オカルト黄斑ジストロフィの2症例における新基準の視覚障害手帳判定とFunctional Vision Scoreの評価

Evaluation of the criteria as visually handicapped status and of Functional Visual Score in two cases of occult macular dystrophy

要約　緒言：オカルト黄斑ジストロフィの2例について視覚の身体障害者手帳（手帳）の新基準での等級判定とFunctional Vision Score（FVS）の評価を行ったので報告する。

症例：症例1は21歳，女性。17歳時に視力低下で井上眼科病院（当院）を受診した。診断ガイドラインを満たし，オカルト黄斑ジストロフィと診断された。21歳時に大学卒業後の就労相談で当院ロービジョン外来を受診した。手帳は視力4級で視野は該当がなかった。FVSは48〔Functional Acuity Score（FAS）は48，Functional Field Score（FFS）は100〕で，重度視覚喪失に該当した。以上から視覚障害の支援団体・支援機関のサポートを受け，障害者枠の雇用を勧めた。症例2は74歳，男性。視力低下を主訴に当院を受診し，オカルト黄斑ジストロフィと診断された。手帳は，視力・視野とも該当なしであった。FVSは74（FASは74，FFSは100）で，中等度視覚喪失に該当した。以上の結果から拡大鏡の自費購入となった。

考按：オカルト黄斑ジストロフィの視力評価は手帳よりFVSでの評価が実態に即していた。視野評価については手帳，FVSいずれの基準でも評価が難しかった。

Abstract　Purpose：To report two cases of occult macular dystrophy, which were evaluated for the criteria as visually handicapped status and evaluated for the Functional Vision Score（FVS）.

Case：Case 1：A 21-year-old female. At the age of 17, she visited our hospital with poor vision. She satisfied the diagnostic guidelines, and was diagnosed with occult macular dystrophy. At the age of 21, she visited a Low Vision outpatient for employment consultation. We evaluated her criteria as visually handicapped status and FVS. The criteria was grade 4 visual acuity and not applicable visual field. FVS was 48〔Functonal Acuity Score（FAS）was 48, Functional Field Score（FFS）was 100〕, resulting in severe vision loss. We suggested the support of organizations for the visually impaired. Case 2：A 74-year-old man. He visited our hospital for poor vision. He satisfied the diagnostic guidelines, and was diagnosed with occult macular dystrophy. We evaluated his criteria as visually handicapped status and FVS. His criteria had neither visual acuity nor visual field. FVS was 74（FAS was 74 and FFS was 100）with moderate vision loss. He had to purchase the magnifying glass at his own expense.

Conclusion：The occult macular dystrophy was more likely to be evaluated by FVS than in the previous criteria as visually handicapped status. It was difficult to evaluate the visual field in both the handicapped status and FVS.