Part 3 — continued

3.3 — Failure to Assess Functional Vision

3.3 — Failure to Assess Functional Vision

The 2026 assessment did not include any form of functional‑vision assessment, even though functional vision is the area where the young person experiences the greatest difficulty and the greatest risk.

This is a major procedural failure because functional vision — how a person sees in real‑world environments — is essential for understanding safety, independence, and support needs.

What functional‑vision assessment should include

A proper functional‑vision assessment evaluates how the person manages:

• movement in the environment
• depth perception
• spatial layout
• visual stability during motion
• navigation in unfamiliar spaces
• visual overload
• real‑world tasks such as steps, kerbs, crossings, and cluttered areas

These are the areas where neurological visual impairment has the strongest impact.

Functional‑vision assessment is not optional. It is a required component when:

• the impairment is neurological
• the impairment affects spatial awareness
• the impairment affects safety
• the impairment has been documented for decades

What actually happened

The 2026 assessment:

• remained entirely within the confines of a routine sight‑test room
• used only static, ocular‑based tests
• did not observe the young person moving
• did not assess navigation
• did not evaluate spatial awareness
• did not test visual stability during motion
• did not assess real‑world functional tasks

In other words, the clinician assessed eyes, not vision.

Why this is a procedural failure

Functional vision is the bridge between:

• clinical findings and
• real‑world safety.

Without assessing functional vision, a clinician cannot:

• understand the person’s actual needs
• identify risk
• recognise environmental challenges
• provide safe recommendations
• maintain continuity with the long‑term baseline

Routine optometry does not measure functional vision. By relying solely on routine methods, the clinician failed to assess the most important aspect of the young person’s impairment.

Consequences of failing to assess functional vision

Because functional vision was not assessed:

• spatial‑awareness deficits were missed
• real‑world risks were not identified
• the impairment was minimised
• the clinical record became misleading
• safeguarding needs were obscured
• professionals relying on the letter would be misinformed
• continuity with the 30‑year baseline was broken

This failure directly contributed to the incorrect conclusion that the impairment was “intermittent” or “variable” — a conclusion that would have been impossible if functional vision had been assessed properly.

Why this matters for governance

Functional‑vision assessment is not a luxury. It is a required component when assessing a neurological visual impairment.

By failing to conduct it, the 2026 assessment:

• did not meet clinical standards
• did not meet safeguarding expectations
• did not meet continuity‑of‑care requirements
• did not provide a safe or accurate record

This is a procedural failure with direct implications for safety and governance.

The failure to assess functional vision meant that the most important aspect of the young person’s impairment was overlooked. The next section examines another major procedural failure: the omission of the 30‑year clinical baseline that should have guided the assessment.

Next 3.4 — Failure to Recognise Neurological Features

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