The visual impairment certificate is a type of physical disability certificate under the Act on Welfare of Persons with Physical Disabilities, targeting visual impairments. It is issued by prefectural governors, mayors of designated cities, or mayors of core cities 1). The target is visual impairment that is above a certain level and permanent 1).
The degree of disability is classified into grades 1 to 6 based on the grade table in Appendix No. 5 of the Enforcement Regulations of the Act on Welfare of Persons with Physical Disabilities 1)2). Both visual acuity impairment and visual field impairment can be eligible for certification. It is a certificate required to receive various welfare services, assistive device provision, and financial support.
QIs the certificate issued by a hospital?
A
It is not a system where hospitals directly issue the certificate. The process involves an ophthalmologist preparing a medical certificate and opinion letter, which you then submit to the municipal office in your area of residence to apply. 1)7)
For visual impairment certification, visual acuity and visual field are central. Visual acuity is determined using the best corrected visual acuity with appropriate lenses. 3) Visual field is evaluated using a Goldmann perimeter or automated perimeter. 3)
Visual Acuity Criteria
Grade 1: The better eye has visual acuity of 0.01 or less.
Grade 2: The better eye has visual acuity between 0.02 and 0.03 inclusive, or the better eye is 0.04 and the other eye is hand motion or worse.
Grade 3: The better eye has visual acuity between 0.04 and 0.07 inclusive, or the better eye is 0.08 and the other eye is hand motion or worse.
Grades 4 to 6: Divided into categories such as 0.08 to 0.1 inclusive, 0.2 with the other eye 0.02 or less, 0.3 to 0.6 inclusive with the other eye 0.02 or less, etc. 2)
Visual Field Criteria
Grade 2: The sum of peripheral visual field angles is 80 degrees or less in each eye and the binocular central visual field angle is 28 degrees or less, or the binocular open visual field recognition points are 70 or less and the binocular central visual field recognition points are 20 or less.
Grade 3: The sum of peripheral visual field angles is 80 degrees or less in each eye and the binocular central visual field angle is 56 degrees or less, or the binocular open visual field recognition points are 70 or less and the binocular central visual field recognition points are 40 or less.
Grades 4 to 5: Determined by peripheral visual field angle of 80 degrees or less, loss of half or more of the binocular visual field, binocular central visual field angle of 56 degrees or less, binocular open visual field recognition points of 70 to 100 or less, etc. 2)3)
Supplementary Information
Grade 7 alone: A single Grade 7 disability does not qualify for the certificate.
Multiple disabilities: If there are two or more grade 7 disabilities, or if a grade 7 disability overlaps with a grade 6 or higher disability, it may be eligible3).
Assessment method: Results from Goldmann perimetry and automated perimetry cannot be mixed3).
QCan certification be granted based solely on visual field impairment even if visual acuity is relatively good?
A
It can be certified. Under the current criteria, the assessment method using peripheral and central visual fields by Goldmann perimetry, or binocular open visual field score and central visual field score by automated perimetry, has been clarified2)3)6).
Combination rules for multiple disabilities (grade determination by total index)
When visual acuity impairment and visual field impairment overlap, the grade is determined by the total index. The index corresponding to each disability grade is summed, and the certification grade is calculated from the total index.
Index table for visual acuity and visual field impairment
Disability grade
Visual acuity impairment index
Visual field impairment index
Grade 1
18
—
Grade 2
11
11
Grade 3
7
7
Grade 4
4
4
Grade 5
2
2
Grade 6
1
—
Correspondence between total index and disability grade
Total index
Disability grade
18 or more
Grade 1
11–17
Grade 2
7–10
Grade 3
4–6
Grade 4
2–3
Grade 5
1
Grade 6
Example: Visual impairment Grade 3 (index 7) + Visual field impairment Grade 2 (index 11) = total 18 → certified as Grade 1.
QIf a person has both visual acuity and visual field impairments, what grade will they receive?
A
The indices corresponding to each impairment grade are added together to calculate the total index, which determines the certification grade. For example, if visual impairment Grade 3 (index 7) and visual field impairment Grade 2 (index 11) overlap, the total is 18, and the person is certified as Grade 1. This may result in a higher grade than if each impairment were assessed individually.
The following points should be confirmed before applying.
Confirmation of designated physician: Medical certificates and opinions must be completed by a physician designated under Article 15 of the Act on Welfare of Persons with Physical Disabilities 7).
Confirmation of correction conditions: Visual acuity is generally assessed based on best-corrected visual acuity. If regular glasses or contact lenses are insufficient, adjustments may be needed before the examination 3).
Confirmation of visual field testing method: Be aware whether the assessment uses a Goldmann perimeter or an automated perimeter. Results from different methods cannot be mixed 3)4).
Understanding of system revisions: Since July 1, 2018, certification criteria using automated perimeters have been clearly defined. It is important not to confuse this with older explanations 6).
Confirmation of local government office: The name of the office, photo requirements, and documents needed for proxy applications may vary by municipality 7).
The nationwide process generally follows the order below.
Step
Details
Main contact
1
Ophthalmology visit
Designated physician
2
Medical certificate preparation
Medical institution
3
Application submission
Municipal office
4
Review
Rehabilitation counseling center, etc.
5
Issuance of certificate
Local government
According to the guidance of Yokohama City, the certificate is generally delivered about two months after the application date 7). Since the date of issuance may serve as the reference date for other systems, prompt application after completion of the medical certificate is recommended 7).
QHow long does it take from application to issuance?
A
Although it varies by local government, Yokohama City states that the certificate is issued approximately two months after application 7). If re-evaluation or additional documents are required, it may take longer.
In certification practice, not only numerical values but also the consistency of examination conditions and records are checked.
Corrected visual acuity: If refractive error is present, judgment is made based on corrected visual acuity with the most appropriate lens 3).
Goldmann perimeter: Peripheral visual field angle is determined with the I/4 target, and central visual field angle with the I/2 target 3).
Automated perimeter: Evaluation using the binocular open Esterman test with 120 points and the 10-2 program with 68 points 3).
No mixing: Results from Goldmann perimeter and automated perimeter cannot be combined for a single certification 3).
Handling discrepancies: Inconsistencies between the disease and visual field defects, old test results, and misreading of test targets may be subject to review 4)5).
QCan I apply using only old visual field test results?
A
Ultimately, it is up to the local government and the designated physician, but test results reflecting the current disability status are preferable. Especially for visual field disorders, it is important that the testing method and attached documents meet current standards 3)4).
7. Welfare services after issuance of the certificate
Once you obtain the certificate, you can use various welfare services. The main services are as follows.
Service category
Details
Financial support
Medical assistance for persons with disabilities, medical care for independent living support, medical care for specific diseases
Provision of assistive devices
Costs for glasses, white canes, etc. (generally 10% copayment)
Provision of daily living aids
Provision of magnifying readers, talking clocks, etc.
Education and facility use
Use of special needs schools, disability facilities, and welfare facilities
Transportation fare discounts
Discounts on train, JR, and domestic airfare
Postal and communication services
Free mailing service for visually impaired individuals
Broadcast reception fees
Exemption from NHK reception fees
The higher the grade (Grade 1 or 2), the broader the range of services and the higher the benefit amounts may be. If the disability grade changes due to disease progression, it is possible to apply for a grade change.
For visual impairment certification, the revision that took effect on July 1, 2018, was a major milestone 6). This revision clarified the criteria using automated perimetry, and the judgment using the binocular open Esterman test and the 10-2 program was systematically organized 3)6).
