Federal Register / Vol. 77, No. 29 / Monday, February 13, 2012 / Proposed Rules 7549 

3Note: In the regulations.gov Web site, this is 

listed as comment 52, although it was originally 

comment 49, and its header identifies it as 

comment 49. 

freezer—automatic defrost with topmounted freezer without through-thedoor ice service (product class 3) and 

refrigerator-freezer—automatic defrost 

with side-mounted freezer with 

through-the-door ice service (product 

class 7)) and because DOE expected that 

results for these product classes would 

be representative for all of the product 

classes. DOE had this expectation 

because these two product classes 

represent a large majority of refrigeratorfreezers, which in turn represent the 

majority of energy use of refrigeration 

products. (See pages 5–9 and 2–1 of the 

2005 report). The technical report and 

the associated data sheets helped direct 

the priorities for DOE’s rulemaking 

activities. As a result, other products 

were given a higher priority, and limited 

rulemaking work on refrigerators and 

freezers was carried out in the following 

years prior to the enactment of the 

Energy Independence and Security Act 

of 2007, Public Law 110–140 (Dec. 19, 

2007) (EISA). 

EISA required DOE to publish a final 

rule to determine whether to amend the 

standards in effect for residential 

refrigeration products manufactured 

starting in 2014. Consistent with this 

requirement, DOE issued a notice of 

proposed rulemaking on September 27, 

2010. 75 FR 59470. Subsequently, on 

September 15, 2011, DOE issued a final 

rule that established energy 

conservation standards for over 40 

classes of residential refrigeration 

products. See 76 FR 57516 and 76 FR 

70865 (November 16, 2011) (date 

correction notice). The standards 

adopted in that final rule were largely 

based on a consensus agreement that a 

coalition of energy efficiency advocates 

and industry representatives submitted 

to DOE in July 2010, see DOE Docket 

No. EERE–2008–BT–STD–0012, 

Comment 49,3 and provided 

manufacturers with the requisite threeyear lead time contemplated by EPCA. 

See 42 U.S.C. 6295(m). 

In the preamble to the final rule, DOE 

discussed the issue of wine chiller 

coverage. See, e.g. 76 FR at 57534. The 

test procedure final rule and interim 

final rule distinguished between those 

products designed to safely store fresh 

food and those that were not. See 75 FR 

78810, 78817 (Dec. 16, 2010). Wine 

chillers are not treated as refrigerators 

because they are not designed to be 

capable of achieving compartment 

temperatures below the 39 °F limit 

specified in the definition for ‘‘electric 

refrigerator.’’ See 10 CFR 430.2. DOE 

indicated that it would consider the 

coverage of wine chillers as part of a 

separate future rulemaking. Today’s 

notice begins that process of examining 

the coverage of those residential 

refrigeration products, including wine 

chillers, that are not yet addressed by 

any Federal energy conservation 

standards. Under EPCA, refrigerators, 

refrigerator-freezers, and freezers are 

limited to those products that can be 

operated by alternating current 

electricity, but excluding (A) any type 

designed to be used without doors; and 

(B) any type which does not include a 

compressor and condenser unit as an 

integral part of the cabinet assembly. 

See 42 U.S.C. 6292(a)(1). 

The framework document explains 

the issues, analyses, and process that 

DOE is considering for the development 

of energy efficiency standards for wine 

chillers and miscellaneous refrigeration 

products. An accompanying public 

meeting will be held that will focus on 

the analyses and issues contained in 

various sections of the framework 

document. DOE plans to present and 

solicit discussion regarding these issues. 

DOE will also make a brief presentation 

on the process that it plans to follow 

when evaluating potential standards for 

these products. 

DOE encourages anyone who wishes 

to participate in the public meeting to 

obtain and review the framework 

document and to be prepared to discuss 

its contents. A copy of the draft 

framework document is available at 

http://www1.eere.energy.gov/buildings/ 

appliance_standards/residential/ 

refrigerators_freezers.html. 

However, public meeting participants 

need not limit their comments to the 

topics identified in the framework 

document. DOE is also interested in 

receiving views on other relevant issues 

that participants believe would affect 

energy conservation standards for these 

products. DOE invites all interested 

parties, whether or not they participate 

in the public meeting, to submit in 

writing by March 14, 2012, comments 

and information on matters addressed in 

the framework document and on other 

matters relevant to consideration of 

standards for wine chillers and 

miscellaneous refrigeration products. 

DOE will conduct the public meeting 

in an informal, facilitated, conference 

style. There shall be no discussion of 

proprietary information, costs or prices, 

market shares, or other commercial 

matters regulated by U.S. antitrust laws. 

A court reporter will record the minutes 

of the meeting, after which a transcript 

will be available for purchase from the 

court reporter and placed on the DOE 

Web site at www1.eere.energy.gov/ 

buildings/appliance_standards/ 

residential/refrigerators_freezers.htm. 

After the public meeting and the close 

of the comment period for the 

framework document, DOE will begin 

collecting data, conducting the analyses 

as discussed at the public meeting, and 

reviewing public comments. 

Anyone who wishes to participate in 

the public meeting, receive meeting 

materials, or be added to the DOE 

mailing list to receive future notices and 

information about wine chillers and 

miscellaneous refrigeration products 

should contact Ms. Brenda Edwards at 

(202) 586–2945. 

Issued in Washington, DC, on February 6, 

2012. 

Kathleen B. Hogan, 

Deputy Assistant Secretary for Energy 

Efficiency, Energy Efficiency and Renewable 

Energy. 

[FR Doc. 2012–3261 Filed 2–10–12; 8:45 am] 

BILLING CODE 6450–01–P 

SOCIAL SECURITY ADMINISTRATION 

20 CFR Part 404 

[Docket No. SSA–2010–0078] 

RIN 0960–AH28 

Revised Medical Criteria for Evaluating 

Visual Disorders 

AGENCY: Social Security Administration. 

ACTION: Notice of proposed rulemaking. 

SUMMARY: We propose to revise and 

reorganize the criteria in the Listing of 

Impairments (listings) that we use to 

evaluate cases involving visual 

disorders in adults and children under 

titles II and XVI of the Social Security 

Act (Act). The proposed revisions reflect 

our program experience and address 

adjudicator questions we have received 

since we last revised these criteria in 

2006. These proposed revisions reflect 

guidance we have issued in response to 

adjudicator questions and will ensure 

more timely adjudication of claims in 

which we evaluate visual impairments 

that involve a loss of visual acuity or 

loss of visual fields. 

DATES: To ensure that your comments 

are considered, we must receive them 

by no later than April 13, 2012. 

ADDRESSES: You may submit comments 

by any one of three methods—Internet, 

fax, or mail. Do not submit the same 

comments multiple times or by more 

than one method. Regardless of which 

method you choose, please state that 

your comments refer to Docket No. 

SSA–2010–0078 so that we may 


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1 71 FR 67037. 2 71 FR 67040, 67045, 67046, and 67049. 

associate your comments with the 

correct regulation. 

Caution: You should be careful to 

include in your comments only 

information that you wish to make 

publicly available. We strongly urge you 

not to include in your comments any 

personal information, such as Social 

Security numbers or medical 

information. 

1. Internet: We strongly recommend 

that you submit your comments via the 

Internet. Visit the Federal eRulemaking 

portal at http://www.regulations.gov. 

Use the Search function to find docket 

number SSA–2010–0078. The system 

will issue you a tracking number to 

confirm your submission. You will not 

be able to view your comment 

immediately because we must post each 

comment manually. It may take up to a 

week for your comment to be viewable. 

2. Fax: Fax comments to (410) 966– 

2830. 

3. Mail: Address your comments to 

the Office of Regulations, Social 

Security Administration, 107 Altmeyer 

Building, 6401 Security Boulevard, 

Baltimore, Maryland 21235–6401. 

Comments are available for public 

viewing on the Federal eRulemaking 

portal at http://www.regulations.gov or 

in person, during regular business 

hours, by arranging with the contact 

person identified below. 

FOR FURTHER INFORMATION CONTACT: 

Cheryl Williams, Office of Medical 

Listings Improvement, Social Security 

Administration, 6401 Security 

Boulevard, Baltimore, Maryland 21235– 

6401, (410) 965–1020. For information 

on eligibility or filing for benefits, call 

our national toll-free number, 1–800– 

772–1213 or TTY 1–800–325–0778, or 

visit our Internet site, Social Security 

Online, at http:// 

www.socialsecurity.gov. 

SUPPLEMENTARY INFORMATION: 

Why are we proposing to revise the 

listings for evaluating visual disorders? 

We last published final rules revising 

the criteria that we use to evaluate 

visual disorders in the Federal Register 

on November 20, 2006.1 Although these 

listings do not expire until February 20, 

2015, we are proposing to revise them 

now to reflect our program experience 

and to address adjudicator questions 

that we have received since 2006. We 

intend to publish revisions that would 

update the criteria for evaluating 

hearing disorders and speech and 

language disorders separately. 

What changes are we proposing to the 

introductory text of the adult listings 

for evaluating visual disorders? 

Most of the proposed introductory 

text is substantively the same as the 

current introductory text. We propose to 

clarify, simplify, and reorganize the 

introductory text. We also propose to 

expand some sections to clarify the 

existing guidance and to include 

additional acceptable testing for 

evaluating a person’s visual field loss. In 

the following paragraphs, we describe 

the significant changes we propose to 

make to the introductory text of the 

adult listings for evaluating visual 

disorders in part A of appendix 1 to 

subpart P of part 404, using the titles of 

the proposed sections. 

Section 2.00A2, How do we define 

statutory blindness? 

In proposed 2.00A2a, we would add 

the word ‘‘central’’ before ‘‘visual 

acuity’’ to correct the definition of 

statutory blindness in current 2.00A2. 

We would also add a reference to 

proposed 2.00A5, which explains visual 

acuity testing requirements. In proposed 

2.00A2b, we would add a reference to 

proposed 2.00A6, which explains our 

visual field testing requirements. In 

proposed 2.00A2c, we would add 

proposed listings 2.04A and 2.04B to 

our guidance in current 2.00A2, which 

explains that if your visual disorder 

medically equals the criteria of 2.02 or 

2.03A, or meets or medically equals 

2.03B, 2.03C, or 2.04, we will find that 

you have a disability if your visual 

disorder also meets the duration 

requirement. 

Section 2.00A4, What evidence do we 

need to evaluate visual disorders, 

including those that result in statutory 

blindness under title II? 

In proposed 2.00A4, we would 

remove current 2.00A4b, which 

describes cortical visual disorders, 

because it does not provide useful 

guidance to adjudicators on how to 

evaluate vision loss due to cortical 

visual disorders. While we added 

current 2.00A4b when we last published 

final rules making comprehensive 

revisions to section 2.00 on November 

20, 2006,2 it is not our intention to list 

in these rules every visual disorder that 

may result in vision loss. We propose to 

include cortical visual disorders as an 

example of a disorder that may result in 

abnormalities that do not appear on a 

standard eye examination. We also 

intend to provide guidance for 

evaluating a person’s vision loss due to 

cortical visual disorders and any other 

disorders that may result in vision loss 

or a loss in visual functioning (for 

example, blepharospasm) in our internal 

operating instructions and training. 

Section 2.00A5, How do we measure 

your best-corrected central visual 

acuity? 

We propose to make the following 

changes to current 2.00A5: 

• Provide guidance in proposed 

2.00A5a(ii) that explains how we use 

visual acuity measurements not 

recorded in Snellen notation, such as 

counts fingers (CF) or no light 

perception (NLP), to evaluate your 

vision loss. This guidance is in response 

to questions from our adjudicators. 

• Add the guidance in current 

2.00A8a, which explains how we use 

test charts that measure visual acuity 

between 20/100 and 20/200, to 

proposed 2.00A5b. 

• Provide guidance in proposed 

2.00A5d, which we currently provide in 

our internal operating instructions, that 

explains how we use the results of 

cycloplegic refraction. 

Section 2.00A6, How do we measure 

your visual fields? 

We propose to make the following 

changes to current 2.00A6: 

• Combine the guidance in current 

2.00A6a(i) and 2.00A6a(ii) in proposed 

2.00A6a, with one exception. As we 

explain below, we would move the 

guidance that explains our requirements 

for acceptable perimeters in current 

2.00A6a(ii) to proposed section 2.00A8. 

• Move the guidance on visual field 

testing requirements in current 

2.00A6a(iii), (vi), and (vii), to proposed 

2.00A6b(i), (ii), and (iii), respectively. 

• Revise our guidance on automated 

static threshold perimeters to remove 

specific references to perimeter 

manufacturers. In the preamble to our 

final rules published in the Federal 

Register on November 20, 2006, we 

explained that while the National 

Research Council (NRC) 2002 report, 

Visual Impairments: Determining 

Eligibility for Social Security Benefits, 

cited both the Humphrey Field Analyzer 

and the Octopus perimeter as acceptable 

perimeters, we were not including the 

Octopus perimeter as an example of an 

acceptable perimeter. We decided not to 

include the Octopus perimeter at that 

time because we did not intend to list 

every acceptable perimeter in our rules. 

However, since the publication of those 

rules, we have received numerous 

questions from adjudicators on the 

acceptability of the tests performed on 

Octopus and other perimeters. We have 

determined that other tests (including 

the Octopus 32) and perimeters 


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(including the Octopus 300 Series), 

meet our requirements for acceptable 

testing and acceptable perimeters. 

• Move the guidance in current 

2.00A6a(iv), which explains how we 

evaluate vision loss under 2.03A, to 

proposed 2.00A6c, and add the Octopus 

32 test as an acceptable test. 

• Move the guidance in current 

2.00A6a(v), which explains how we 

evaluate vision loss under 2.03B, to 

proposed 2.00A6d. We would add the 

definition of the term mean deviation 

(or defect), abbreviated as MD, which 

we use in current and proposed 2.03B 

but do not define. We would explain 

that Humphrey Field Analyzer (HFA) 

tests report the MD as a negative 

number and, therefore, we use the 

absolute value of the MD when 

determining whether the person’s visual 

field loss meets the listing. 

• Move the guidance in current 

2.00A6a(viii), which explains when we 

can use visual field measurements 

obtained using kinetic perimetry to 

evaluate vision loss, to proposed 

2.00A6e. 

• Move the guidance on visual field 

screening tests in current 2.00A6a(ix) to 

proposed 2.00A6f. 

• Move the guidance on the use of 

corrective lenses in visual field testing 

in current 2.00A6b to proposed 

2.00A6g. 

• Move the guidance on scotomas in 

current 2.00A8c to proposed 2.00A6h. 

2.00A7, How do we determine your 

visual acuity efficiency, visual field 

efficiency, and visual efficiency? 

We propose to make the following 

changes to current 2.00A7: 

• Introduce ‘‘value’’ as a term to 

express visual efficiency, in addition to 

the term ‘‘percentage,’’ in proposed 

2.00A7a, which we explain in the 

paragraphs below. 

• Add current Table 1 (Percentage of 

Visual Acuity Efficiency Corresponding 

to Best-Corrected Visual Acuity), which 

is located at the end of the current 

special senses and speech listings, to 

proposed 2.00A7b because it is more 

useful to our adjudicators to place this 

table in the introductory text 

immediately after the explanation of 

visual acuity efficiency. Our current 

rules describe overall visual efficiency 

as a percentage and we provide the 

equivalent visual acuity efficiency 

percentages corresponding to Snellen 

best-corrected central visual acuities for 

distance in Table 1. In the proposed 

table, we would include a column for 

visual acuity efficiency values that 

correspond to Snellen best-corrected 

central visual acuities for distance. 

• Expand current 2.00A7b and 

redesignate as proposed 2.00A7c. A 

person’s visual field efficiency can be 

expressed as a percentage (using the 

visual field determined by kinetic 

perimetry) or as a value (using the MD 

determined by automated static 

threshold perimetry). We would explain 

that a visual field efficiency percentage 

of 20 is comparable to an MD of 22, 

which we currently explain in training. 

• Add guidance in proposed 

2.00A7c(i) on how to calculate visual 

field efficiency value using the MD 

determined by automated static 

threshold perimetry, which we 

currently provide in our internal 

operating instructions. 

• Redesignate current 2.00A7b as 

proposed 2.00A7c(ii). 

• Add current Table 2 (Chart of 

Visual Fields), which is located at the 

end of the current special senses and 

speech listings, to proposed 2.00A7c(ii), 

and redesignate it as Figure 1, because 

it is more useful to our adjudicators to 

place this figure in the introductory text 

immediately after the explanation of 

visual field efficiency. We would also 

add, and make minor changes to, the 

example for calculating visual field 

efficiency percentage under the current 

table to proposed 2.00A7c(ii)A and B. 

• Expand current 2.00A7c and 

redesignate as proposed 2.00A7d. We 

would add an example for calculating 

visual efficiency value in proposed 

2.00A7d(i). In proposed 2.00A7d(ii), we 

would revise the example for 

calculating visual efficiency percentage, 

which is in current 2.00A7c, to simply 

state more clearly how we convert a 

decimal value to a percentage. 

Section 2.00A8, What are our 

requirements for an acceptable 

perimeter? 

We propose to move the guidance on 

acceptable perimeters in current 

2.00A6a(ii)A–F to proposed section 

2.00A8 because perimeter 

manufacturers must provide us with the 

evidence that their automated static 

threshold perimeter(s) meet these 

requirements before we can use any 

results of visual field testing performed 

on their perimeters to evaluate visual 

field loss. Although we are not 

proposing to change these requirements, 

we believe placing them at the end of 

the introductory text will allow 

adjudicators to more quickly access the 

guidance on visual field testing 

requirements that are applicable to 

testing performed on all acceptable 

perimeters. We would also remove the 

reference to the HFA because acceptable 

perimeters may change over time and 

we do not want to appear to be giving 

preference in our rules to one 

manufacturer over another. 

Other Changes 

We propose to remove 2.00A8b, 

which describes blepharospasm, 

because it does not provide useful 

guidance to adjudicators on how to 

evaluate vision loss due to 

blepharospasm and has led to repeated 

questions from our adjudicators. As we 

explained earlier with cortical visual 

disorders, we intend to provide 

guidance for evaluating a person’s 

vision loss due to blepharospasm and 

any other visual disorders that may 

result in vision loss or a loss in visual 

functioning in our internal operating 

instructions and training. 

What changes are we proposing to the 

listings for evaluating visual disorders 

in adults? 

In the following paragraphs, we 

describe the substantive changes to the 

adult listings for evaluating visual 

disorders in part A of appendix 1 to 

subpart P of part 404. We propose to: 

• Add 2.04A to evaluate visual 

efficiency determined using the MD 

from acceptable automated static 

threshold perimetry. 

• Redesignate current 2.04, which we 

use to evaluate visual efficiency 

determined by kinetic perimetry, as 

proposed 2.04B. 

What changes are we proposing to the 

introductory text and listings for 

evaluating visual disorders in children? 

We propose to clarify, simplify, and 

reorganize the introductory text in the 

childhood rules as in the adult rules. 

Since these are conforming changes, we 

do not summarize them here. We also 

propose to move the examples in 

current 102.00A5b(iii) to proposed 

102.02B. We believe it is more helpful 

to adjudicators to include these 

examples directly in the listing to which 

they apply. 

What is our authority to make rules 

and set procedures for determining 

whether a person is disabled under the 

statutory definition? 

The Act authorizes us to make rules 

and regulations and to establish 

necessary and appropriate procedures to 

implement them. Sections 205(a), 

702(a)(5), and 1631(d)(1). 

How long would these proposed rules 

be effective? 

If we publish these proposed rules as 

final rules, they will remain in effect for 

5 years after the date they become 

effective, unless we extend them, or 

revise and issue them again. 


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7552 Federal Register / Vol. 77, No. 29 / Monday, February 13, 2012 / Proposed Rules 

Clarity of These Proposed Rules 

Executive Order 12866, as 

supplemented by Executive Order 

13563, requires each agency to write all 

rules in plain language. In addition to 

your substantive comments on these 

proposed rules, we invite your 

comments on how to make them easier 

to understand. 

For example: 

• Would more, but shorter sections be 

better? 

• Are the requirements in the rules 

clearly stated? 

• Have we organized the material to 

suit your needs? 

• Could we improve clarity by adding 

more tables, lists, or diagrams? 

• What else could we do to make the 

rules easier to understand? 

• Do the rules contain technical 

language or jargon that is not clear? 

• Would a different format make the 

rules easier to understand, e.g., grouping 

and order of sections, use of headings, 

paragraphing? 

When will we start to use these rules? 

We will not use these rules until we 

evaluate public comments and publish 

final rules in the Federal Register. All 

final rules we issue include an effective 

date. We will continue to use our 

current rules until that date. If we 

publish final rules, we will include a 

summary of those relevant comments 

we received along with responses and 

an explanation of how we will apply the 

new rules. 

Regulatory Procedures 

Executive Order 12866, as 

Supplemented by Executive Order 

13563 

We have consulted with the Office of 

Management and Budget (OMB) and 

determined that this NPRM meets the 

criteria for a significant regulatory 

action under Executive Order 12866, as 

supplemented by Executive Order 

13563. Therefore, OMB reviewed it. 

Regulatory Flexibility Act 

We certify that these proposed rules 

will not have a significant economic 

impact on a substantial number of small 

entities because they affect individuals 

only. Therefore, a regulatory flexibility 

analysis is not required under the 

Regulatory Flexibility Act, as amended. 

Paperwork Reduction Act 

These proposed rules do not create 

any new or affect any existing 

collections and, therefore, do not 

require OMB approval under the 

Paperwork Reduction Act. 

(Catalog of Federal Domestic Assistance 

Program Nos. 96.001, Social Security— 

Disability Insurance; 96.002, Social 

Security—Retirement Insurance; 96.004, 

Social Security—Survivors Insurance; and 

96.006, Supplemental Security Income) 

List of Subjects in 20 CFR Part 404 

Administrative practice and 

procedure; Blind, Disability benefits; 

Old-age, survivors, and disability 

insurance; Reporting and recordkeeping 

requirements; Social Security. 

Michael J. Astrue, 

Commissioner of Social Security. 

For the reasons set out in the 

preamble, we propose to amend 20 CFR 

chapter III, part 404, subpart P as set 

forth below: 

PART 404—FEDERAL OLD-AGE, 

SURVIVORS AND DISABILITY 

INSURANCE (1950–) 

Subpart P—[Amended] 

1. The authority citation for subpart P 

of part 404 continues to read as follows: 

Authority: Secs. 202, 205(a)–(b) and (d)– 

(h), 216(i), 221(a), (i), and (j), 222(c), 223, 

225, and 702(a)(5) of the Social Security Act 

(42 U.S.C. 402, 405(a)–(b) and (d)–(h), 416(i), 

421(a), (i), and (j), 422(c), 423, 425, and 

902(a)(5)); sec. 211(b), Pub. L. 104–193, 110 

Stat. 2105, 2189; sec. 202, Pub. L. 108–203, 

118 Stat. 509 (42 U.S.C. 902 note). 

2. Amend appendix 1 to subpart P of 

part 404 by: 

a. Revising item 3 of the introductory 

text before part A; 

b. Revising section 2.00A and sections 

2.01 through 2.04 in part A; and 

c. Revising section 102.00A and 

sections 102.01 through 102.04 in part 

B. 

The revisions read as follows: 

APPENDIX 1 TO SUBPART P OF PART 

404—LISTING OF IMPAIRMENTS 

* * * * * 

3. Special Senses and Speech (2.00 and 

102.00): [Insert date 5 years from the effective 

date of the final rules]. 

* * * * * 

Part A 

* * * * * 

2.00 Special Senses and Speech 

A. How do we evaluate visual disorders? 

1. What are visual disorders? Visual 

disorders are abnormalities of the eye, the 

optic nerve, the optic tracts, or the brain that 

may cause a loss of visual acuity or visual 

fields. A loss of visual acuity limits your 

ability to distinguish detail, read, or do fine 

work. A loss of visual fields limits your 

ability to perceive visual stimuli in the 

peripheral extent of vision. 

2. How do we define statutory blindness? 

Statutory blindness is blindness as defined in 

sections 216(i)(1) and 1614(a)(2) of the Social 

Security Act (Act). 

a. The Act defines blindness as central 

visual acuity of 20/200 or less in the better 

eye with the use of a correcting lens. We use 

your best-corrected central visual acuity for 

distance in the better eye when we determine 

if this definition is met. (For visual acuity 

testing requirements, see 2.00A5.) 

b. The Act also provides that an eye that 

has a visual field limitation such that the 

widest diameter of the visual field subtends 

an angle no greater than 20 degrees is 

considered as having a central visual acuity 

of 20/200 or less. (For visual field testing 

requirements, see 2.00A6.) 

c. You have statutory blindness only if 

your visual disorder meets the criteria of 2.02 

or 2.03A. In order to find that you have 

statutory blindness under the law for a 

period of disability and for payment of 

disability insurance benefits, your blindness 

under 2.02 or 2.03A must also meet the 

duration requirement (see §§ 404.1509 and 

404.1581). You do not have statutory 

blindness if your visual disorder medically 

equals the criteria of 2.02 or 2.03A or meets 

or medically equals the criteria of 2.03B, 

2.03C, 2.04A, or 2.04B because your 

disability is based on criteria other than those 

in the statutory definition of blindness. If 

your visual disorder medically equals the 

criteria of 2.02 or 2.03A or meets or 

medically equals the criteria of 2.03B, 2.03C, 

2.04A, or 2.04B, we will find that you are 

under a disability if your visual disorder also 

meets the duration requirement (see 

§§ 404.1509 and 416.909 of this chapter). 

3. What evidence do we need to establish 

statutory blindness under title XVI? To 

establish that you have statutory blindness 

under title XVI, we need evidence showing 

only that your central visual acuity in your 

better eye or your visual field in your better 

eye meets the criteria in 2.00A2, provided 

that those measurements are consistent with 

the other evidence in your case record. We 

do not need documentation of the cause of 

your blindness. Also, there is no duration 

requirement for statutory blindness under 

title XVI (see §§ 416.981 and 416.983 of this 

chapter). 

4. What evidence do we need to evaluate 

visual disorders, including those that result 

in statutory blindness under title II? To 

evaluate your visual disorder, we usually 

need a report of an eye examination that 

includes measurements of your bestcorrected central visual acuity (see 2.00A5) 

or the extent of your visual fields (see 

2.00A6), as appropriate. If you have visual 

acuity or visual field loss, we need 

documentation of the cause of the loss. A 

standard eye examination will usually 

indicate the cause of any visual acuity loss. 

An eye examination can also indicate the 

cause of some types of visual field deficits. 

Some disorders, such as cortical visual 

disorders, may result in abnormalities that do 

not appear on a standard eye examination. If 

the eye examination does not indicate the 

cause of your vision loss, we will request the 

information the physician or optometrist 

used to establish the presence of your visual 

disorder. If your visual disorder does not 

satisfy the criteria in 2.02, 2.03, or 2.04, we 

will request a description of how your visual 

disorder affects your ability to function. 

5. How do we measure your best-corrected 

central visual acuity? 


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a. Visual acuity testing. When we need to 

measure your best-corrected central visual 

acuity, which is your optimal visual acuity 

attainable with the use of a corrective lens, 

we use visual acuity testing for distance that 

was carried out using Snellen methodology 

or any other testing methodology that is 

comparable to Snellen methodology. 

(i) Your best-corrected central visual acuity 

for distance is usually measured by 

determining what you can see from 20 feet. 

If your visual acuity is measured for a 

distance other than 20 feet, we will convert 

it to a 20-foot measurement. For example, if 

your visual acuity is measured at 10 feet and 

is reported as 10/40, we will convert this 

measurement to 20/80. 

(ii) A visual acuity recorded as CF (counts 

fingers), HM (hand motion only), LP or LPO 

(light perception or light perception only), or 

NLP (no light perception) indicates that no 

optical correction will improve your visual 

acuity. If your central visual acuity in an eye 

is recorded as CF, HM, LP or LPO, or NLP, 

we will determine that your best-corrected 

central visual acuity is 20/200 or less in that 

eye. 

(iii) We will not use the results of pinhole 

testing or automated refraction acuity to 

determine your best-corrected central visual 

acuity. These tests provide an estimate of 

potential visual acuity but not an actual 

measurement of your best-corrected central 

visual acuity. 

b. Other test charts. Most test charts that 

use Snellen methodology do not have lines 

that measure visual acuity between 20/100 

and 20/200. Some test charts, such as the 

Bailey-Lovie or the Early Treatment Diabetic 

Retinopathy Study (ETDRS) used mostly in 

research settings, have such lines. If your 

visual acuity is measured with one of these 

charts, and you cannot read any of the letters 

on the 20/100 line, we will determine that 

you have statutory blindness based on a 

visual acuity of 20/200 or less. For example, 

if your best-corrected central visual acuity for 

distance in the better eye is 20/160 using an 

ETDRS chart, we will find that you have 

statutory blindness. Regardless of the type of 

test chart used, you do not have statutory 

blindness if you can read at least one letter 

on the 20/100 line. For example, if your bestcorrected central visual acuity for distance in 

the better eye is 20/125+1 using an ETDRS 

chart, we will find that you do not have 

statutory blindness because you are able to 

read one letter on the 20/100 line. 

c. Testing using a specialized lens. In some 

instances, you may perform visual acuity 

testing using a specialized lens; for example, 

a contact lens. We will use the visual acuity 

measurements obtained with a specialized 

lens only if you have demonstrated the 

ability to use the specialized lens on a 

sustained basis. We will not use visual acuity 

measurements obtained with telescopic 

lenses because they significantly reduce the 

visual field. 

d. Cycloplegic refraction. Cycloplegic 

refraction, which measures your visual acuity 

in the absence of accommodation (focusing 

ability) after the eye has been dilated, is not 

part of a routine eye examination because it 

is not needed to determine your bestcorrected central visual acuity. If your case 

record contains the results of cycloplegic 

refraction, we may use the results to 

determine your best-corrected central visual 

acuity. We will not purchase cycloplegic 

refraction. 

e. Visual evoked response (VER) testing. 

VER testing measures your response to visual 

events and can often detect dysfunction that 

is undetectable through other types of 

examinations. If you have an absent response 

to VER testing in your better eye, we will 

determine that your best-corrected central 

visual acuity is 20/200 or less in that eye and 

that your visual acuity loss satisfies the 

criterion in 2.02, when these test results are 

consistent with the other evidence in your 

case record. If you have a positive response 

to VER testing in an eye, we will not use that 

result to determine your best-corrected 

central visual acuity in that eye. 

6. How do we measure your visual fields? 

a. General. We generally need visual field 

testing when you have a visual disorder that 

could result in visual field loss, such as 

glaucoma, retinitis pigmentosa, or optic 

neuropathy, or when you display behaviors 

that suggest a visual field loss. When we 

need to measure the extent of your visual 

field loss, we use visual field testing (also 

referred to as perimetry) carried out using 

automated static threshold perimetry 

performed on an acceptable perimeter (for 

perimeter requirements, see 2.00A8). 

b. Automated static threshold perimetry 

requirements. 

(i) The test must use a white size III 

Goldmann stimulus and a 31.5 apostilb (asb) 

white background (or a 10 candela per square 

meter (cd/m2) white background). The 

stimuli test locations must be no more than 

6 degrees apart horizontally or vertically. 

Measurements must be reported on standard 

charts and include a description of the size 

and intensity of the test stimulus. 

(ii) We measure the extent of your visual 

field loss by determining the portion of the 

visual field in which you can see a white 

III4e stimulus. The ‘‘III’’ refers to the 

standard Goldmann test stimulus size III (4 

mm2), and the ‘‘4e’’ refers to the standard 

Goldmann intensity filter (0 dB attenuation, 

which allows presentation of the maximum 

luminance) used to determine the intensity of 

the stimulus. 

(iii) In automated static threshold 

perimetry, the intensity of the stimulus 

varies. The intensity of the stimulus is 

expressed in decibels (dB). A perimeter’s 

maximum stimulus luminance is usually 

assigned the value 0 dB. We need to 

determine the dB level that corresponds to a 

4e intensity for the particular perimeter being 

used. We will then use the dB printout to 

determine which points you see at a 4e 

intensity level (a ‘‘seeing point’’). For 

example: 

A. When the maximum stimulus 

luminance (0 dB stimulus) on an acceptable 

perimeter is 10,000 asb, a 10 dB stimulus is 

equivalent to a 4e stimulus. Any point you 

see at 10 dB or greater is a seeing point. 

B. When the maximum stimulus 

luminance (0 dB stimulus) on an acceptable 

perimeter is 4,000 asb, a 6 dB stimulus is 

equivalent to a 4e stimulus. Any point you 

see at 6 dB or greater is a seeing point. 

c. Evaluation under 2.03A. To determine 

statutory blindness based on visual field loss 

in your better eye (2.03A), we need the 

results of a visual field test that measures the 

central 24 to 30 degrees of your visual field; 

that is, the area measuring 24 to 30 degrees 

from the point of fixation. Acceptable tests 

include the Humphrey Field Analyzer (HFA) 

30–2, HFA 24–2, and Octopus 32. 

d. Evaluation under 2.03B. To determine 

whether your visual field loss meets listing 

2.03B, we use the mean deviation or defect 

(MD) from acceptable automated static 

threshold perimetry that measures the central 

30 degrees of the visual field. MD is the 

average sensitivity deviation from normal 

values for all measured visual field locations 

within the central 30 degrees of the field. 

When using results from HFA tests, which 

report the MD as a negative number, we use 

the absolute value of the MD to determine 

whether your visual field loss meets listing 

2.03B. We cannot use tests that do not 

measure the central 30 degrees of the visual 

field, such as the HFA 24–2, to determine if 

your impairment meets or medically equals 

2.03B. 

e. Other types of perimetry. If your case 

record contains visual field measurements 

obtained using manual or automated kinetic 

perimetry, such as Goldmann perimetry or 

the HFA ‘‘SSA Test Kinetic,’’ we can 

generally use these results if the kinetic test 

was performed using a white III4e stimulus 

projected on a white 31.5 asb (10 cd/m2) 

background. Automated kinetic perimetry, 

such as the HFA ‘‘SSA Test Kinetic,’’ does 

not detect limitations in the central visual 

field because testing along a meridian stops 

when you see the stimulus. If your visual 

disorder has progressed to the point at which 

it is likely to result in a significant limitation 

in the central visual field, such as a scotoma 

(see 2.00A6h), we will not use automated 

kinetic perimetry to determine the extent of 

your visual field loss. Instead, we will 

determine the extent of your visual field loss 

using automated static threshold perimetry or 

manual kinetic perimetry. 

f. Screening tests. We will not use the 

results of visual field screening tests, such as 

confrontation tests, tangent screen tests, or 

automated static screening tests, to determine 

that your impairment meets or medically 

equals a listing or to evaluate your residual 

functional capacity. We can consider normal 

results from visual field screening tests to 

determine whether your visual disorder is 

severe when these test results are consistent 

with the other evidence in your case record. 

(See §§ 404.1520(c), 404.1521, 416.920(c), 

and 416.921 of this chapter.) We will not 

consider normal test results to be consistent 

with the other evidence if the clinical 

findings indicate that your visual disorder 

has progressed to the point that it is likely 

to cause visual field loss, or you have a 

history of an operative procedure for retinal 

detachment. 

g. Use of corrective lenses. You must not 

wear eyeglasses during visual field testing 

because they limit your field of vision. You 

may wear contact lenses or perimetric lenses 

to correct your visual acuity during the visual 

field test to obtain the most accurate visual 

field measurements. For this single purpose, 


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you do not need to demonstrate that you 

have the ability to use the contact or 

perimetric lenses on a sustained basis. 

h. Scotoma. A scotoma is a non-seeing area 

(also referred to as a blind spot) in the visual 

field surrounded by a seeing area. When we 

measure your visual field, we subtract the 

length of any scotoma, other than the normal 

blind spot, from the overall length of any 

diameter on which it falls. 

7. How do we determine your visual acuity 

efficiency, visual field efficiency, and visual 

efficiency? 

a. General. Visual efficiency is the 

combination of your visual acuity efficiency 

and your visual field efficiency expressed as 

a value or as a percentage. 

b. Visual acuity efficiency. Visual acuity 

efficiency is a value or a percentage that 

corresponds to the best-corrected central 

visual acuity for distance in your better eye. 

See Table 1. 

TABLE 1 

Snellen best-corrected central 

visual acuity for distance 

Visual acuity 

efficiency 

value 

(2.04A) 

Visual acuity 

efficiency 

percentage 

English Metric (2.04B) 

20/16 ........................................................................... 6/5 0.00 ............................................................................ 100 

20/20 ........................................................................... 6/6 0.00 ............................................................................ 100 

20/25 ........................................................................... 6/7.5 0.10 ............................................................................ 95 

20/30 ........................................................................... 6/9 0.18 ............................................................................ 90 

20/40 ........................................................................... 6/12 0.30 ............................................................................ 85 

20/50 ........................................................................... 6/15 0.40 ............................................................................ 75 

20/60 ........................................................................... 6/18 0.48 ............................................................................ 70 

20/70 ........................................................................... 6/21 0.54 ............................................................................ 65 

20/80 ........................................................................... 6/24 0.60 ............................................................................ 60 

20/100 ......................................................................... 6/30 0.70 ............................................................................ 50 

c. Visual field efficiency. Visual field 

efficiency is a value or a percentage that 

corresponds to the visual field in your better 

eye. Under 2.03C, we require kinetic 

perimetry to determine your visual field 

efficiency percentage. (A visual field 

efficiency percentage of 20, determined using 

kinetic perimetry, is comparable to an MD of 

22, determined using automated static 

threshold perimetry.) 

(i) Value determined by automated static 

threshold perimetry. Using the MD from 

acceptable automated static threshold 

perimetry, we calculate the visual field 

efficiency value by dividing the absolute 

value of the MD by 22. For example, if your 

MD on an HFA 30–2 is ¥16, your visual field 

efficiency value is: |¥16| ÷ 22 = 0.73. 

(ii) Percentage determined by kinetic 

perimetry. Using kinetic perimetry, we 

calculate the visual field efficiency 

percentage by adding the number of degrees 

you see along the eight principal meridians 

found on a visual field chart (0, 45, 90, 135, 

180, 225, 270, and 315) in your better eye and 

dividing by 5. For example, in Figure 1: 

A. The diagram of the left eye illustrates a 

visual field, as measured with a III4e 

stimulus, contracted to 30 degrees in two 

meridians (180 and 225) and to 20 degrees in 

the remaining six meridians. The visual 

efficiency percentage of this field is: ((2 × 30) 

+ (6 × 20)) ÷ 5 = 36 percent. 

B. The diagram of the right eye illustrates 

the extent of a normal visual field as 

measured with a III4e stimulus. The sum of 

the eight principal meridians of this field is 

500 degrees. The visual efficiency percentage 

of this field is 500 ÷ 5 = 100 percent. 

d. Visual efficiency. (i) Determined by automated static 

threshold perimetry (2.04A). Under 2.04A, 

we calculate the visual efficiency value by 

adding your visual acuity efficiency value 


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(see 2.00A7b) and your visual field efficiency 

value (see 2.00A7c(i)). For example, if your 

visual acuity efficiency value is 0.48 and 

your visual field efficiency value is 0.73, 

your visual efficiency value is: 0.48 + 0.73 = 

1.21. 

(ii) Determined by kinetic perimetry 

(2.04B). Under 2.04B, we calculate the visual 

efficiency percentage by multiplying your 

visual acuity efficiency percentage (see 

2.00A7b) by your visual field efficiency 

percentage (see 2.00A7c(ii)) and dividing by 

100. For example, if your visual acuity 

efficiency percentage is 75 and your visual 

field efficiency percentage is 36, your visual 

efficiency percentage is: (75 × 36) ÷ 100 = 27 

percent. 

8. What are our requirements for an 

acceptable perimeter? We will use results 

from automated static threshold perimetry 

performed on a perimeter that: 

a. Uses optical projection to generate the 

test stimuli. 

b. Has an internal normative database for 

automatically comparing your performance 

with that of the general population. 

c. Has a statistical analysis package that is 

able to calculate visual field indices, 

particularly mean deviation or mean defect. 

d. Demonstrates the ability to correctly 

detect visual field loss and correctly identify 

normal visual fields. 

e. Demonstrates good test-retest reliability. 

f. Has undergone clinical validation studies 

by three or more independent laboratories 

with results published in peer-reviewed 

ophthalmic journals. 

* * * * * 

2.01 Category of Impairments, Special 

Senses and Speech 

2.02 Loss of central visual acuity. 

Remaining vision in the better eye after best 

correction is 20/200 or less. 

2.03 Contraction of the visual field in the 

better eye, with: 

A. The widest diameter subtending an 

angle around the point of fixation no greater 

than 20 degrees. 

OR 

B. An MD of 22 decibels or greater, 

determined by automated static threshold 

perimetry that measures the central 30 

degrees of the visual field (see 2.00A6d). 

OR 

C. A visual field efficiency of 20 percent 

or less, determined by kinetic perimetry (see 

2.00A7c). 

2.04 Loss of visual efficiency in the better 

eye, with: 

A. A visual efficiency value of 1.00 or 

greater after best correction (see 2.00A7d(i)). 

OR 

B. A visual efficiency percentage of 20 or 

less after best correction (see 2.00A7d(ii)). 

* * * * * 

Part B 

* * * * * 

102.00 Special Senses and Speech 

A. How do we evaluate visual disorders? 

1. What are visual disorders? Visual 

disorders are abnormalities of the eye, the 

optic nerve, the optic tracts, or the brain that 

may cause a loss of visual acuity or visual 

fields. A loss of visual acuity limits your 

ability to distinguish detail, read, do fine 

work, or perform other age-appropriate 

activities. A loss of visual fields limits your 

ability to perceive visual stimuli in the 

peripheral extent of vision. 

2. How do we define statutory blindness? 

Statutory blindness is blindness as defined in 

sections 216(i)(1) and 1614(a)(2) of the Social 

Security Act (Act). 

a. The Act defines blindness as central 

visual acuity of 20/200 or less in the better 

eye with the use of a correcting lens. We use 

your best-corrected central visual acuity for 

distance in the better eye when we determine 

if this definition is met. (For visual acuity 

testing requirements, see 102.00A5.) 

b. The Act also provides that an eye that 

has a visual field limitation such that the 

widest diameter of the visual field subtends 

an angle no greater than 20 degrees is 

considered as having a central visual acuity 

of 20/200 or less. (For visual field testing 

requirements, see 102.00A6.) 

c. You have statutory blindness only if 

your visual disorder meets the criteria of 

102.02A, 102.02B, or 102.03A. You do not 

have statutory blindness if your visual 

disorder medically equals the criteria of 

102.02A, 102.02B, or 102.03A or meets or 

medically equals the criteria of 102.03B, 

102.03C, 102.04A, or 102.04B because your 

disability is based on criteria other than those 

in the statutory definition of blindness. If 

your visual disorder medically equals the 

criteria of 102.02A, 102.02B, or 102.03A or 

meets or medically equals the criteria of 

102.03B, 102.03C, 102.04A, or 102.04B, we 

will find that you are under a disability if 

your visual disorder also meets the duration 

requirement (see § 416.909 of this chapter). 

3. What evidence do we need to establish 

statutory blindness under title XVI? To 

establish that you have statutory blindness 

under title XVI, we need evidence showing 

only that your central visual acuity in your 

better eye or your visual field in your better 

eye meets the criteria in 102.00A2, provided 

that those measurements are consistent with 

the other evidence in your case record. We 

do not need documentation of the cause of 

your blindness. Also, there is no duration 

requirement for statutory blindness under 

title XVI (see §§ 416.981 and 416.983 of this 

chapter). 

4. What evidence do we need to evaluate 

visual disorders, including those that result 

in statutory blindness under title II? To 

evaluate your visual disorder, we usually 

need a report of an eye examination that 

includes measurements of your bestcorrected central visual acuity (see 102.00A5) 

or the extent of your visual fields (see 

102.00A6), as appropriate. If you have visual 

acuity or visual field loss, we need 

documentation of the cause of the loss. A 

standard eye examination will usually 

indicate the cause of any visual acuity loss. 

An eye examination can also indicate the 

cause of some types of visual field deficits. 

Some disorders, such as cortical visual 

disorders, may result in abnormalities that do 

not appear on a standard eye examination. If 

the eye examination does not indicate the 

cause of your vision loss, we will request the 

information the physician or optometrist 

used to establish the presence of your visual 

disorder. If your visual disorder does not 

satisfy the criteria in 102.02, 102.03, or 

102.04, we will request a description of how 

your visual disorder affects your ability to 

function. 

5. How do we measure your best-corrected 

central visual acuity? 

a. Visual acuity testing. When we need to 

measure your best-corrected central visual 

acuity, which is your optimal visual acuity 

attainable with the use of a corrective lens, 

we use visual acuity testing for distance that 

was carried out using Snellen methodology 

or any other testing methodology that is 

comparable to Snellen methodology. 

(i) Your best-corrected central visual acuity 

for distance is usually measured by 

determining what you can see from 20 feet. 

If your visual acuity is measured for a 

distance other than 20 feet, we will convert 

it to a 20-foot measurement. For example, if 

your visual acuity is measured at 10 feet and 

is reported as 10/40, we will convert this 

measurement to 20/80. 

(ii) A visual acuity recorded as CF (counts 

fingers), HM (hand motion only), LP or LPO 

(light perception or light perception only), or 

NLP (no light perception) indicates that no 

optical correction will improve your visual 

acuity. If your central visual acuity in an eye 

is recorded as CF, HM, LP or LPO, or NLP, 

we will determine that your best-corrected 

central visual acuity is 20/200 or less in that 

eye. 

(iii) We will not use the results of pinhole 

testing or automated refraction acuity to 

determine your best-corrected central visual 

acuity. These tests provide an estimate of 

potential visual acuity but not an actual 

measurement of your best-corrected central 

visual acuity. 

(iv) Very young children, such as infants 

and toddlers, cannot participate in testing 

using Snellen methodology or other 

comparable testing. If you are unable to 

participate in testing using Snellen 

methodology or other comparable testing, we 

will consider clinical findings of your 

fixation and visual-following behavior. If 

both these behaviors are absent, we will 

consider the anatomical findings or the 

results of neuroimaging, electroretinogram, or 

visual evoked response (VER) testing when 

this testing has been performed. 

b. Other test charts. 

(i) Children between the ages of 3 and 5 

often cannot identify the letters on a Snellen 

or other letter test chart. Specialists with 

expertise in assessment of childhood vision 

use alternate methods for measuring visual 

acuity in young children. We consider 

alternate methods, for example, the Landolt 

C test or the tumbling-E test, which are used 

to evaluate young children who are unable to 

participate in testing using Snellen 

methodology, to be comparable to testing 

using Snellen methodology. 

(ii) Most test charts that use Snellen 

methodology do not have lines that measure 

visual acuity between 20/100 and 20/200. 

Some test charts, such as the Bailey-Lovie or 

the Early Treatment Diabetic Retinopathy 

Study (ETDRS) used mostly in research 

settings, have such lines. If your visual acuity 


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is measured with one of these charts, and you 

cannot read any of the letters on the 20/100 

line, we will determine that you have 

statutory blindness based on a visual acuity 

of 20/200 or less. For example, if your bestcorrected central visual acuity for distance in 

the better eye is 20/160 using an ETDRS 

chart, we will find that you have statutory 

blindness. Regardless of the type of test chart 

used, you do not have statutory blindness if 

you can read at least one letter on the 20/100 

line. For example, if your best-corrected 

central visual acuity for distance in the better 

eye is 20/125+1 using an ETDRS chart, we 

will find that you do not have statutory 

blindness because you are able to read one 

letter on the 20/100 line. 

c. Testing using a specialized lens. In some 

instances, you may perform visual acuity 

testing using a specialized lens; for example, 

a contact lens. We will use the visual acuity 

measurements obtained with a specialized 

lens only if you have demonstrated the 

ability to use the specialized lens on a 

sustained basis. We will not use visual acuity 

measurements obtained with telescopic 

lenses because they significantly reduce the 

visual field. 

d. Cycloplegic refraction. Cycloplegic 

refraction, which measures your visual acuity 

in the absence of accommodation (focusing 

ability) after the eye has been dilated, is not 

part of a routine eye examination because it 

is not needed to determine your bestcorrected central visual acuity. It can be 

useful for determining refractive error and 

visual acuity in some children. If your case 

record contains the results of cycloplegic 

refraction, we may use the results to 

determine your best-corrected central visual 

acuity. We will not purchase cycloplegic 

refraction. 

e. VER testing. VER testing measures your 

response to visual events and can often 

detect dysfunction that is undetectable 

through other types of examinations. If you 

have an absent response to VER testing in 

your better eye, we will determine that your 

best-corrected central visual acuity is 20/200 

or less in that eye and that your visual acuity 

loss satisfies the criterion in 102.02A or 

102.02B4, as appropriate, when these test 

results are consistent with the other evidence 

in your case record. If you have a positive 

response to VER testing in an eye, we will 

not use that result to determine your bestcorrected central visual acuity in that eye. 

6. How do we measure your visual fields? 

a. General. We generally need visual field 

testing when you have a visual disorder that 

could result in visual field loss, such as 

glaucoma, retinitis pigmentosa, or optic 

neuropathy, or when you display behaviors 

that suggest a visual field loss. When we 

need to measure the extent of your visual 

field loss, we use visual field testing (also 

referred to as perimetry) carried out using 

automated static threshold perimetry 

performed on an acceptable perimeter (for 

perimeter requirements, see 102.00A8). 

b. Automated static threshold perimetry 

requirements. 

(i) The test must use a white size III 

Goldmann stimulus and a 31.5 apostilb (asb) 

white background (or a 10 candela per square 

meter (cd/m2) white background). The 

stimuli test locations must be no more than 

6 degrees apart horizontally or vertically. 

Measurements must be reported on standard 

charts and include a description of the size 

and intensity of the test stimulus. 

(ii) We measure the extent of your visual 

field loss by determining the portion of the 

visual field in which you can see a white 

III4e stimulus. The ‘‘III’’ refers to the 

standard Goldmann test stimulus size III (4 

mm2), and the ‘‘4e’’ refers to the standard 

Goldmann intensity filter (0 dB attenuation, 

which allows presentation of the maximum 

luminance) used to determine the intensity of 

the stimulus. 

(iii) In automated static threshold 

perimetry, the intensity of the stimulus 

varies. The intensity of the stimulus is 

expressed in decibels (dB). A perimeter’s 

maximum stimulus luminance is usually 

assigned the value 0 dB. We need to 

determine the dB level that corresponds to a 

4e intensity for the particular perimeter being 

used. We will then use the dB printout to 

determine which points you see at a 4e 

intensity level (a ‘‘seeing point’’). For 

example: 

A. When the maximum stimulus 

luminance (0 dB stimulus) on an acceptable 

perimeter is 10,000 asb, a 10 dB stimulus is 

equivalent to a 4e stimulus. Any point you 

see at 10 dB or greater is a seeing point. 

B. When the maximum stimulus 

luminance (0 dB stimulus) on an acceptable 

perimeter is 4,000 asb, a 6 dB stimulus is 

equivalent to a 4e stimulus. Any point you 

see at 6 dB or greater is a seeing point. 

c. Evaluation under 102.03A. To determine 

statutory blindness based on visual field loss 

in your better eye (102.03A), we need the 

results of a visual field test that measures the 

central 24 to 30 degrees of your visual field; 

that is, the area measuring 24 to 30 degrees 

from the point of fixation. Acceptable tests 

include the Humphrey Field Analyzer (HFA) 

30–2, HFA 24–2, and Octopus 32. 

d. Evaluation under 102.03B. To determine 

whether your visual field loss meets listing 

102.03B, we use the mean deviation or defect 

(MD) from acceptable automated static 

threshold perimetry that measures the central 

30 degrees of the visual field. MD is the 

average sensitivity deviation from normal 

values for all measured visual field locations 

within the central 30 degrees of the field. 

When using results from HFA tests, which 

report the MD as a negative number, we use 

the absolute value of the MD to determine 

whether your visual field loss meets listing 

102.03B. We cannot use tests that do not 

measure the central 30 degrees of the visual 

field, such as the HFA 24–2, to determine if 

your impairment meets or medically equals 

102.03B. 

e. Other types of perimetry. If your case 

record contains visual field measurements 

obtained using manual or automated kinetic 

perimetry, such as Goldmann perimetry or 

the HFA ‘‘SSA Test Kinetic,’’ we can 

generally use these results if the kinetic test 

was performed using a white III4e stimulus 

projected on a white 31.5 asb (10 cd/m2) 

background. Automated kinetic perimetry, 

such as the HFA ‘‘SSA Test Kinetic,’’ does 

not detect limitations in the central visual 

field because testing along a meridian stops 

when you see the stimulus. If your visual 

disorder has progressed to the point at which 

it is likely to result in a significant limitation 

in the central visual field, such as a scotoma 

(see 102.00A6h), we will not use automated 

kinetic perimetry to determine the extent of 

your visual field loss. Instead, we will 

determine the extent of your visual field loss 

using automated static threshold perimetry or 

manual kinetic perimetry. 

f. Screening tests. We will not use the 

results of visual field screening tests, such as 

confrontation tests, tangent screen tests, or 

automated static screening tests, to determine 

that your impairment meets or medically 

equals a listing, or functionally equals the 

listings. We can consider normal results from 

visual field screening tests to determine 

whether your visual disorder is severe when 

these test results are consistent with the other 

evidence in your case record. (See 

§ 416.924(c) of this chapter.) We will not 

consider normal test results to be consistent 

with the other evidence if the clinical 

findings indicate that your visual disorder 

has progressed to the point that it is likely 

to cause visual field loss, or you have a 

history of an operative procedure for retinal 

detachment. 

g. Use of corrective lenses. You must not 

wear eyeglasses during visual field testing 

because they limit your field of vision. You 

may wear contact lenses or perimetric lenses 

to correct your visual acuity during the visual 

field test to obtain the most accurate visual 

field measurements. For this single purpose, 

you do not need to demonstrate that you 

have the ability to use the contact or 

perimetric lenses on a sustained basis. 

h. Scotoma. A scotoma is a non-seeing area 

(also referred to as a blind spot) in the visual 

field surrounded by a seeing area. When we 

measure your visual field, we subtract the 

length of any scotoma, other than the normal 

blind spot, from the overall length of any 

diameter on which it falls. 

7. How do we determine your visual acuity 

efficiency, visual field efficiency, and visual 

efficiency? 

a. General. Visual efficiency is the 

combination of your visual acuity efficiency 

and your visual field efficiency expressed as 

a value or as a percentage. 

b. Visual acuity efficiency. Visual acuity 

efficiency is a value or a percentage that 

corresponds to the best-corrected central 

visual acuity for distance in your better eye. 

See Table 1. 


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Federal Register / Vol. 77, No. 29 / Monday, February 13, 2012 / Proposed Rules 7557 

TABLE 1 

Snellen best-corrected central 

visual acuity for distance 

Visual acuity 

efficiency 

value 

(102.04A) 

Visual acuity 

efficiency 

percentage 

English Metric (102.04B) 

20/16 ........................................................................... 6/5 0.00 ............................................................................ 100 

20/20 ........................................................................... 6/6 0.00 ............................................................................ 100 

20/25 ........................................................................... 6/7.5 0.10 ............................................................................ 95 

20/30 ........................................................................... 6/9 0.18 ............................................................................ 90 

20/40 ........................................................................... 6/12 0.30 ............................................................................ 85 

20/50 ........................................................................... 6/15 0.40 ............................................................................ 75 

20/60 ........................................................................... 6/18 0.48 ............................................................................ 70 

20/70 ........................................................................... 6/21 0.54 ............................................................................ 65 

20/80 ........................................................................... 6/24 0.60 ............................................................................ 60 

20/100 ......................................................................... 6/30 0.70 ............................................................................ 50 

c. Visual field efficiency. Visual field 

efficiency is a value or a percentage that 

corresponds to the visual field in your better 

eye. Under 102.03C, we require kinetic 

perimetry to determine your visual field 

efficiency percentage. (A visual field 

efficiency percentage of 20, determined using 

kinetic perimetry, is comparable to an MD of 

22, determined using automated static 

threshold perimetry.) 

(i) Value determined by automated static 

threshold perimetry. Using the MD from 

acceptable automated static threshold 

perimetry, we calculate the visual field 

efficiency value by dividing the absolute 

value of the MD by 22. For example, if your 

MD on an HFA 30–2 is ¥16, your visual field 

efficiency value is: |¥16| ÷ 22 = 0.73. 

(ii) Percentage determined by kinetic 

perimetry. Using kinetic perimetry, we 

calculate the visual field efficiency 

percentage by adding the number of degrees 

you see along the eight principal meridians 

found on a visual field chart (0, 45, 90, 135, 

180, 225, 270, and 315) in your better eye and 

dividing by 5. For example, in Figure 1: 

A. The diagram of the left eye illustrates a 

visual field, as measured with a III4e 

stimulus, contracted to 30 degrees in two 

meridians (180 and 225) and to 20 degrees in 

the remaining six meridians. The visual 

efficiency percentage of this field is: ((2 × 30) 

+ (6 × 20)) ÷ 5 = 36 percent. 

B. The diagram of the right eye illustrates 

the extent of a normal visual field as 

measured with a III4e stimulus. The sum of 

the eight principal meridians of this field is 

500 degrees. The visual efficiency percentage 

of this field is 500 ÷ 5 = 100 percent. 

d. Visual efficiency. 

(i) Determined by automated static 

threshold perimetry (102.04A). Under 

102.04A, we calculate the visual efficiency 

value by adding your visual acuity efficiency 

value (see 102.00A7b) and your visual field 

efficiency value (see 102.00A7c(i)). For 

example, if your visual acuity efficiency 

value is 0.48 and your visual field efficiency 

value is 0.73, your visual efficiency value is: 

0.48 + 0.73 = 1.21. 

(ii) Determined by kinetic perimetry 

(102.04B). Under 102.04B, we calculate the 

visual efficiency percentage by multiplying 

your visual acuity efficiency percentage (see 

102.00A7b) by your visual field efficiency 

percentage (see 102.00A7c(ii)) and dividing 

by 100. For example, if your visual acuity 

efficiency percentage is 75 and your visual 

field efficiency percentage is 36, your visual 

efficiency percentage is: (75 × 36) ÷ 100 = 27 

percent. 

8. What are our requirements for an 

acceptable perimeter? We will use results 

from automated static threshold perimetry 

performed on a perimeter that: 

a. Uses optical projection to generate the 

test stimuli. 


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7558 Federal Register / Vol. 77, No. 29 / Monday, February 13, 2012 / Proposed Rules 

b. Has an internal normative database for 

automatically comparing your performance 

with that of the general population. 

c. Has a statistical analysis package that is 

able to calculate visual field indices, 

particularly mean deviation or mean defect. 

d. Demonstrates the ability to correctly 

detect visual field loss and correctly identify 

normal visual fields. 

e. Demonstrates good test-retest reliability. 

f. Has undergone clinical validation studies 

by three or more independent laboratories 

with results published in peer-reviewed 

ophthalmic journals. 

* * * * * 

102.01 Category of Impairments, Special 

Senses and Speech 

102.02 Loss of central visual acuity. 

A. Remaining vision in the better eye after 

best correction is 20/200 or less. 

OR 

B. An inability to participate in visual 

acuity testing using Snellen methodology or 

other comparable testing, clinical findings 

that fixation and visual-following behavior 

are absent in the better eye, and one of the 

following: 

1. Abnormal anatomical findings 

indicating a visual acuity of 20/200 or less in 

the better eye (such as the presence of Stage 

III or worse retinopathy of prematurity 

despite surgery, hypoplasia of the optic 

nerve, albinism with macular aplasia, or 

bilateral optic atrophy); or 

2. Abnormal neuroimaging documenting 

damage to the cerebral cortex which would 

be expected to prevent the development of a 

visual acuity better than 20/200 in the better 

eye (such as neuroimaging showing bilateral 

encephalomyelitis or bilateral 

encephalomalacia); or 

3. Abnormal electroretinogram 

documenting the presence of Leber’s 

congenital amaurosis or achromatopsia in the 

better eye; or 

4. An absent response to VER testing in the 

better eye. 

102.03 Contraction of the visual field in 

the better eye, with: 

A. The widest diameter subtending an 

angle around the point of fixation no greater 

than 20 degrees. 

OR 

B. An MD of 22 decibels or greater, 

determined by automated static threshold 

perimetry that measures the central 30 

degrees of the visual field (see 102.00A6d). 

OR 

C. A visual field efficiency of 20 percent 

or less, determined by kinetic perimetry (see 

102.00A7c). 

102.04 Loss of visual efficiency in the 

better eye, with: 

A. A visual efficiency value of 1.00 or 

greater after best correction (see 

102.00A7d(i)). 

OR 

B. A visual efficiency percentage of 20 or 

less after best correction (see 102.00A7d(ii)). 

* * * * * 

[FR Doc. 2012–3226 Filed 2–10–12; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF HOUSING AND 

URBAN DEVELOPMENT 

24 CFR Part 202 

[Docket No. FR–5416–N–02] 

RIN 2502–AI91 

Withdrawal of Proposed Rule on 

Approval of Farm Credit System 

Lending Institutions in Federal 

Housing Administration (FHA) 

Mortgage Insurance Programs 

AGENCY: Office of the Assistant 

Secretary for Housing—Federal Housing 

Commissioner, HUD. 

ACTION: Withdrawal of proposed rule. 

SUMMARY: This notice withdraws HUD’s 

August 2011 rule that proposed to 

amend HUD’s regulations to enable the 

direct lending institutions of the Farm 

Credit System to seek approval to 

participate in the FHA mortgage 

insurance programs as approved 

mortgagees and lenders. 

DATES: The proposed rule is withdrawn 

February 13, 2012. 

FOR FURTHER INFORMATION CONTACT: 

Office of Lender Activities and Program 

Compliance, Department of Housing 

and Urban Development, 451 7th Street 

SW., Washington, DC 20410–8000; 

telephone number 202–708–1515 (this 

is not a toll-free number). Persons with 

hearing or speech impairments may 

access this number through TTY by 

calling the toll-free Federal Information 

Relay Service at 800–877–8339. 

SUPPLEMENTARY INFORMATION: 

I. Background 

On August 26, 2011, at 76 FR 53362, 

HUD published a proposed rule that 

would enable the direct lending 

institutions of the Farm Credit System 

to seek approval to participate in the 

FHA mortgage insurance programs as 

FHA-approved mortgagees and lenders. 

In the proposed rule, HUD noted that 

recent difficulties in mortgage finance 

markets indicated reduced availability 

of housing credit in rural areas. HUD 

therefore proposed to extend FHA 

mortgagee and lender eligibility to the 

lending institutions of the Farm Credit 

System to provide an additional avenue 

for mortgage financing in rural areas. 

The Farm Credit System is a federally 

chartered network of borrower-owned 

lending institutions composed of 

cooperatives and related service 

organizations. The public comment 

period for the proposed rule closed on 

October 25, 2011. HUD received 

approximately 27 substantive public 

comments in response to the August 26, 

2011, proposed rule. Certain comments 

were identical in substance, having been 

submitted as part of mailing campaigns. 

The public comments on this rule can 

be found at http://www.regulations.gov/ 

#!searchResults;rpp=10;po=0;s=FR5416-P-01. 

The commenters were almost evenly 

divided in their support of and 

opposition to the rule. Those 

commenters that supported the rule 

stated that there was indeed a need for 

available housing credit in rural areas 

and that allowing Farm Credit lending 

institutions to be FHA-approved lenders 

would aid in the necessary extension of 

credit. The commenters stated that the 

Farm Credit System has been a source 

of consistent and reliable credit for rural 

homeowners and that the ability to 

provide the option of FHA programs to 

families in rural areas will help ensure 

that the borrowing needs of rural 

families are met. Those commenters that 

opposed the rule stated that there was 

no need to expand FHA mortgage 

availability to Farm Credit member 

institutions; that the banking 

community was satisfactorily meeting 

the need for credit in rural areas. The 

commenters opposing the rule also 

stated that it was their view that 

approval of Farm Credit lending 

institutions to originate FHA insured 

loans runs afoul of the Administration’s 

proposal to reduce government 

involvement in the housing finance 

market. 

Upon consideration of the issues 

raised by public comments, HUD is 

withdrawing the August 26, 2011, 

proposed rule. While HUD seeks to 

ensure the availability of mortgage 

financing for qualified borrowers 

nationwide—and particularly in 

underserved areas—HUD and the 

Administration remain committed to 

reducing FHA’s market share and 

facilitating the return of private capital 

to the housing finance market. 

Therefore, in concert with its network of 

FHA-approved lending partners, FHA 

will continue to monitor the adequacy 

of mortgage credit in rural areas to 

ensure that rural residents have access 

to homeownership. 

Accordingly, the proposed rule to 

amend 24 CFR 202.10, published on 

August 26, 2011, at 76 FR 53362, 

entitled ‘‘Approval of Farm Credit 

System Lending Institutions in FHA 

Mortgage Insurance Programs,’’ is 

hereby withdrawn. 

Dated: February 7, 2012. 

Carol J. Galante, 

Acting Assistant Secretary for Housing— 

Federal Housing Commissioner. 

[FR Doc. 2012–3289 Filed 2–10–12; 8:45 am] 

BILLING CODE 4210–67–P 


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