Purpose: To clarify the prefecture-wise impact of the revised criteria for visual impairment certification based on the status of visual impairment certification for the fiscal year 2019.
Participants and methods: A nationwide questionnaire-based survey was conducted in 161 regional welfare offices that manage physical disability certificates to determine the number and attributes of adult individuals (aged ≥ 18 years) newly certified as visually-impaired between April 1,2019, and March 31,2020. All offices responded (response rate: 100%). Linear regression analyses were performed on the factors that could be related to the number of visually-impaired individuals according to prefecture.
Results: We analyzed data from 16,504 individuals certified as visually impaired nationwide. The proportion of adult individuals certified as visually-impaired (per 100,000 individuals aged ≥ 18 years) (hereinafter referred to as "the proportion of certified visually-impaired individuals") was significantly associated with the ratio of individuals aged ≥ 65 years in the total population (hereinafter referred to as "aging rate"). Every 1% increase in the aging rate increased the proportion of certified visually-impaired individuals by 0.63 (p=0.003, regression coefficient 0.63,95% confidence interval 0.23-1.03); no significant association was observed with the number of ophthalmologists who were designated physicians under Article 15 of the Act on the Welfare of Persons with Physical Disabilities per 100,000 population or with the number of ophthalmologists per 100,000 population. The three prefectures with the maximum proportion of certified visually-impaired individuals were Kochi (35.6), Yamaguchi (26.1), and Shimane (23.5), while Tochigi (10.3), Iwate (10.6), and Ishikawa (10.7) had the least proportion of such individuals. Compared to the fiscal year 2015,83.3% of the prefectures exhibited an increase in the proportion of certified visually-impaired individuals, with Tottori (+111.8%), Kochi (+89.8%), Toyama (+77.1%), Yamaguchi (+75.2%), and Shimane (+74.7%) reporting the maximum increase rate, while the largest decrease rate was -34.6%, showing a large variation by prefecture. Glaucoma was the leading causative disease in all prefectures. The prefectures with the highest percentage of Grade 1 and 2 certifications combined, in order, were Saga (72.6%), Fukui (71.6%), and Ibaraki (70.9%). The prefectures with the highest percentage of Grade 5 and 6 certifications combined, in order, were Kochi (49.8%), Osaka (35.8%), and Iwate (31.5%).
Conclusions: The proportion of certified visually-impaired individuals was positively correlated with the aging rate. The proportion of these individuals increased in most prefectures, and the rate of change in their proportion varied widely among prefectures, compared to that in fiscal year 2015. The revision of the certification criteria in July 2018 may have driven this short-term change.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 127: 1095-1102,2023.