Legal blindness in America

Excerpted from page 48 of the May/June 2023 edition of AOA Focus

It is estimated that 12 million adults 40 years and older in the United States are living with uncorrectable vision loss, including more than 1 million Americans who are characterized as blind. The number of blind individuals is predicted to increase to 8.96 million by 2050 due to the increase in diabetes and other chronic diseases and our rapidly aging U.S. population. Additionally, nearly 3% of children younger than 18 years are blind or visually impaired, according to the Centers for Disease Control and Prevention (CDC).

The World Health Organization (WHO) separates levels of visual impairment as Low Vision and Blindness. This can be seen in the WHO ICD-10 table. The term “low vision” comprises categories 1 and 2, and the term “blindness” comprises categories 3, 4 and 5.

Vision disability is one of the top 10 disabilities among adults 18 years and older and one of the most prevalent disabling conditions among children, according to the CDC. The federal definition of blindness, as defined in the Social Security Act (SSA), is referred to as legal blindness or statutory blindness.

The SSA updated the Legal Blindness definition in 2006 and the rules were put into effect in 2007. The SSA definition still addresses the best corrected visual acuity (VA) of 20/200 or less in the better-seeing eye and the visual field (VF) limitation such that the widest diameter of the visual field subtends an angle no greater than 20 degrees, but the rules of how to quantify VA and VF were modified.

For visual acuity testing, the criteria have changed because most Snellen test charts did not have lines that measure visual acuity between 20/100 and 20/200. Newer charts do have that capability.

Under the new criteria, if a person’s visual acuity is measured with one of the newer charts, and they cannot read any of the letters on the 20/100 line, they will qualify as legally blind, based on a visual acuity of 20/200 or less. For example, if the person’s best-corrected visual acuity for distance in the better eye was determined to be 20/160 using an ETDRS chart, they would now be classified as legally blind. Regardless of the type of test chart used, the person will not be classified as legally blind if they can read at least one letter on the 20/100 line. The Social Security Administration will not use the results of pinhole acuities or automated refraction acuities to determine legal blindness.

For visual field testing, either automated static threshold perimetry (Humphrey Field Analyzer 30-2 and 24-2 and Octopus 32) or manual kinetic perimetry (Goldmann III-4e stimulus) can be used to measure the extent of VF loss. Social Security will not use the results of visual field screening tests, such as confrontation tests, tangent screen tests, or automated static screening tests to determine legal blindness.

Patients who meet this legal blindness definition should be given a Certificate of Legal Blindness by their doctor of optometry. The patient also should be educated about the opportunities that may benefit them. Agencies use a Certificate of Legal Blindness to determine eligibility for vocational training, rehabilitation, schooling, Social Security disability benefits, IRS tax exemption, state agency services, housing, utilities, telephone services, and services such as audible books, handicap plates or placards, etc.

Please check with your state affiliate’s Vision Rehabilitation Committee or the AOA Vision Rehabilitation Committee to learn more about specific services for your patient.

Written by Maria Richman, O.D., a member of the AOA’s Vision Rehabilitation Committee.

Disclaimer: The information contained in this article represents the opinion of the author and not the AOA. These are not clinical practice guidelines, nor has the evidence been peer-reviewed. There are additional aspects to this topic that may not be presented, or considered, based on the specifics of the case.