国内外视野缺损残疾标准及计算方法的比较研究

A comparative study of forensic criteria and assessment methods for visual field loss at home and broard

视野缺损测评是法医学鉴定领域方法研究与鉴定实操的难点。本文通过将国内外现行残疾标准视野评定条款及视野缺损计算方法进行比较与总结,发现国内残疾标准中《致残分级》关于视野缺损条款的覆盖范围及等级划分较《工伤伤残》《保险伤残》更为合理和完备,但是较国外权威残疾标准如美国AMA指南(第六版)仍存有差距。视野有效值法与国外视野评分法相比,计算简单、可操作性较强,但在不规则视野缺损、偏盲、双眼功能视野等方面欠准确甚至无法计算。建议日后在国内视野缺损残疾标准的修订时,结合国内残疾研究和实操状况适当参考国外视野缺损残疾标准的设计理念、方法和视野评分法,进一步完善我国残疾标准相关视野缺损的评定问题。

The Assessment of visual field loss is considered a difficult component in forensic clinical methods study and practice.This study compared and analyzed domestic and foreign pertinent criteria and assessment methods in visual field loss.As results,the Gradation of Disability in Human Body Injuries was more comprehensive and applicable in visual field loss than other pertinent criteria,such as the Standard for work ability identification—Gradation of disability caused by workrelated injuries and occupational diseases and the Standard and code for disability assessment of life insurance.However,when compared to foreign authoritative criteria,for example the the AMA Guides to the Evaluation of Permanent Impairment(Sixth Edition),deficiency was observed.On the other hand,“Visual Field Efficiency”method and“Visual Field Score”method are respectively the main methods of visual field loss assessment in domestic and foreign criteria.“Visual Field Efficiency”method is convenient and maneuverable,but is less precise in irregular visual field loss,binocular field,and even incalculable in hemianopsia situation.Some advanced concepts,methods and“Visual Field Score”method are suggested to provide references and further improvement of domestic visual field loss impairment.