Certification of vision impairment in primary and community care (WHC/2024/029)

Status:

Compliance.

Category:

Policy.

Title:

Certification of vision impairment in primary and community care.

Date of expiry / review:

Not applicable.

Action by:

Local health boards.

Required by:

With immediate effect.

Sender:

Sarah O’Sullivan-Adams, Head of Optometry and Audiology, Primary Care Division.

Enclosures:

Certification of Vision Impairment Wales 2024 (CVIW 2024) form and explanatory notes.

Certification is the pre-requisite to registration with a vision impairment. People with vision impairment that meet certain criteria^{[footnote 1], [footnote 2]} are eligible to be registered with their local authority social services department as sight impaired (SI) or severely sight impaired (SSI). Registration ensures access to services and support aimed at maintaining a person’s independence. In Wales, Consultant Ophthalmologists currently sign a Certificate of Vision Impairment (CVI). However, there is no legal requirement in Wales stating that only a Consultant Ophthalmologist can sign a CVI.

Recent research concluded that there is comparable agreement with regards to certification eligibility between ophthalmologists and optometrists trained and accredited to deliver low vision services, relative to a consensus panel^{[footnote 3]}. Accordingly, a new All-Wales patient pathway will be introduced that will enable patients to be certified as visually impaired by Wales Eye Care Services (WECS) optometrists who are low vision accredited and have completed an approved training module as determined by Health Education and Improvement Wales (HEIW) and outlined in WECS Standard Operating Procedures. This will be in addition to Consultant Ophthalmologists certifying patients. This new approach aligns to the principles of prudent healthcare and our commitments in A Healthier Wales and the Future Approach for Optometry Services.

Prior to optometry contract reform, the accreditation required is Eye Health Examination Wales (EHEW) plus Low Vision Service Wales.

4 changes have been made to the existing Certification of Vision Impairment Wales (CVIW) form to accommodate this:

• the heading "to be completed by the Ophthalmologist (tick one)" changed to "to be completed by the Ophthalmologist/Optometrist (tick one)"
• inclusion of tick boxes to indicate whether the practitioner is an ophthalmologist or optometrist
• inclusion of tick boxes to indicate whether certification was performed within the hospital eye service, an optometry practice or a mobile setting
• the label "hospital address" changed to "certifiers primary hospital / optometry practice address"

The same CVIW 2024 form will be used for certification in primary and community care and in secondary care. The patient pathway for this service can be found in the relevant clinical manuals.

[1] RNIB, the criteria for certification.

[2] Department of Health (2017), Certificate of Vision Impairment: explanatory notes for consultant ophthalmologists and hospital eye clinic staff in England.

[3] Bartlett, R., Jones, H., Williams, G. et al. (2021), Agreement between ophthalmologists and optometrists in the certification of vision impairment. Eye 35, 433–440.