# A nurse is assessing a 68-year-old client who has been referred for evaluation of potential legal blindness. Which assessment finding would most accurately indicate that the client meets the criteria for legal blindness?

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## 문제

A nurse is assessing a 68-year-old client who has been referred for evaluation of potential legal blindness. Which assessment finding would most accurately indicate that the client meets the criteria for legal blindness?

## 보기

1. Visual acuity of 20/100 in the better eye with corrective lenses
2. Peripheral vision loss affecting 30% of the visual field in both eyes
3. Visual acuity of 20/200 or worse in the better eye with best possible correction **✔ 정답**
4. Difficulty distinguishing colors and night blindness with 20/80 vision

**정답: 3**

## 해설

Legal blindness is defined as visual acuity of 20/200 or worse in the better eye with best correction. Option 3 matches this exact criterion. Other options describe conditions that do not meet the standard definition.

## 심화 해설

Understanding Legal Blindness Criteria

When evaluating a client for legal blindness, it is essential to distinguish between general visual impairment and the specific statutory definition. Legal blindness is not simply "very poor vision"; it is a precisely defined term used to determine eligibility for government disability benefits, vocational training, and rehabilitation services. The definition rests on two central components: central visual acuity and visual field.

The most widely accepted criterion for legal blindness, and the one most relevant to NCLEX-RN examinations, is a central visual acuity of 20/200 or worse **in the better eye** with the **best possible correction** (i.e., wearing glasses or contact lenses). This means that what a person with normal vision can see clearly at 200 feet, the legally blind individual can only see at 20 feet. The emphasis on the "better eye" and "best correction" is a critical testing point; a client cannot be classified as legally blind based solely on the vision in their worse eye or without their corrective lenses. The provided research by Wu et al. (2026) directly uses this threshold, defining legal blindness by the VA criterion as VA ≤ 1 logMAR, which is equivalent to 20/200 [1].

The second pathway to meeting the criteria involves the visual field. Even with intact central acuity of 20/20, a client is considered legally blind if their peripheral field of vision is constricted to 20 degrees or less in the better eye. This is often described as "tunnel vision" and is commonly associated with conditions like advanced glaucoma or retinitis pigmentosa. It is important to note that a percentage of visual field loss, such as 30%, does not automatically qualify a person as legally blind; the field must be reduced to the specific diameter of 20 degrees or less.

Analysis of Assessment Findings

Let's apply these strict definitions to the assessment findings presented in the question:

- **Option 1:** A visual acuity of 20/100 indicates significant visual impairment, but it does not meet the 20/200 threshold required for legal blindness. This client would be classified as having low vision, a condition that impacts daily function but does not constitute statutory blindness [1].

- **Option 2:** Peripheral vision loss affecting 30% of the visual field is a concerning finding that requires further investigation. However, it does not describe the specific criterion of a visual field constricted to a 20-degree radius. The degree measurement, not a percentage of loss, is the defining factor.

- **Option 3:** This finding directly aligns with the statutory definition. A visual acuity of 20/200 or worse in the better eye, even with corrective lenses, is the hallmark assessment finding for acuity-defined legal blindness. This is the precise threshold validated and utilized in screening research [1].

- **Option 4:** Difficulty with color distinction and night blindness, combined with 20/80 vision, describes symptoms that may be associated with specific retinal disorders like retinitis pigmentosa. While debilitating, the central acuity of 20/80 does not satisfy the acuity criterion for legal blindness, and the description does not quantify the visual field to the required 20-degree threshold.

In clinical nursing practice, accurately identifying the criteria for legal blindness is crucial for appropriate referral to social services and for helping clients understand their diagnosis and eligibility for support. The nurse must document the specific quantitative findings—the exact Snellen fraction for acuity and the degree of visual field—rather than qualitative descriptions of functional deficits, to support a formal diagnosis. The study by Wu et al. underscores the importance of precise, threshold-based screening questions to identify individuals who meet this specific VA-defined criterion, as it triggers a cascade of non-medical interventions and legal determinations [1].

References (research sources)

- [1]Screening Questions to Identify Low Vision and Acuity-Defined Legal Blindness.Research articleWu YH, Yu D, Goldstein J, Kwon M, Wang C, Legge GE. (2026) · DOI: 10.1167/iovs.67.1.28

## 임상 시나리오

Determining Legal BlindnessKey criteria for documentation and referral
The primary criterion is best-corrected visual acuity of 20/200 or worse in the better eye. This is measured using a Snellen chart with the client wearing their glasses or contact lenses.

The secondary criterion is a visual field constricted to 20 degrees or less in the better eye, even if central acuity is normal. This is often assessed via confrontation testing or perimetry.

CautionAlways document the vision in each eye separately and note whether correction was used. Do not base the determination on the worse eye or uncorrected vision. This definition is for legal and benefits eligibility, not a complete functional assessment.

## 핵심 개념

- **Legal Blindness** — A statutory definition of visual impairment, defined as best-corrected visual acuity of 20/200 or worse in the better eye, or a visual field of 20 degrees or less.
- **Visual Acuity** — A measure of the eye's ability to distinguish object details and shape, typically assessed using a Snellen chart.
- **Snellen Chart** — A standardized eye chart used to measure visual acuity, where the 20/200 line indicates the threshold for legal blindness.
- **Visual Field** — The entire area that can be seen when the eye is focused on a central point, including peripheral vision.

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