3.6.3.120 Guidelines to Table 12 - Visual Function

Summary

Table 12 is used where a person has functional impairment when performing activities involving visual function.

The diagnosis of the condition must be made by an appropriately qualified medical practitioner. If the diagnosis has been made by an appropriately qualified practitioner, there must also be supporting evidence from an ophthalmologist. Corroborating evidence may be provided by an, optometrist or neurologist where the diagnosis has been made by another medical practitioner.

If a person uses any visual aids, such as spectacles or contact lenses, they must be assessed on their ability to undertake activities listed in Table 12 while using any aids that they have and usually use.

In determining whether the person has received reasonable treatment for their impairment, consideration is to be given to the aids and equipment or other assistive devices they have and usually use. For example, if a person would benefit significantly from spectacles or contact lenses but chooses not to use them, consideration is to be given to whether they have received reasonable treatment and if their impairment can be considered fully treated and fully stabilised.

Where severe or extreme loss of visual function is evident or suspected, it must be recommended to the person that they undergo an assessment by a qualified ophthalmologist to determine whether they meet the criteria for permanent blindness (3.6.2.20) as per SSAct section 95.

A PERSON'S SELF-REPORTED SYMPTOMS MUST NOT BE SOLELY RELIED UPON in determining functional impacts of the person's permanent condition (impairment). There must be corroborating medical evidence of a person's impairment.

Determining the level of functional impact - general rules

When determining which impairment rating applies to a person the rating that best describes the person's abilities or difficulties must be assigned. In applying the descriptors, each descriptor sets out how the points within it are to apply.

For example, to meet the 20-point impairment rating in Table 12, a person must meet all the points of the descriptor (1)(a), (b), (c), and (e), and satisfy either (1)(d)(i) or (ii).

The 30-point impairment rating allows for assessment of people who are not considered permanently blind but have an extreme level of vision impairment which impacts their ability to mobilise and perform their daily activities.

The descriptors in Table 12 use the term 'assistance'. 'Assistance' means assistance from another person, rather than any aids or equipment the person has and usually uses (refer to 3.6.3.05 'Use of aids, equipment & assistive technology').

The structure of the Tables requires that, in assessing the level of functional impact, a comparison must be made of all the descriptors for each level of impairment. An assessment starts by considering the descriptors for 0 points, and if a person has more than 'no functional impact', the descriptors for 5 points are then considered, and so on for the descriptors for higher impairment levels. When it is determined that the person meets all the required descriptors for a certain impairment rating level, but does not meet all the required descriptors for the next impairment rating level, the appropriate impairment rating applicable to the person's circumstances will be the lower of those 2 impairment ratings (i.e. the rating at which all the required descriptors are met).

Note: Individual descriptors or their parts must not be applied in isolation from one another.

In determining whether the required descriptors for a specific impairment level are met or not, ALL the descriptors for that level must be considered and applied as set out in the descriptor. NO descriptors or their parts are to be disregarded. However, one of several descriptor points may be sufficient for that rating when the word 'or' links the descriptors.

Determination of the descriptor that best fits the person's impairment level must be based on the available medical evidence including the person's medical history, investigation results and clinical findings. A person's self-reported symptoms must not solely be relied on. It would be inappropriate to apply an impairment rating based solely on a person's self-reported functional capacity if this level of functional impairment is not consistent with the medical evidence available.

Consideration should be given to the fact that 2 people with the same level of vision loss can have different levels of independence and skills. Assumptions must not be made based solely on the clinical level of visual loss the person has.

A single impairment rating under Table 12 is to be determined, regardless of whether one or both eyes suffer vision loss.

0-point impairment rating level

The 0-point descriptor specifies that the person has NO or minimal functional impact on activities involving vision.

5-point impairment rating level

The 5-point descriptor requires that there is a MILD functional impact on activities involving vision. The person can perform most day to day activities involving vision and has mild difficulties seeing things at a distance or close up when wearing glasses or contact lenses (if these are usually worn), and at least one of the following applies (1)(a), (b), (c), (d), or (e).

10-point impairment rating level

The 10-point descriptor requires that there is a MODERATE functional impact on activities involving vision. The person must meet (1)(a), (b) and (c), at least one of (1)(d)(i), (ii) or (iii), and (2)(a) and (b) must also apply.

20-point impairment rating level

The 20-point descriptor requires that there is a SEVERE functional impact on activities involving vision. The person must meet (1)(a), (b), (c), and (e), and at least one of (1)(d)(i) or (ii).

30-point impairment rating level

The 30-point descriptor requires that there is an EXTREME functional impact on activities involving vision. The person must meet both (1)(a) and (b).

Some conditions causing impairment commonly assessed using Table 12

These include but are not limited to:

• diabetic retinopathy
• glaucoma
• retinitis pigmentosa
• macular degeneration, and
• cataracts.

Impairments that should not be assessed using Table 4

Impairment in vision which is not due to functions of the eye or visual tracts. Cases of 'functional blindness', where there is no identified anatomical or physiological abnormality of the eyes, optic nerves, visual tracts or occipital lobes of the brain, would usually be given an impairment rating under Table 5 - Mental Health Function, if the condition is assessable as fully diagnosed, treated and stabilised. Functional blindness is considered to be a psychiatric disorder under the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) classification-functional neurological symptom disorder, also known as conversion disorder.