July 25, 2019
In recent weeks ophthalmologists have been urged to complete a social security document called the "Application for Disability Allowance". It is asked to certify the physiological disability of those who wear glasses.
The unusual increase in requests is related to the recent disclosure by social networks of the existence of a bonus granted by social security to those who wear glasses and are under 24 years.
This bonus has been awarded by the social security system for several decades. For years it remained in the sphere of knowledge of special education teachers, social workers and doctors who monitor disabled children more closely.
The question that colleagues have raised is whether wearing glasses, or any other refractive correction, constitutes a visual impairment.
For those who think so, based on the simplistic reasoning that if there was no disability there would be no need for correction, it should be remembered that the prevalence of refractive errors is over 40 %. The bonus would have to be granted to a considerable part of the population. On the other hand, it would be enough for someone who feels better with more or less 0.25 to be eligible for the bonus, opening the door to widespread fraud.
In this regard it is impossible to forget what happened a few years ago when a secretary of state decreed that the reduction or exemption of the IRS would take place when the visual acuity, measured without correction, was below a certain value. Doctors, including Surgeons, Judges, Business and Bank Administrators etc, with mild ametropias were given as incapable or disabled and excused from the IRS or had the IRS greatly reduced. All perfectly legal, but as with many other laws, deeply immoral.
Therefore it is necessary to clarify what a disability is.
ACAPO defines disability as a visual condition that affects our ability to perform everyday tasks and is aggravated by the environment in which we live.
The ICD consultation (2018) allows the classification of visual impairment into 4 grades. Mild disability implies a visual acuity below 6/12 that does not improve with correction.
The World Health Organization, in line with the ICD (2018), establishes as near normal or mildly decreased vision a corrected visual acuity in the best eye between 20/30 and 20/60.
The International Classification of Functioning (ICF) is a classification system that describes the situation of each person in his/her life context. The ICF "...allows for the description of situations related to human functioning and its restrictions and serves as a framework to organize this information. It structures information in a useful, integrated and easily accessible way".
The ICF can and should be used as a clinical tool for assessing needs, matching treatments to specific conditions, assessing vocational skills, rehabilitation and outcomes.
In the ICF, disabilities are classified into appropriate categories using defined identification criteria (e.g. present or absent according to a threshold value). These criteria are the same for body functions and structures. They are: (a) loss or absence; (b) reduction; (c) increase or excess and (d) deviation. Once a disability is present, it can be graded in terms of severity using the ICF generic qualifier.
In the ICF, unlike the DCI, does not classify diseases but disabilities. The disability, once deemed to be present, can be graded in terms of severity using qualifiers. The criterion, as is understood, for deciding whether or not the disability is present depends on a threshold value.
In the case of ametropia, the classification according to the ICF is b (function indicator) 210 (vision functions) 0 (visual acuity indicator) 0 (binocular distance visual acuity indicator with correction), i.e., b21000. The severity qualifier is entered with the digits 0 to 4 after a period. Thus b21000.0 means no problem or insignificant problem, b21000.4 indicates total loss. Qualifiers 1,2 and 3 indicate the impairment as mild, moderate and severe.
The ophthalmologist should not base his attitude on common knowledge. The common knowledge that parents exhibit is not acceptable in the doctor. Simplistic reasoning should not be applied here. Note that the document is to be completed by the ophthalmologist and not by the family doctor who would be sufficient to certify the wearing of spectacles. Parents whose children wear glasses do not treat them as disabled, the children do not feel disabled and neither does the school and society consider them disabled.
The doctor cannot hide behind a document simply to please the parents. The bonus, to be applied to the entire ametrope population, would worsen public accounts and ultimately reduces or prevents the money, in the fair and necessary amount, to benefit those who really need it.
The eye doctor has no excuse for doing what he should: refusing to certify disability when this does not occur. It is enough to consult the ICF.
For the Management,
Falcão-Reis
Chairman (Biennium 2019/2020)
