International Standards:

For Vision, Eye Care and Ophthalmology

Standards headlines:

• ICO Standards Committee Report on Functional Vision
  
  
• 1984 ICO Visual Acuity Measurement Standard
  
  
• Council approves report on vision requirements for driving
  
  
• Driving report recommends greater uniformity in testing
  
  
• WHO recommends standards for definition of vision loss
  
  
• WHO report emphasizes visual functioning and quality of life
  
  
• ICO resolution on standards for measurement of vision loss
  
  
• Vision loss resolution available as PDF
  
  
• International clinical disease severity scales adopted for diabetic retinopathy and diabetic macular edema

(Also see: More News of international standards)

The report makes the distinction between “Visual Functions,” which describe how the eye functions and “Functional Vision,” which describes how the person functions in vision-related activities.

“As societal attention is extended … from the prevention and treatment of disease to its functional consequences and their rehabilitation,” the report says, “it is imperative that we more clearly define those consequences and provide means to measure their remediation.”

The report aims at (a) expanding the awareness of all those involved with eye care to the functional consequences of vision loss (Part 1), and (b) pointing to ways in which the effectiveness of vision rehabilitation can be measured (Part 2).

The draft of Part 1 can be downloaded from (www.icoph.org/pdf/FunctionalVisionDraft.pdf). Part 2 is in preparation.

The final report will be presented at the 2008 World Ophthalmology Congress®, June 28 - July 2 in Hong Kong, and at the "Vision 2008" International Conference on Vision Rehabilitation, July 7 – 9, in Montreal.

1984 ICO Visual Acuity Measurement Standard available

The ICO's involvement in defining international standards for measuring visual acuity date back at least to 1978, when it published a Recommendation of Visual Acuity Standardization. That document was replaced in October 1984, when the ICO adopted a Visual Acuity Measurement Standard recommended by its Visual Functions Committee.

You can download the 1984 Visual Acuity Measurement Standard from:

www.icoph.org/pdf/ICOVisualAcuity1984.pdf (188 Kb).

Council approves report on vision requirements for driving

The International Council of Ophthalmology (ICO) approved a report on "Vision Requirements for Driving Safety" at its meeting in February 2006 in São Paulo Brazil.

Prepared by ICO Committee on Standards Chairman Jean-Jacques DeLaey, MD, and Standards Committee Member August Colenbrander, MD, the report had been circulated for comment and revised prior to approval.

It can be downloaded as a PDF file from www.icoph.org/pdf/visionfordriving.pdf (376 KB). The full report will be posted on the ICO Eye Site.

The recommendations are listed at www.icoph.org/standards/drivingrecs.html.

Driving report recommends greater uniformity in testing

The ICO's draft report on "Vision Requirements for Driving Safety" recognizes the profound impact vision requirements for driving have and the need to make them more uniform around the world.

It evaluates:

• current visual requirements for obtaining a driver’s license in various countries
• the literature on the relationship between vision and driving safety, and
• ways to assess different visual functions that relate to driving ability.

The report suggests that the common requirement of 20/40 (0.5) visual acuity represents a reasonable safety margin between performance during acuity testing and performance on the road under adverse conditions. Those with visual acuity of 20/40 (0.5) or better should qualify to drive if there are no other limiting factors.

Those with acuity  of 20/200 or worse (<0.1) should not be allowed to drive, the report says.

For those in between, the report recommends individual consideration by the licensing authority, with a road test if needed. The authority can then decide to grant a license, deny a license or issue a restricted license.

The report evaluates various options for testing and suggests that a compromise may have to be found between ideal testing and economic feasibility.

WHO recommends standards for definition of vision loss and visual functioning

The World Health Organization (WHO) has issued a report that recommends a modification of the categorization of visual impairment and codes for blindness and low vision to be incorporated into the International Classification of Diseases and used for reporting internationally.

The report on "Development of Standards for Characterization of Vision Loss And Visual Functioning" is based on a WHO consultation in September 2003.

Among the participants was International Council of Ophthalmology (ICO) Standards Committee Member August Colenbrander, MD, who prepared the ICO’s 2002 resolution on "Visual Standards - Aspects and Ranges of Vision Loss."

In line with the ICO report and with the finding that the most common cause that of vision loss is undercorrected refractive error, WHO recommends reporting vision loss based on the presenting, binocular acuity (a measure of how the person functions), rather than on the best-corrected acuity of the better eye (a measure of how the eyes function).

You can download the WHO report at: whqlibdoc.who.int/hq/2003/WHO_PBL_03.91.pdf (80 KB).

WHO emphasizes visual functioning and quality of life

The WHO report on "Development of Standards for Characterization of Vision Loss And Visual Functioning" also recommends greater focus on developing cross-cultural methods for assessing visual functioning and vision-related quality of life, particularly patient-reported assessments.

The participants suggested that a new Visual Functioning Questionnaire with 20 questions, VFQ-20, which is included in the report, be tested and validated for international use.

ICO resolution on standards for measurement of vision loss

The ICO resolution on "Visual Standards - Aspects and Ranges of Vision Loss" was approved by the Council and International Federation of Ophthalmological Societies (IFOS) at the XXIX International Congress of Ophthalmology in Sydney, Australia in April 2002.

The resolution was developed by August Colenbrander, MD, and the Advisory Committee to the ICO to encourage consistent measurement and reporting of vision loss in population surveys.

Vision loss resolution available as PDF

The Visual Standards resolution (13 KB) and full report (144 KB) are available as Portable Document Format (PDF) files.

To read them, you will need Adobe Reader, which is a free download.

International clinical disease severity scales adopted for diabetic retinopathy and diabetic macular edema

An international task force has adopted grading scales for evaluating the severity of different levels of diabetic retinopathy and macular edema disease.

The scales were developed to increase consistency of grading diabetic retinopathy and macular edema internationally.

They are also intended to facilitate communication among retina subspecialists, general ophthalmologists, endocrinologists/ diabetologists and primary care physicians.

The scales were defined through a consensus development process, including an invitational workshop during the International Congress of Ophthalmology in Sydney in April 2002.

Development of the scales was led by the American Academy of Ophthalmology and announced at the Academy meeting in October 2002.

The Academy adopted the scales in February 2003.

Next: More News of international standards

Also see: ICO Standards for Measurement of Vision Loss