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Abstract
The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) used the Snell Visual Efficiency Scale (1925). Following scientific progress, the Vision chapter in the fifth and sixth editions of the AMA Guides began using the Functional Vision Score (FVS) that is endorsed by the International Council of Ophthalmology and the International Society for Low Vision Research and Rehabilitation. Use of the FVS provided an opportunity to correct many inconsistencies in the VES system and also is better integrated with modern measurement methods and the ratings used for other organ systems. The FVS score is obtained by combining the Functional Acuity Score and the Functional Field Score; if any adjustments are introduced in this combination, they must be completely justified and cannot be based on subjective arguments. The disability is rated on the basis of functional considerations and is not influenced by nonfunctional factors. Combining visual acuity loss and visual field loss into a single number is attractive for administrative and legal purposes, but this step is meaningless in the context of rehabilitation because rehabilitation for visual acuity loss is entirely different from rehabilitation for visual field loss. The FVS system provides internationally endorsed statistical estimates of the effects of visual impairment on the ability to perform activities of daily living.
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Snell AC. Visual efficiency of various degrees of subnormal visual acuity, its effect on earning ability. JAMA. 1925;85:1367-1373.
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Snell AC, Sterling S. The percentage evaluation of macular vision. Arch Ophthalmol. 1925;54:443-461.
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Report of the Committee on Compensation for Eye Injuries. JAMA. 1925;85:113-112.
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World Health Organization. International Classification of Impairments, Disabilities, and Handicaps. Geneva, Switzerland: World Health Organization; 1980.
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World Health Organization. ICF: International Classification of Functioning, Disability and Health. Geneva, Switzerland: World Health Organization; 2001.
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Colenbrander A. The Functional Vision Score: A coordinated scoring system for visual impairments, disabilities, and handicaps. In: Kooiman AC, et al, eds. Low Vision: Research and New Developments in Rehabilitation. Studies in Health Technology and Informatics. Amsterdam, The Netherlands: IOS Press; 1994:552-561.
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International Council of Ophthalmology (ICO). Visual Standards, Aspects and Ranges of Vision Loss with Emphasis on Population Studies. Melbourne, Australia: ICO; 2002. Available as PDF at: www.icoph.org/standards. Accessed May, 2007.
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Workgroup for the International Society for Low Vision Research and Rehabilitation. Guide for the Evaluation of Visual Impairment. San Francisco, Calif: Pacific Vision Foundation; 1999. Available as PDF at: www.ski.org/Colenbrander. Accessed May, 2007.
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Karnofsky DA, Burchenal JH. The Clinical Evaluation of Chemotherapeutic Agents in Cancer. In McLeod, C.M. (ed): Evaluation of Chemotherapeutic Agents. New York, Columbia University Press (1949).
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Ferris FL, Kassov A, Bresnick GH, Bailey I. New visual acuity charts for clinical research. Am J Ophthalmol. 1982;94:91-96.
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Fuhr PSW, Holmes LD, Fletcher DC, et al. The AMA Guides Functional Vision Score is a better predictor of vision-targeted quality of life than traditional measures of visual acuity or visual field extent. Vis Impairment Res. 2003;5(3):137-146.
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