Discrepancy in the evaluation of visual impairment of elderly low-vision patients by general eye care practitioners and by low-vision practitioners.

Levels of impairment and disability determine eligibility for different welfare programs for visually handicapped persons. General eye care practitioners have to determine the level of impairment for administrative purposes, whereas the low-vision practitioner measures the level of impairment in order to plan the rehabilitation program. We compared the severity of visual impairment reported by the referring practitioners and the one reported by the low-vision specialists for the population of elderly low-vision patients receiving care from one of the largest rehabilitation centers for the visually handicapped in Quebec. Visual acuity ratings reported by general practitioners are lower than those reported by low-vision practitioners. The presence of visual handicap is generally well identified but the severity of visual impairment according to the World Health Organization (WHO)'s categories is not properly gauged by the general eye care practitioners as expressed by the sensitivity and the positive predictive value of the classification of the general practitioners in respect to the classification of the low-vision optometrists. The need to use existing standardized methods to measure visual acuity (VA) is emphasized. It may be hypothesized that this overestimation of the severity of the visual condition may have a negative impact on the process of rehabilitation of the elderly.