Glaucoma is one of the most common chronic diseases in ophthalmology, and it is also the disease where the gap between Israel’s two disability systems is at its widest. The same patient, with an identical medical file, can leave a National Insurance committee with 0% and a Ministry of Defence committee with a percentage — not because of differing judgement, but because the two schedules are built differently.
The National Insurance Institute has no glaucoma clause
This is not an anecdote or an interpretation. The list of ophthalmic items in the National Insurance disability tests simply contains no clause 58 — the clause that at the Ministry of Defence is titled “Glaucoma, raised intraocular pressure”. In its place there is an explicit referral: glaucoma and raised intraocular pressure are determined according to the visual field restriction and the impairment of visual capacity.
The practical meaning is sharp. The Institute does not rate the disease — it rates only the holes it has left. A patient with advanced glaucoma, three drops a day, two operations and a decade of follow-up, but with a field that is still wide and acuity that is preserved, does not reach a percentage through the disease itself. He has to reach it through visual field loss or through reduced acuity, not through the diagnosis.
How the visual field is translated into percentages
This is the central axis of every glaucoma file at the Institute. Clause 52(2) rates by the type of loss, not by the percentage of field lost, and it is divided into three groups.
Quadrant loss (or less):
| Finding | One eye | Both eyes |
|---|---|---|
| Loss of less than a quadrant of the field | 0% | 0% |
| Upper nasal | 0% | 0% |
| Upper temporal | 5% | 15% |
| Lower nasal | 5% | 15% |
| Lower temporal | 10% | 25% |
| Lower nasal in one eye and lower temporal in the other | — | 30% |
Half-field loss:
| Finding | One eye | Both eyes |
|---|---|---|
| Upper | 10% | 30% |
| Inner | 10% | 25% |
| Complete right or left homonymous | — | 60% |
| Outer | 20% | 50% |
| Lower | 20% | 65% |
Concentric constriction, by diameter:
| Diameter of the visual field | One eye | Both eyes |
|---|---|---|
| Above 80° | 0% | 0% |
| 61°–80° | 0% | 5% |
| 41°–60° | 5% | 20% |
| 20°–40° | 10% | 40% |
| Under 20° | 30% | 100% |
That last row explains why end-stage glaucoma is a heavy disability at the Institute too: bilateral constriction below 20° is rated 100%, even when central acuity has remained 6/6. Tunnel vision is functional blindness, and the schedule recognises that in full. On what these ratings mean beyond the percentages — see the blind certificate.
The point that sinks glaucoma files: the upper nasal step
Look at the second row of the first table. Loss of the upper nasal quadrant is rated 0% — in both eyes as well.
That is precisely the shape of the classic early glaucomatous defect. The arcuate scotoma and the nasal step appear characteristically in the upper field, and they are the finding the ophthalmologist looks for in the first years of the disease. In other words: the most distinctive, earliest and most diagnostic defect of glaucoma is exactly the defect the schedule rates at zero.
The same extent of damage, had it sat in the lower temporal quadrant, would be rated 10% for one eye and 25% for both. The schedule’s logic is not medical but functional — the lower field is the one used for walking, descending stairs and detecting obstacles, so it carries heavier weight. But the consequence is that many glaucoma patients receive 0% at the stage where the disease is already clearly diagnosed, and only begin to accumulate percentages once the defect spreads beyond the upper quadrant.
Two technical definitions that are worth percentages
The “diameter of the visual field” for the concentric constriction table is the average of the vertical and the horizontal diameter. This is not cosmetic: a field constricted mainly along one axis yields a higher average than the chart appears to show at a glance, and vice versa. It is worth computing the number in advance rather than leaving it to interpretation.
Chart reliability. If the chart is unreliable on repeat testing as well, the rating is set from the clinical findings rather than from the chart. In glaucoma this is critical, because older or fatigued patients not infrequently produce tests with a high rate of fixation losses. Such a test is not evidence, and a large share of committee disputes turn on reliability rather than on the finding itself. Two reliable, consistent tests are worth more than five noisy ones.
Visual acuity — the second axis
Alongside the field, the Institute derives percentages from the corrected acuity of both eyes together, using a table that cross-references the values 6/6, 6/9, 6/12, 6/18, 6/24, 6/36, 6/60, 3/60, 1/60 and NLP. In glaucoma central acuity is usually preserved until a late stage, so this axis generally enters the picture late — but when it does, it is heavy. One eye at 6/6 against a fellow eye at 6/60 is rated 20%; against an eye that has lost light perception — 30%. A full explanation of the calculation and of how the two axes cross is on eye disability assessment.
At the Ministry of Defence: clause 58 stands on its own
Here the picture is reversed. The Disabled Persons Regulations have a dedicated clause, and it is short:
| Finding | One eye | Both eyes |
|---|---|---|
| Glaucoma | 5% | 10% |
| Following successful surgery or laser treatment | 1% | 2% |
| Raised intraocular pressure justifying monitoring only | 1% | — |
The third row is given in the one-eye form only, whether the monitoring is unilateral or bilateral.
And the part that really matters sits in the clause’s own note: the impairment of acuity and of visual field accompanying glaucoma confers additional disability. That is, unlike at the Institute — where the functional damage is the whole story — at the Ministry of Defence the diagnosis carries value of its own, and the damage accumulates on top of it.
The same patient, two numbers
The gap becomes concrete across three scenarios.
Controlled glaucoma, no documented damage. At the Institute — 0%, because there is nothing to measure. At the Ministry of Defence — 5% for one eye or 10% for both, for the disease itself.
Ocular hypertension under monitoring, without glaucoma. At the Institute — 0%, and there is no other route. At the Ministry of Defence — 1%. A small number, but it is not zero, and once it is weighted with other impairments in the file it moves.
Successful surgery, controlled pressure, a field already constricted to 20°–40° in both eyes. At the Institute — 40%, all of it from the concentric constriction table; the surgery and the disease itself add nothing. At the Ministry of Defence — 2% for the post-surgical state, and on top of it the field loss under clause 52(b) of the Disabled Persons Regulations, which is built differently and opens with a finer scale.
The line worth taking away: at the National Insurance Institute the claim must be functional, and at the Ministry of Defence it can also be diagnostic. A file built correctly for one system is not necessarily built correctly for the other.
What should be documented before the committee
- A series of visual fields, not a single test. Glaucoma is a disease of trend, and a series shows progression that one test cannot.
- Printed reliability indices — fixation losses, false positives and false negatives. A reliable chart is evidence; a noisy chart is an invitation to refusal.
- A precise description of the defect’s location — quadrant, half or concentric constriction, and where. The schedule rates by location, so generic wording such as “visual field damage” loses percentages.
- The diameter calculation as the average of vertical and horizontal, where concentric constriction is involved.
- Corrected visual acuity measured on more than one occasion.
- OCT documentation of the nerve fibre layer — not rated on its own in either schedule, but it is what turns a borderline chart into a reliable finding.
- A documented treatment sequence — drops, laser, surgery and the response to each.
Anyone preparing for a National Insurance committee will find the full framework on eye expert opinion for the National Insurance Institute; for the Disabled Persons track — on eye expert opinion for the Ministry of Defence. If a decision has already been issued and does not reflect the situation, the deadlines and rules are collected on appealing a medical committee.
Bottom line
Glaucoma is the cleanest case in which the question “how many percent am I entitled to” is meaningless without first asking “against which system”. At the National Insurance Institute it has no clause and is measured solely through the visual field and acuity — so the classic early glaucomatous defect, the upper nasal step, is rated zero. At the Ministry of Defence it is a standalone clause conferring a percentage in its own right, with the accompanying damage accumulating on top.
A patient who walks into a committee holding that distinction knows what to bring: not the diagnosis, but the map of what it has already taken.
Frequently asked questions
How many disability percentages does glaucoma carry?
It depends entirely on which system. The National Insurance Institute has no clause named glaucoma; disability is set solely by the visual field restriction and the impairment of visual capacity the disease has left behind — so a well-controlled glaucoma with no documented functional damage can come out at 0%. At the Ministry of Defence glaucoma is a standalone clause (clause 58) worth 5% for one eye or 10% for both, and the loss of field and acuity is added on top of it.
I have raised intraocular pressure under monitoring, with no damage. Is that worth anything?
At the National Insurance Institute — no. There is no clause on which ocular hypertension without damage can be hung, and with no field or acuity loss there is nothing to derive a percentage from. At the Ministry of Defence there is an explicit row for raised intraocular pressure justifying monitoring alone, worth 1% — a single percent, and only in the one-eye form, whether the monitoring is unilateral or bilateral.
My glaucoma surgery succeeded and the pressure is controlled. Have I lost the percentages?
The Ministry of Defence has a separate row for the state following successful surgery or laser treatment, worth 1% for one eye or 2% for both — less than active glaucoma, but not zero. More importantly: damage already done to the visual field is not erased by successful surgery. A constricted field stays constricted, and it continues to be measured and counted in both systems.
Why did a committee rate me 0% despite proven glaucomatous damage?
The most common reason is the shape of the defect rather than its severity. The classic early glaucomatous defect is a nasal step in the upper field, and the National Insurance schedule rates loss of the upper nasal quadrant explicitly at 0% — in both eyes as well. The same extent of damage, had it sat in the lower temporal quadrant, would be rated 10% for one eye or 25% for both. The second common reason is reliability: a chart with a high rate of fixation losses or false responses does not carry evidential weight.
