NDIS and Functional Vision Assessment: What Is Covered?
Do you or the person you care for have vision challenges, but have been told that your eyes are fine? Have you attended an eye test, but been left with more questions than answers? If so, it is likely that a functional vision assessment would be helpful to determine how vision affects daily life.
Questions about NDIS funding for vision assessments come up regularly in our clinic. The answer depends on the purpose of the assessment. In this article we'll explain the difference between a standard eye test and a functional vision assessment, and why the funding pathway may be different.
Image of an optometrist standing beside a traditional letter chart. She is using a stick with a red ladybug bead at the end to point to individual letters on the chart.
The short answer
In many cases, yes.
Routine eye examinations are generally funded through Medicare.
However, when the purpose of an assessment is to understand how vision impacts a person's disability, communication, learning, mobility, independence, or participation in daily life, NDIS funding may be appropriate.
The most appropriate funding pathway depends on the purpose of the assessment.
What does Medicare cover?
For most people, when you think of eye healthcare, you think of an ‘eye test’. You book in with an optometrist, you go along, sit in the chair, read the letters on the chart, they use some machines and get you to look through different lenses, and then, if needed, they write you a prescription for glasses.
Some people have eye conditions and need to visit an ophthalmologist for monitoring and treatment. These appointments are similar to a standard optometrist eye test: they involve reading letters, and using various machines to obtain images of the eyes, then, at the end, you might be instructed to use some eye drops and/or return for a review. Some people use private ophthalmology practices, while others are cared for through hospital outpatient services.
One thing these services all have in common is that they are funded through public health or Medicare. When you visit an optometrist, or private ophthalmologist, you may have to contribute towards the cost of the visit, but you will be entitle to claim some of the fee back from Medicare, while care through the public hospital system is free at the point of access.
All of the above services, optometrist, private ophthalmology, and hospital eye services have another thing in common: they focus on the health and function of your eyes. While this is extremely important, what we have found over many years of working with people with disabilities is that often, when these services are used in isolation, families tend to be left with a lot of questions. They are told that ‘eyes are healthy’, but left wondering what their child or the person they care for can actually see. Often, this is something of a burning question, because families and carers have observed behaviours indicating that the person experiences challenges with vision, so ‘eyes are fine’ is quite confusing and inconclusive. What they really want to know is how vision affects daily life.
How is a functional vision assessment different from a standard eye test?
A functional vision assessment is quite different from a traditional eye test; it often includes some of the same assessments, but where traditional eye healthcare services aim to assess ‘visual function’ - how well the eyes are working, a functional vision assessment aims to establish what and how someone sees and how their vision affects daily life. This is an important distinction, because two people can have what appears to be a very similar level of visual function, but be functioning very differently from each other.
Functional vision assessment can be particularly important for people who are non-speaking, have intellectual disability, autism, cerebral palsy, acquired brain injury, or other complex disabilities. When a person cannot easily describe what they can and cannot see, understanding how they use vision in everyday life often requires a different assessment approach.
Traditional assessments of visual function tend to focus narrowly on specific aspects of vision. The main measure used is visual acuity (the letter chart), which determines whether someone can see small detail, but this is one single aspect of vision. When we assess functional vision, we still assess visual acuity, but we would also typically consider at least some of the following:
Contrast sensitivity
Can things still be seen when they aren’t high contrast black and white? Can someone discern the dark greys from the light greys? Can they discern the edges of steps if there are no high contrast markings? Do they bump into furniture if it is similar in colour to the surrounding.
Functional visual field
The area above, below, and out to the sides that a person is able to visually attend to. This can vary under different conditions, such as when there is noise, or when the person is having a conversation, and the area a person can functionally access can sometimes be quite different from what we measure clinically, using standardised testing. A lot of people with complex disabilities have challenges accessing their lower visual field, which can make getting around safely very challenging.
Visual complexity
Can the person see as well when there is a lot of visual information, or does visual information become inaccessible when there is too much to search /scan through?
Motion perception
Can the person still see things when they are moving? If this is challenging, then getting around safely can be significantly impaired, as we move through space we need to be able to interpret our surroundings, which are moving in relation to ourselves.
In addition to these aspects of vision, we need to consider how accessible vision is under different conditions, such as in unfamiliar environments and busy, noisy environments like playgrounds and shopping centres. We also need to consider how consistently accessible vision is. If vision is very variable day-to-day or seeing is very tiring, this needs to be understood if we are to avoid vision limiting access to everyday activities.
Is this evidence-based?
Functional vision assessment is supported by international expert consensus. Because many aspects of functional vision cannot yet be measured reliably using standardised clinical tests alone, assessment typically combines structured history-taking, clinical observation, and formal vision testing.
Can NDIS funding be used for a vision assessment?
If a person has functional vision limitations, this can reduce their functional capacity in several areas of life, including:
language and communication
personal care
mobility and movement
interpersonal interactions
functioning (including psychosocial functioning)
community living
A functional vision assessment can help identify disability-related barriers and provide evidence to support environmental modifications, assistive technology, therapy recommendations, orientation and mobility services, communication supports, and carer education. This can be invaluable for NDIS support planning and review.
Sometimes we need to create environmental adjustments, to ensure the person can visually access their environment, while other times, we need to substitute with other sensory input, such as auditory or tactile.
Real-world examples
An adult with intellectual disabilities may have challenges accessing their lower visual field. This is common among people with Down syndrome, genetic conditions, or chromosomal disorders. They would benefit from this being recognised. Support might include working with an orientation and mobility specialist, who can teach them safe strategies for navigating, learning to use a white cane, which allows tactile substitution for their unreliable vision, and/or low vision professionals working with their family and carers how they can best support the person, including techniques such as acting as a ‘sighted guide’ or providing auditory substitution: “We are coming to three steps going down.”
A child with language delay who is working with a speech pathologist to devise an appropriate augmentative and alternative communication system (AAC). When we are looking at communication options, it is crucial that we understand the child’s functional vision. They may be able to see small things, but not able to access vision on one side, if a communication system is presented on that side, it may be totally inaccessible, and if nobody has realised this, they probably have a 50:50 chance of visually accessing their communication system, depending on which side the person using it with them chooses to sit. A child might struggle with complexity, in which case they may be able to recognise images when presented individually, but these may become totally inaccessible when displayed in a grid of multiple symbols, which is the standard format for a lot of AAC devices. For some children, vision becomes significantly less accessible when there is noise, they may do great with their AAC in a quiet clinic environment, but seem totally uninterested at school, and this could actually be because it is visually inaccessible in this noisier environment. For some children, a visual-based communication may be entirely inaccessible in most settings and years can be wasted attempting to get them to visually engage because nobody has realised that they can only see under optimum conditions.
Medicare or NDIS?
Having got this far through our blog, hopefully you have a clear understanding of these two possible pathways:
If your goal is to check that eyes are healthy and to determine if glasses can help, then accessing a standard eye test, with part-funding from Medicare is likely the right pathway. We provide standard eye tests for people with complex disabilities, and we can help you claim part of the cost back from Medicare.
If, in addition to the above, you are wanting is a better understanding of what and how you or the person you care for sees, how vision impacts on everyday activities, what supports are needed to ensure full participation and functional capacity, then a functional vision assessment is more likely to answer these questions, and since functional vision impacts on pretty much every area of our lives, a functional vision assessment may be appropriately funded through the NDIS where it relates to the participant's disability-related functional capacity and goals.
Here’s a quick table summary:
| Medicare | NDIS |
|---|---|
| Are the eyes healthy? | How does vision affect daily life? |
| Do glasses help? | What supports are needed? |
| Medical assessment | Functional assessment |
| Focus on eye health | Focus on participation and capacity |
How do I know if my NDIS plan can fund this?
If you have a support coordinator, it can be helpful to ask them. We have created some resources for this: you can either direct them to information on our website here, or you can use our email template and send them our brief information flyer. If you are self-managed, you just need to determine if a functional vision assessments aligns with your NDIS goal.
The National Disability Insurance Scheme (NDIS) uses six core domains of functioning to assess how a disability impacts an individual's daily life and overall functional capacity. These domains include: mobility, communication, social interaction, learning, self-care, and self-management. If you cannot reliably access good vision, it is likely that you will experience challenges in some or all of these areas, for example:
Mobility - difficulties with mobility can be associated with functional visual field limitations: a person may not be able to reliably access their lower visual field, which can make getting around very challenging and often dangerous. Another common issue is something called ‘hemianopia’ which is where a person cannot see on one side, this is a common characteristic in people with cerebral palsy, particularly if they have hemiplegia, yet often this seems to have gone undetected.
Communication - As described in our real-world example above, if a person has functional vision challenges they may not be able to access an AAC device/system.
Social Interaction - Recognising faces requires good visual acuity and contrast sensitivity, while interpreting facial expressions is difficult if you have challenges with motion perception.
Learning - We need good vision to access visual learning; this includes seeing the board and the teacher at school, looking at pictures, accessing print, and copying physical activities that might be required in sport or in physical therapies.
Self-care - If our vision prohibits us from being able to find our personal possessions it is very difficult to manage our self-care activities independently. Good use of lighting and contrast, control of clutter and complexity, and establishment of designated places for personal possessions are a few examples of environmental adjustments that can help.
Self-management - Paying bills and making sure you are taking your medications correctly, or correctly administering them to you child can be impossible if your vision is reduced, and we need to use magnification, or alternative access methods to ensure this goal can be attained.
Funding decisions are ultimately made by the participant, their plan manager, support coordinator, or the NDIA. We cannot guarantee that NDIS funding will be available in every situation, but we are happy to discuss whether a functional vision assessment appears relevant to a person's disability-related needs and goals.
Want to learn more?
If you are keen to find out more, please reach out to us. You can email us, or call us. Our reception is usually staffed 10am-2.30pm Mondays and Thursday and we are very happy to discuss funding options with you and answer any questions you may have. You can find more general funding information here.