01Role and principlesWho benefits and the main preventive aims.
Certification records a clinically assessed degree of visual impairment and can connect a person to services that preserve independence. It should be discussed as an opportunity for support, while acknowledging that the language can be upsetting and that people vary in readiness to engage. It does not mean every treatment has ended, and it should not replace careful explanation of what vision remains, what can still be treated and what help is available now.
In England, a consultant ophthalmologist completes the medical certification using the current Certificate of Vision Impairment form. With the person's consent, the information enables their local authority to offer registration and assess support needs. Registration is voluntary and may help evidence eligibility for particular concessions, but refusing it does not remove a person's need for rehabilitation, accessible information or social-care assessment.
Key points
- The DHSC CVI documents described here apply to England; other UK nations have their own forms and arrangements.
- A consultant ophthalmologist certifies sight impairment or severe sight impairment using clinical judgement.
- Acuity and visual field loss must be considered together, with their effect on everyday function.
- Certification and local-authority registration are separate steps, and registration is voluntary.
- Support can begin before certification and does not require agreement to registration.
- Use the RVI route for hospital referral when a CVI is not yet appropriate or registration is declined.
- Explain information-sharing choices and provide the patient with an accessible copy.
- Refer children directly for specialist educational vision support without waiting for a CVI.
02Assessment and patient selectionRisk features, eligibility and important cautions.
Explore reading correspondence, identifying medication, cooking, recognising faces, navigating steps and travelling independently. Ask about priorities rather than assuming that every patient wants the same device or service. Field loss may cause major mobility difficulty even when the person reads relatively small letters.
The adult guidance uses the better-seeing eye as a starting point, alongside field loss and functional effect. Record best-corrected acuity for each eye and binocular function. Recent loss can be especially disabling while adaptation is incomplete, and the consultant's judgement is not replaced by one acuity cut-off.
Ask what certification or registration means to the person. They may believe it removes autonomy, signals total blindness or automatically ends employment. Explain the actual process and allow time for discussion, while making a practical referral when support is wanted before a final registration decision.
Hearing loss, cognitive impairment, reduced mobility or language barriers can make ordinary leaflets and telephone contact ineffective. Record a usable contact method and preferred format. A large-print letter is not an adequate adjustment for everyone with visual loss.
Visual impairment can affect development, access to learning and independence skills. The England guidance calls for direct referral to the local authority specialist education vision impairment service as soon as impairment is identified and appropriate consent is obtained. The CVI is not the educational referral route.
03Baseline assessmentMeasurements that guide the plan and track progress.
Read from the initial assessment onwards. Tests may run in parallel in urgent care; first-line, preferred, confirmatory, definitive and gold-standard labels appear only when the chapter explicitly states them.
- 01
Best-corrected acuity and visual field assessmentFirst step - Why
- Provide clinical evidence for the consultant's certification judgement.
- Interpretation and limitations
- Measure corrected acuity in each eye and binocular function, with formal fields when appropriate. England adult guidance considers severe certification with better-eye acuity worse than 3/60; acuity from 3/60 to worse than 6/60 with field contraction; or 6/60 or better with clinically significant contracted fields impairing function. Consultant judgement integrates these findings with daily activities.
- 02
Sight-impaired acuity and field groupings - Why
- Apply the England guidance to impairment that may qualify for the sight-impaired category.
- Interpretation and limitations
- The guidance includes acuity from 3/60 to 6/60 with a full field; between 6/60 and 6/24 with moderate field contraction, media opacity or aphakia; and 6/18 or better with marked field loss such as homonymous hemianopia. These adult better-eye groupings guide an individual consultant assessment rather than determining the category automatically.
- 03
Clinical assessment of impairment and cause - Why
- Identify the main causes, potentially treatable components and implications for prognosis.
- Interpretation and limitations
- Record the cause in each eye and the main contributor to the person's qualifying impairment. Continuing treatment does not inherently prevent certification. Avoid making the person wait for every possible intervention to end before discussing support.
- 04
Daily-living and rehabilitation assessment - Why
- Translate visual loss into practical needs and achievable rehabilitation goals.
- Interpretation and limitations
- Consider home layout, mobility, reading, communication and self-care. A professional may identify helpful aids, training or adaptations, but the person's goals should direct the plan. Social support eligibility is not determined solely by the Snellen fraction.
- 05
Information and consent assessment - Why
- Ensure the person understands the process and can choose how information is shared.
- Interpretation and limitations
- Explain destinations and purposes on the current form, document the decision and use an accessible explanation. Do not assume that inability to read print means inability to decide. Where capacity or a child's competence is in question, apply the appropriate decision-making framework.
- 06
Child development and education referral review - Why
- Check that educational and habilitation support has begun through the correct service.
- Interpretation and limitations
- Verify contact with the specialist education vision impairment team rather than assuming a completed CVI has triggered it. Children may need certification based on clinical evidence even when standard acuity cannot yet be measured reliably.
04InterventionsLifestyle, treatment and escalation options.
01Considering certificationDiscuss eligibility and meaning with the patientFirst stepVisual impairment affects everyday function and certification may be appropriate.+
- 1Ask about current difficulties, treatment status and the person's understanding of certification.
- 2Arrange consultant ophthalmology assessment using best-corrected acuity, fields, diagnosis and functional information.
- 3Explain sight impaired and severely sight impaired categories without implying that severe certification requires total absence of vision.
- 4Offer eye clinic liaison and rehabilitation support while discussing the person's preferences and next steps.
02CVI completionConnect a completed certificate to supportThe consultant certifies sight impairment or severe sight impairment and the sharing decision has been discussed.+
- 1Complete the current England form accurately, including diagnosis, function, communication needs and relevant immediate support concerns.
- 2Obtain and document the appropriate information-sharing choices, and provide an accessible signed copy and patient information.
- 3Send the required copies through the approved secure route to the consented recipients; the current form specifies council transmission within five working days.
- 4Check that the local authority makes contact to offer registration and support, with follow-up if the expected contact within two weeks has not occurred.
03Support before registrationRefer according to need without waiting for a labelThe person wants help but certification is premature or they do not want registration.+
- 1Explain that social-care support and visual rehabilitation can be explored without joining the sight-loss register.
- 2Use the hospital RVI referral route, with consent, when appropriate to communicate functional difficulties and support needs.
- 3Arrange low-vision or eye clinic liaison input and address urgent problems with medication, nutrition or safe mobility.
- 4For a child, make the separate direct specialist educational referral and involve the family in development and habilitation goals.
05Targets, monitoring and follow-upResponse, safety and longer-term review.
- Confirm that support referrals were received and that the person can use the proposed contact method, equipment or training.
- Review vision and treatment separately from administrative registration, including new symptoms that may need urgent eye assessment.
- Ask at follow-up whether the person's most important daily-living goal has improved and whether new barriers have appeared.
- Revisit a declined certification or registration discussion sensitively if needs or preferences change, without making support conditional on agreement.
- If sight improves enough that certification no longer applies, arrange consultant-led communication about decertification and update support according to remaining needs.
06Special situationsVariants, exceptions and circumstances that change the usual approach.
Acuity alone can underestimate disability
England's sight-impaired guidance includes people with 6/18 acuity or better when a marked field defect, such as homonymous hemianopia, causes significant impairment. The severe category can also include better acuity with a clinically significant contracted field. Field pattern and function determine how the guidance is applied.
The categories are not equivalent to darkness
A severely sight-impaired person may retain useful residual vision. Explain what they can use, including magnification, contrast or lighting changes where suitable, while avoiding promises that a particular aid will work for everyone. Rehabilitation aims to build useful skills around the individual's remaining function.
Registration and consent are not identical
Consent to send information allows a council to contact the person; the person can still decide whether to join the register or accept offered help. Explain these choices separately. The form also addresses sharing with the GP and the Certifications Office for service and epidemiological purposes.
Driving advice must be explicit
The current England CVI patient information says that a person certified as sight impaired or severely sight impaired must not drive and must inform DVLA. Draw attention to this directly and organise alternative travel. Registration choice does not remove the underlying visual driving restriction.
Support reaches beyond low-vision devices
Useful services can include home adaptations, orientation and mobility training, assistive technology, benefits advice, workplace or education support and emotional care. Ask about isolation and loss of confidence. An ECLO can help connect clinical explanations with the practical choices the patient faces.
07Common pitfallsFrequent interpretation and management errors.
- 01
Making social support conditional on first accepting voluntary registration.
- 02
Using preserved central reading acuity to rule out certification despite substantial functional field loss.
- 03
Treating the CVI as evidence that all eye treatment should now stop.
- 04
Sending an ordinary print letter as the sole explanation to someone who cannot access it.
- 05
Assuming a child's CVI automatically replaces referral to the specialist educational vision service.