APPENDIX B: PUBLIC FORUM ON VISUAL DISABILITY DETERMINATION METHODS AND ISSUES

The Committee on Disability Determination for Individuals with Visual Impairments held a public forum on November 15, 2000, at theNational 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.

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

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

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.

1. Do the current vision tests and criteria² adequately assess a claimant's ability to engage in gainful employment (adults) or age-appropriate activities (children)?

a. 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?)

b. If other visual functions could and should be tested to provide an adequate assessment, what functions are they? (For adults? For children?)

c. If particular tests are inadequate, what tests would provide a better assessment? (For adults? For children?)

d. If the criteria are inappropriate, what criteria would permit a better determination? (For adults? For children?)

2. 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)?

3. 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?)

4. 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.

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.

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.

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

¹DI: 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.

²The 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, fordetails.