Exploring the proportion of patients with reduced visual acuity in whom certification of vision impairment was undertaken at a large UK center.

Abstract

Purpose : In the UK, the Certificate of Vision Impairment (CVI) process can enable individuals to access a range of support. Certification is voluntary, and clinicians are advised to explain the benefits of certification and its potential effect on a patient’s quality of life. Timely identification and certification of eligible patients is important. Here, we explored numbers of patients with vision of 20/200 or worse seen at a large UK center over a 3 year period and estimated the proportion who were not certified.

Methods : Data was extracted from the electronic health record in our center (the largest ophthalmic center in the UK) to ascertain numbers of patients seen with a best recorded visual acuity of 20/200 or worse between July 2018 and July 2021. Data were cross-referenced with CVI records to ascertain whether CVI was undertaken or had been completed previously.

Results : Over the three-year period, 5214 patients were seen with a best visual acuity of 20/200 or worse. Of these, 2458 (47%) had a record of CVI. The remaining 2756 patients (53%) did not have a record of CVI. The largest numbers of patients without CVI were in those services managing the largest numbers of patients (namely medical retina and glaucoma; proportions without CVI 52% and 46% respectively), but the phenomenon was observed across all services with proportions varying between 38% and 94% (though in some cases numbers were small).

Conclusions : A large proportion of patients with visual acuity of 20/200 or worse did not have evidence of CVI, potentially being unable to access support that could improve quality of life. Our study has important limitations. We have taken a single visual acuity criterion, whilst there are other criteria, such as visual field loss, that could confer eligibility, and so our findings would underestimate those eligible. On the other hand, it is possible that CVI was discussed with some patients, who then declined certification, and, given our center is a tertiary referral center, it is also possible that patients underwent certification at other centers, which would cause our data to overestimate the proportion not being offered CVI. Our study thus supports the need for better documentation to enable more reliable future data collection, as well as the need for strategies for ensuring all eligible patients have access to CVI.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.