国内外视觉系统残疾标准比较研究

A comparative study on domestic and foreign criteria for visual system disability appraisal

视觉系统残疾评定是法医临床工作的重要组成部分。国内相关残疾标准在实践中不断地完善,尤其是2017年1月1日《人体损伤致残程度分级》开始实施。和先前的残疾标准比较,该标准总体上具有很大的进步,也较符合我国残疾评定的现状。但是,和国外标准如美国《永久性残损评定指南》、韩国医学科学院标准化指南及《欧洲生理和心理残疾医疗评估指南》比较,在视觉系统评残依据、指标和条款的表述方式等方面存在不同,操作上也有较大的差异,同时暴露出国内标准整体条款设计的不足。而国外标准内容更精细和丰富,特别是美国和韩国标准化指南中,诸如双眼视和近视力等指标,中心视野缺损和一体化评估视觉等方法,更科学地反映视觉作为特殊感觉的真实状况。建议今后标准的制修订时,适当考虑国外标准中评估视觉残损的科学理念和方法,进一步完善我国视觉系统残疾标准体系。

Visual system impairment or disability evaluation is one of the important components in forensic clinical practice.Pertinent criteria in our country have been progressively and apparently improved in practice.Especially the Gradation of Disability in Human Body Injuries,implemented since January 1,2017,is more applicable to the current appraisal situation compared to the previous criteria.When compared to the foreign criteria,such as the AMA Guides to the Evaluation of Permanent Impairment(GEPI),Korean Academy of Medical Sciences Guides(KAMS),and European Physical and Mental Disability Rating Scale for Medical Purposes,differences were observed in the evaluation basis,evaluation index,expression of the clauses and the evaluation operations.Through the comparison,it was also indicated that deficiencies existed in the design of domestic disability criteria.And foreign criteria,represented by the GEPI and KAMS guides,provided more comprehensive and scientific impairment rating.Some advanced concepts and methods,such as values of binocular vision and reading acuity and measurements of central visual field defect and visual system impairment,are suggested to provide references for the revision and further improvement of domestic visual impairment appraisal system.