Vision Impairment Certification Pathway Must Improve to Serve Visually Impaired

The vision impairment certification pathway is flawed and must provide patients with more access to information concerning services available to them.

Vision impairment certification knowledge may be lacking among individuals with dry age-related macular degeneration (AMD), according to research published in Ophthalmic and Physiological Optics. Providing these patients with more accessible information pertaining to the optometrist’s role in treatment and modifiable risk factors prior to, during, and following their diagnosis may affect the course of disease development, the report suggests.

Evaluation of the new primary care [certification of vision impairment] pathway should include both access and provision of information.

Investigators conducted semi-structured interviews with individuals with AMD (n=9; women, 7) who were between the ages of 61 and 90 years and performed a thematic analysis of their responses. Themes identified included living with dry AMD, experience of eye care, certification knowledge, communication of information, and vision impairment certification in primary care. Despite an AMD diagnosis in all participants, none underwent the certification process.

An analysis of the living with AMD theme showed that the disease prompted lifestyle modifications including relocation to urban environments and driving cessation. Some individuals expressed feelings of loneliness or isolation and concern for their ability to complete certain tasks.

Some patients reported experiencing challenges when trying to access eye care, which included difficulty traveling to hospitals and the use of public transportation. However, many patients expressed more satisfaction with visiting their primary care optometrist than a hospital.

The patients demonstrated a limited knowledge regarding vision impairment certification and sometimes communicated incorrect information, including a belief that an AMD diagnosis barred them from obtaining certification. Overall, many patients reported a desire to access more information pertaining to their condition and the devices and support systems available to them. Some patients reported being advised to read information online — a task that maybe impractical for some patients with vision impairment.

“Patients should be included throughout the pathway design to ensure that their needs are met,” according to the study authors. “Evaluation of the new primary care [certification of vision impairment] pathway should include both access and provision of
information. Additionally, efforts should be made to ensure that professional education includes not only the need for the provision of accessible information for patients regarding the cause of sight loss but also those services that are accessible such as certification.”

Study limitations include a small sample size, the recruitment of patients through 1 organization, and a failure to include patients who underwent vision impairment certification.


Bartlett R, Davies H. People with dry age-related macular degeneration; views on certification of vision impairment in a primary care setting: An explorative qualitative study. Ophthalmic Physiol Opt. Published online April 19, 2023. doi:10.1111/opo.13137