title: [Ophthalmological assessment in procedures for disability benefits for the blind : Why medical certificates alone are insufficient].
abstract: OBJECTIVE
  Financial aid for the blind which is awarded based only on medical certificates and results of examinations has in the past resulted in too many false diagnoses; therefore, Bavaria seeks to pay financial aid to the blind only on the basis of a specific ophthalmological assessment according to the standards of the German pension medical ordinance (VersMedV, Versorgungsmedizinische Verordnung). Because these ophthalmological assessments initially contribute to a higher financial burden on the state, longer processing times and inconvenience to the patient, investigations should be undertaken to determine if ophthalmological findings, reports and medical certificates can be a suitable basis for an expert assessment and in how many cases blindness which had been certified by the original examination could be confirmed by a specific ophthalmological assessment.
  
  
  METHODS
  A total of 925 applications for financial assistance to the blind within the catchment area of the Bavarian Center for Family and Social Services (ZBFS, Zentrum Bayern Familie und Soziales) regional center in Upper Bavaria between 2003 and 2008, all of which had been subjected to an assessment by the same practitioner acting as external expert, were statistically analyzed.
  
  
  RESULTS
  Of the 357 applicants who had been classified as blind according to the medical certificate and findings, 283 (79 %) were confirmed as being blind after the assessment and in 73 (21 %) blindness could not be confirmed. Of the 262 applicants who were classified as not being blind during the first examination, the diagnosis was confirmed in 192 (73 %) while 70 cases (27 %) were classified as blind. Of the 304 applicants for whom an assessment was not possible by the medical certification, 165 were ultimately classified as blind and 139 as not blind. Out of 32 applicants who were explicitly classified as being blind in the medical certificate, 13 were confirmed as being blind while the remaining 18 were classified in the subsequent assessment as not blind.
  
  
  CONCLUSIONS
  Apart from unambiguous cases, the awarding of financial aid to the blind should only be based on an ophthalmological assessment which follows the VersMedV guidelines. Only this approach can result in an equal treatment of all applicants before the law and the awarding of financial aid to the blind to assist those truly in need. In addition, fiscal budget results revealed that the falsely awarded financial aid to the blind reached well beyond millions of Euros.
authors.affiliation: Universitätsaugenklinik der LMU München, Mathildenstraße 8, 80336, München, Deutschland. Bettina.livonius@med.uni-muenchen.de.
authors.forename: B
authors.initials: B
authors.lastname: von Livonius
authors.affiliation: Zentrum Bayern Familie und Soziales, Ärztlicher Dienst, München, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Pause
authors.affiliation: Universitätsaugenklinik der TU München, München, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Ulbig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000175:diagnosis*; D002568:Certification / Q000706:statistics & numerical data*; D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards*; D004185:Disability Evaluation; D004608:Eligibility Determination / Q000592:standards*; D005104:Expert Testimony / Q000592:standards; D005260:Female; D005858:Germany; D006801:Humans; D007342:Insurance Benefits / Q000592:standards*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D019987:Persons with Visual Disabilities / Q000145:classification; D055815:Young Adult
keywords: Assessment; Blindness; Costs; Medical certicate; Pension medical ordinance