Appendix B
PUBLIC FORUM ON VISUAL DISABLILITY DETERMINATION METHODS AND ISSUES

The Committee on Disability Determination for Individuals with Visual Impairments held a public forum on November 15, 2000, at the National Academy of Sciences in Washington, DC. This appendix includes:

  • A list of all organizations invited to nominate speakers, indicating which ones provided nominations;

  • The questions the committee sent to nominating organizations and to speakers;

  • A list of speakers, their affiliations, and major topics each addressed;

  • Information on where the full text of the speakers’ presentations is filed.



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Visual Impairments: Determining Eligibility for Social Security Benefits Appendix B PUBLIC FORUM ON VISUAL DISABLILITY DETERMINATION METHODS AND ISSUES The Committee on Disability Determination for Individuals with Visual Impairments held a public forum on November 15, 2000, at the National Academy of Sciences in Washington, DC. This appendix includes: A list of all organizations invited to nominate speakers, indicating which ones provided nominations; The questions the committee sent to nominating organizations and to speakers; A list of speakers, their affiliations, and major topics each addressed; Information on where the full text of the speakers’ presentations is filed.

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Visual Impairments: Determining Eligibility for Social Security Benefits ORGANIZATIONS INVITED TO NOMINATE FORUM SPEAKERS The following organizations were invited to nominate speakers for the forum. Those that responded with nominations are in boldface. American Academy of Disability Evaluating Physicians American Academy of Ophthalmology American Board of Independent Medical Examiners American Council of the Blind American Diabetes Association American Foundation for the Blind American Macular Degeneration Foundation American Medical Association American Occupational Therapy Association American Optometric Association Association for Education and Rehabilitation of the Blind and Visually Impaired Blinded Veterans Association Center for the Partially Sighted Columbia Lighthouse for the Blind Council of Citizens with Low Vision International Foundation Fighting Blindness Glaucoma Foundation

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Visual Impairments: Determining Eligibility for Social Security Benefits Glaucoma Research Foundation Jewish Guild for the Blind Job Accommodation Network Lighthouse International Macular Degeneration Foundation Macular Degeneration Partnership National Association for Parents of the Visually Impaired National Association of the Visually Handicapped National Association of Disability Evaluating Professionals National Association of Disability Examiners National Council of State Agencies for the Blind National Federation of the Blind National Institute on Disability and Rehabilitation Research Prevent Blindness America Rehabilitation Research and Training Center on Blindness and Low Vision Research to Prevent Blindness Sensory Access Foundation Social Security Administration

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Visual Impairments: Determining Eligibility for Social Security Benefits QUESTIONS TO BE ADDRESSED BY FORUM PARTICIPANTS We are interested in your responses to the following questions. Please respond both for adults, under DI and SSI,1 and for children under SSI. Do the current vision tests and criteria2 adequately assess a claimant’s ability to engage in gainful employment (adults) or age-appropriate activities (children)? If not: Are there weaknesses in the particulars of the visual functions being measured, in the particular tests used, or in the criteria for presumptive disability? (For adults? For children?) If other visual functions could and should be tested to provide an adequate assessment, what functions are they? (For adults? For children?) If particular tests are inadequate, what tests would provide a better assessment? (For adults? For children?) If the criteria are inappropriate, what criteria would permit a better determination? (For adults? For children?) What everyday tasks that require vision (e.g., reading, driving) best represent the range of visual demands of employment (adults) or age-appropriate activities (children)? 1   DI: Disability Insurance, under Title II of the Social Security Act; SSI: Supplemental Security income, under Title XVI of the Social Security Act. See the Social Security Handbook or Disability Evaluation Under Social Security for details. 2   The current tests are Snellen or comparable acuity and Goldmann or comparable perimetry. Tests are performed monocularly. The current criteria for presumptive disability are acuity ≤ 20/200 or visual field ≤ 20° diameter or 10° minimum radius from fixation, in better eye. See 20CFR §404 Appendix 1, medical listings, or Disability Evaluation Under Social Security, for details.

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Visual Impairments: Determining Eligibility for Social Security Benefits Overall, what specific recommendations would you make for improvements to the SSA’s tests and/or criteria for determining visual disability? (For adults? For children?) If the tests or criteria were to be changed, what are the most important factors to consider in selecting and evaluating new tests or criteria? (For adults? For children?) SPEAKERS Roy Cole, OD Director, Vision Program Development Jewish Guild for the Blind New York, NY Inadequacy of current tests; need to test broader range of functions; need to test contrast sensitivity. (Addressed committee questions directly.) August Colenbrander, MD Director, Low Vision Service California Pacific Medical Center San Francisco, CA Presented justification for Functional Vision Score methodology Anne Corn, EdD Professor of Special Education Peabody College of Vanderbilt University Nashville, TN Difficulty of predicting functional capacity from current tests; desirability of testing function. Charles R. Fox, OD, PhD, FAAO Fox & Associates Baltimore, MD Difficulty of predicting functional capacity from current tests; need for standardization; possibly mobile test facilities; analyze visual requirements of work.

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Visual Impairments: Determining Eligibility for Social Security Benefits Gregory W Good, OD, PhD Chief of Vision Rehabilitation Services Professor of Clinical Optometry College of Optometry, Ohio State University Columbus, OH Need to standardize acuity testing for uniform, fair determination; possibly test contrast sensitivity; issues of combining measures; need to test binocularly. Corinne Kirchner, PhD American Foundation for the Blind New York, NY Social factors in vision testing; variables not currently considered; societal conditions affecting disability criteria. Robert Massof, PhD Director, Lions Vision Research and Rehabilitation Center, Wilmer Ophthalmological Institute Professor of Ophthalmology Johns Hopkins University School of Medicine Baltimore, MD Need to relate vision measures and impairments to real-life functions and methods for doing so; survey on vision requirements for jobs and daily tasks, indicating that 20/200 criterion is too strict. Lylas Mogk, MD Henry Ford Health Care System Grosse Pointe, MI Needs for: additional and different measures of visual function and task performance; temporary and partial disability benefits; coordination of benefits with rehabilitation services. Bruce P. Rosenthal, OD, FAAO Chief of Low Vision Programs Lighthouse International New York, NY Change criteria for definition of visual impairment; use ETDRS chart for acuity; revise visual field testing and criteria; test contrast sensitivity.

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Visual Impairments: Determining Eligibility for Social Security Benefits Sidney Schreiber, MD Scientific Advisor American Macular Degeneration Foundation Northampton, MA Additional tests needed; tests should reflect real-world conditions; consider individual’s functional requirements for vision. Ron Schuchard, PhD Associate Director, VA Geriatric Rehabilitation Center Associate Professor, Emory University School of Medicine Decatur, GA Insensitivity of current tests to central scotomas; need to measure real-life task performance to determine disability; need for binocular testing. Suggested specific tests. Allow partial/temporary disability and coordinate benefits with rehab. Mary Warren, MS, OTR/L Director, Visual Independence Program The Eye Foundation of Kansas City Kansas City, MO Weaknesses of current tests and criteria. Need to measure functional vision, including reading acuity; measure binocularly; consider individual factors in determination. Karen Wolffe, PhD Career Counseling and Consultation Austin, TX Variables beyond those currently tested that affect employment and employability; need to consider these in disability determination. Need for research to determine whether objective tests can be developed for these.

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Visual Impairments: Determining Eligibility for Social Security Benefits Further information, including the papers submitted by forum participants, is on file at: Public Access Records Office The National Academies 2101 Constitution Avenue NW Room NAS 204 Washington, DC 20418 Tel: (202) 334-3543 FAX: (202) 334-1580 Email: publicac@nas.edu