The Blind Certificate — The Criteria, and the Confusion with Disability Ratings

The blind certificate is one of the most sought-after documents in the field of vision, and one of the least well understood. A substantial share of enquiries comes from people who have already been before a medical committee, received a disability percentage, and assume the certificate follows from it. It does not. This is a different authority, a different examination and a different threshold, and the numbers do not speak to one another.

This page is about the threshold itself: what it actually says, how it is measured, and why it is possible to satisfy one track without satisfying the other.

What the criteria actually say

Ministry of Welfare directive 6.3 defines three states, and one of them suffices:

• Complete absence of vision.
• Visual acuity not exceeding 3/60 in the better eye, even with correction.
• A maximum visual field not exceeding 20 degrees in the better eye, even with correction.

Two phrases in that wording do most of the work. The first is “the better eye”: the test does not look at the damaged eye but at the better one. A person who has lost vision entirely in one eye while the other is normal does not meet the threshold — even where the loss in the affected eye is total. The second is “even with correction”: the measurement is taken with the best available spectacles or lenses, not without them. A current refraction before the examination is not a formality.

One certificate, not two tiers

This is where most of the information online is wrong. The directive refers throughout to “a blind or low-vision certificate” — as a single document, with a single set of criteria. There is no second, lower threshold in it. No 6/60, and no intermediate band of 20 to 40 degrees of field.

Many sources present two tiers of eligibility, and that leads people to apply on a mistaken assumption about what is required of them. Someone relying on an imagined lower threshold arrives at the examination with an expectation that has no anchor in the document.

How the visual field is measured — Appendix B

This is the technical part, and it matters more than it appears to, because it can be performed correctly or incorrectly.

Appendix B to the directive specifies:

• A Humphrey perimeter.
• STANDARD SITA 24-2 or 30-2 testing only.
• A size III stimulus, at an intensity of 10 decibels or above.
• The diameter is calculated by joining the points seen at a sensitivity of 10 decibels or more through the fixation centre, as the average of two perpendicular lines.

Note that this is the same method of calculation that appears in the disability schedules for rating purposes — the average of two perpendicular diameters. The detail of how visual field restriction is rated, including what follows from that calculation, is set out in Visual Field Loss.

The practical consequence: a visual field test performed on a different protocol, or rejected for low reliability, does not serve the application even where the clinical state does meet the threshold. This is a point of failure that is technical rather than medical.

A blind certificate is not a disability rating

This is the most important point on this page.

Disability percentages are determined by a medical committee under a schedule of impairments — that of the National Insurance Institute or of the Ministry of Defence — cross-referencing acuity in both eyes and adding clauses for further impairments. The certificate is determined on an entirely separate track, by a different authority, under the three criteria above and nothing else.

The result is that the two figures are not derived from one another:

• It is possible to reach a high disability percentage — for example severe damage to one eye together with accompanying impairments — and not meet the certificate threshold, because the threshold is measured on the better eye alone.
• And it is possible to meet the certificate threshold at a relatively low percentage — for example in severe constriction of the visual field where central acuity is preserved, a situation discussed at length in the context of diabetic retinopathy.

Anyone wanting to see how the disability side in particular is built up can use the eye disability calculator — but it is important to understand that it calculates the disability track, not the certificate threshold.

What the process actually requires

• Examination by a physician of trust. An ophthalmologist appointed by the ministry, not the treating clinic’s doctor.
• The blind/low-vision certificate application form, together with a summary of the medical file from the eye clinic, to the address on the form.
• Documentation to standard. Visual acuity to ETDRS, visual field per Appendix B.
• Validity. The certificate may be issued permanently or for a limited period; the period is recorded on the certificate. Where circumstances change, a re-examination may be requested.

If a decision has already been given on the disability rating track and an appeal is under consideration, the deadlines and procedure — which are entirely separate from the certificate — are set out in Appealing a Medical Committee Decision.

What an ophthalmic opinion adds

• Examines whether the measurements already in the file do meet the threshold, or come close without reaching it.
• Identifies a test performed on a protocol other than the one Appendix B requires.
• Separates the tracks and clarifies what is being measured in each.
• Points to a missing test without which an existing state cannot be demonstrated.
• Considers whether the condition is stable, or whether an assessment made too early will fix a picture that does not hold over time.

And what an opinion does not do: it does not replace the examination by the physician of trust, does not bind the authority and does not guarantee an outcome.

How to get in touch

Examinations and assessments take place in Haifa and Herzliya, by prior arrangement. There is no need to send a full medical file with the first enquiry — a brief description of the finding, the stage the process has reached and the date that has been set is enough to establish whether the case is suited to an assessment within this field of expertise. Every enquiry is considered on its own merits, with no undertaking as to a conclusion or to the outcome of the proceedings.

Get in touch to check suitability for an assessment