, a  tool that enables Vision Impairment Services / Sensory Services to provide an equitable allocation of their resources.  Entry and exit criteria for support are provided as well as a means of identifying the levels of support required. The current version of the Eligibility Framework is the Summer 2017 Edition.

As below, the Eligibility Framework makes specific mention of nystagmus and the fact that visual acuity criteria are for guidance purposes only. You should ask your QTVI about this when it comes to support levels for your child from a QTVI within your local authority’s sensory services team / visual impairment team.

Text from NatSIP Eligibility Framework for Scoring Support Levels – Summer 2017

“Acuity criteria are for guidance purposes only. The professional judgement of a QTVI should be applied as necessary to decide on the classification. For example, a child or young person may have a mild reduction in visual acuity but be functioning within a different visual category due to an additional ophthalmic condition, e.g. an oculomotor disorder such as nystagmus, visual field reduction, cerebral vision impairment, and/or additional learning difficulties.”

The agreed purpose of NatSIP is:

  • to improve educational outcomes for children and young people with sensory impairment, closing the gap with their peers, through joint working with all who have an interest in the success of these young people
  • to help children achieve more and fulfil the potential of children and young people who have SI
  • to promote a national model for the benchmarking of clear progress and impact criteria for children and young people who have SI
  • to support a well-trained SI workforce responsive to the Government agenda for education
  • to inform and advise the DfE and other national agencies on the education of children and young people with SI
  • to promote collaboration between services, schools, professional bodies and voluntary bodies working with children and young people who have SI
  • to promote collaborative working between education, health and social care professionals in the interest of children and young people who have SI

Logmar and Snellen Eye charts – explanation of measurements and conversion table 

Many parents are confused, not surprisingly, by the visual acuity readings they are given at hospital or at the optician.

High street opticians use the familiar Snellen chart which is tested at 6 metres distance (20 feet) and gives visual acuity readings in the format of 6/30 etc. This  means that a person with 6/30 vision can see at 6 metres distance what other people can see at 30 metres distance.

Hospital eye clinics tend to use the Logmar test which is felt to be more accurate and which mimics the crowding effect found in real life.

This short article from the Royal College of Ophthalmology discusses the two different testing systems, the Logmar and Snellen charts and provides a conversion table to provide equivalent readings given by the two systems.

Logmar / Snellen conversion table

LogMAR Snellen Equivalent
1.0 6/60
0.9 6/48
0.8 6/38
0.7 6/30
0.6 6/24
0.5 6/19
0.4 6/15
0.3 6/12
0.2 6/9.5
0.1 6/7.5
0.0 6/6
-0.1 6/5

November 2015 (courtesy of The Royal College of Ophthalmologists)

Nystagmus DLA and PIP

A booklet written by Mike Hughes, Greater Manchester Welfare Rights Advisers Group – is available to download free of charge from The Nystagmus Network website, here.

RNIB Guide to benefits concessions and registration of sight loss

Although being registered as vision impaired does not automatically entitle you to any particular welfare benefits, it does often make it easier to claim some of them. Registration confirms sight loss and helps as evidence in a claim, although further information and evidence will be needed.

Call the RNIB Helpline on 0303 123 9999 for advice on benefit concessions or email: helpline@rnib.org.uk