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Executive Summary
Pages 1-10

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From page 1...
... The SSA asked the National Research Council to study its methods of determining disability for people with visual impairments, to recommend changes that could be made now to improve the process and outcomes, and to identify research needed to develop improved visual disability determination methods over the long term. Two major concerns motivated this study.
From page 2...
... In certain circumstances, this measure adds important information to the assessment of claimants who do not show severe impairments of visual acuity or visual fields. Impairments of other aspects of visual function disorders of binocularity, glare sensitivity or recovery, color vision, visual searchare on their own not generally disabling, the literature provides little evidence that they are major contributors to disability, and these functions do not warrant primary assessment.
From page 3...
... For safe anct efficient orientation anct mobility, the most important aspects of visual function are contrast sensitivity, visual fields, anct acuity. Our recommenclect tests of visual function assess these.
From page 4...
... , can be tested with standard adult tests of visual acuity and contrast sensitivity, as well as with short versions of adult procedures for testing visual fields. Although vision improves slightly between the early school years and adulthood, adult standards for disability determination are appropriate to apply to children whose visual acuity, visual fields, and contrast sensitivity can be tested with adult methods.
From page 5...
... Sound statistical principles have been used in establishing SSA's recently published guidelines for disability determination in children, which set criteria of two standard deviations below the same-age norm performance for "marked" impairment and three standard deviations below it for "severe" impairment of function. RECOMMENDATIONS Tests of Visual Functions For testing visual acuity, our recommendations are similar to those of the Committee on Vision in its 1980 and 1994 reports (National Research Council, 1980; 1994~.
From page 6...
... Given the history and legislation behind the current SSA standard of "20/200 or worse distance acuity" as the principal criterion for visual disability, the committee recommends continuation of the 20/200 cutoff criterion. Since we recommend a visual acuity chart design that would include optotypes at the 20/160 level, applying the "20/200 or worse" criterion literally to scores obtained with such a chart would set the effective criterion to "worse than 20/160 distance acuity." The scoring of the charts currently used in disability determination sets the effective criterion at "worse than 20/100." The recommended charts have a 20/100 line that would allow SSA to maintain the effective criterion at its current position, but SSA must make the decision on whether this should be done.
From page 7...
... score to characterize impairment. The committee recommends that contrast sensitivity be assessed as a supplementary basis for disability determination for claimants with visual acuity between 20/50 and 20/200 and other evidence or selfreport of visual impairment greater than would be expected from the acuity score.
From page 8...
... in the matter of combining scores on multiple visual impairments to arrive at an aggregate impairment score and setting cutoff scores for disability determination, the committee recommends that: . SSA no longer calculate central visual efficiency and visual field efficiency.
From page 9...
... Possibilities range from initiating an accreditation or certification system for providers and their test facilities to establishing dedicated test centers that would operate under SSA supervision. The committee recommends the following additional research efforts related to visual function testing: SSA should support research relating the outcome of visual assessment with such tools as visual acuity charts to an individual's ability to function in the workplace and in society.
From page 10...
... There is a need for tests of driving ability to determine fitness in those who are visually impaired. SSA should support research and development of driving tests for use in vocational assessment.


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