基于ICF和ICD-11的中国6种视力残疾相关标准比较研究

doi:10.3969/j.issn.1006-9771.2025.07.002

Abstract

Abstract:

Objective To compare six existing Chinese standards related to visual disability, including Disability Assessment and Code for Life Insurance (Insurance Standard), Specification for Ability Assessment of Older Adults (Elderly Standard), Grading of Disability due to Human Body Injury (Judicial Standard), Standard for Identify Work Ability—Gradation of Disability Caused by Work-related Injuries and Occupational Diseases (Work Injury Standard), Standard for Assessment of Disability Grades of Military Personnel (Military Standard), and Classification and Grading Criteria of Disability (Disability Classification Standard).

Methods Based on the theoretical framework of International Classification of Functioning, Disability and Health (ICF) and International Classification of Diseases, the 11th Revision (ICD-11), and with reference to World Report on Vision(WRV), this study analyzed and compared five key dimensions of visual disability across the six standards: definition, classification, grading, assessment methods and coding systems.

Results In terms of definition, the insurance, work injury, military, and disability classification standards emphasized visual structure and function, focusing on visual acuity and visual field; the insurance and elderly standards incorporated activities and participation, reflecting the concept of functional vision; the judicial standard lacked a dedicated definition of visual disability. In terms of grading, each standard graded visual disability into different levels acoording to different functional indicators. In terms of coding, only the insurance standard adopted the ICF framework, while others used non-ICF numeric codes or lacked standardized coding. In terms of assessment tools, the elderly standard employed a customized perceptual and participation scoring system, while others relied primarily on vision charts.

Conclusion Most current Chinese standards focus on impairments in visual function, with limited attention to activity limitations and participation restrictions. It is needed for incorporating the concept of functional vision, aligned with ICF and WRV, to establish a unified conceptual framework, terminology, coding system for visual disability, and comprehensive assessments that reflect not only impairments but also the impact on daily functioning and environmental interaction.

Key words: visual disability, classification, grading, functional vision, International Classification of Functioning, Disability and Health

CLC Number:

LÜ Xueli, YANG Yaru, QIU Zhuoying, WANG Zhongyan, TIAN Yifan, LIU Ye, LI Chen, CHEN Di. Comparative study of six visual disability-related standards in China based on ICF and ICD-11[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(7): 755-762.

Figures/Tables 2

Table 1

Table 2

Analysis of six visual disability-related standards in China based on ICF"

残疾标准	发布单位	定义	分类	分级	评估	应用
人身保险伤残评定及代码(GB/T 44893-2024)^[12]	国家市场监督管理总局,国家标准化管理委员会	仅对伤残与残疾进行总定义，无视力残疾单独定义视功能是指与感受存在的光线和感受视觉刺激的形式、大小、形状和颜色等有关的感觉功能。视功能障碍是指眼盲目或低视力，还有视野缺损	参照ICF中有关身体结构与功能的分类理论与方法，将视力残疾归类为眼部结构损伤(s220~s230)和视功能障碍(b210)，将有关视力残疾的内容分为：眼球损伤或视功能障碍视功能障碍眼球的晶状体结构损伤眼睑结构损伤其中视力损害分为盲与视力损害2个亚类	基于视力损伤程度分级	临床检查(视力表、视野仪)及医学影像确认结构损伤	为保险机构评估残疾程度、确定保险赔付标准等提供统一规范
老年人能力评估规范(GB/T 42195-2022)^[13]	国家市场监督管理总局,国家标准化管理委员会	未对残疾进行定义，仅对能力进行定义视力是指感受存在的光线并感受物体的大小、形状的能力。在个体的最好矫正视力下进行	按照评估指标分为一级指标4个，二级指标26个。视力归类为一级指标感知觉与社会参与下的二级指标中视力指标，分为0分、1分、2分3个亚类	根据感知觉能力，残疾级别分为0~2级。最重为第0级，最轻为第2级	感知觉与社会参与指标和评分	为老年人能力评估提供统一、规范、可操作的工具
人体损伤致残程度分级(2016)^[14]	最高人民法院，最高人民检察院，公安部，国家安全部，司法部	无视力残疾定义，只有统一残疾的定义。即人体组织器官结构破坏或者功能障碍，以及个体在现代临床医疗条件下难以恢复的生活、工作、社会活动能力不同程度的降低或者丧失	根据身体结构分为盲和视力损害2个亚类	依据人体组织器官结构破坏、功能障碍及其对医疗、护理的依赖程度，适当考虑由于残疾引起的社会交往和心理因素影响，综合判定致残程度等级，分为10个等级，最重为第1级，最轻为第10级	采用小数记录或者5分记录；接触镜、针孔镜。具体方法参考《视觉功能障碍法医鉴定指南》(SF/ZJD0103004)	司法鉴定领域处理涉及人体损伤致残案件的鉴定标准
劳动能力鉴定职工工伤与职业病致残等级(GB/T 16180-2014)^[15]	中华人民共和国国家质量监督检验检疫总局，中国国家标准化管理委员会	眼球或视神经器质性损伤所致的视力、视野、立体视功能障碍及其他解剖结构和功能的损伤或破坏	根据身体结构分为盲和低视力2个亚类	根据单眼或双眼的矫正视力、视野缺损范围进行严重程度分级。残疾级别分为1~10级。最重为第1级，最轻为第10级	按照GB115 33的规定检查视力。视力记录可采用5分记录(对数视力表)或小数记录	职工工伤与职业病致残程度的鉴定
军人残疾等级评定标准(民发〔2011〕218号)^[16]	民政部，人力资源和社会保障部，卫生部，总后勤部	有无光感、矫正视力度数、眼球是否摘除和双眼视野度数	本标准根据器官缺损、功能障碍、心理障碍和对医疗护理依赖的程度分为10类	根据视敏度功能和视野功能，残疾级别分为1~10 级。最重为第 1 级，最轻为第10级	视野；眼前后节照相；眼前后节OCT检查；眼底造影和眼电生理检查；眼眶、眼球影像资料	现役军人因战、因公(含职业病)致残等级评定标准
残疾人残疾分类和分级(GB/T 26341-2010)^[17]	中华人民共和国国家质量监督检验检疫总局，中国国家标准化管理委员会	双眼视力低下且无法矫正，或视野缩小影响社会参与	按照视力和视野状态分为盲和低视力2个亚类	按照视力和视野状态分级，盲为视力残疾1级和2级，低视力为视力残疾3级和4级	临床视力检查(视力表、视野仪)；《视力残疾评估手册》	用于残疾人的信息统计、管理和服务等
世界视觉报告(2020)^[7]	世界卫生组织	视力损伤是眼部疾病或状况导致视力系统及一种或多种视觉功能受损	按严重程度：轻度、中度、重度视力损伤，盲，近视力损伤按原因：屈光不正、白内障、糖尿病视网膜病变、青光眼、年龄相关性黄斑变性等按功能：远视力损伤、近视力损伤、视野缺损	基于ICD-11视力损伤分级	视觉功能：视力表TADDS 视觉相关的活动功能：WHODAS 2.0相关项目	介绍视觉功能，提高全球眼保健重视

Table 2

References 35

[1]	HOU C, PU C. Association between visual impairment and health care use[J]. Am J Ophthalmol, 2022, 234: 166-173.
[2]	World Health Organization. Blindness and vision impairment[R]. https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment. 2023-8-10.
[3]	玛依努尔・于苏甫, 王宁利. "视觉2020":中国防盲治盲与眼健康工作进展[J]. 中华医学杂志, 2020, 100(48): 3831-3834.
	MAYINUER Y, WANG N L. Vision 2020: the progress of blindness prevention and eye health in China[J]. Nat Med J Chin, 2020, 100(48): 3831-3834.
[4]	STEINMETZ J D, BOURNE R R A, BRIANT P S, et al. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study[J]. Lancet Glob Health, 2021, 9(2): e144-e160.
[5]	GBD 2019 Blindness and Vision Impairment Collaborators, Vision Loss Expert Group of the Global Burden of Disease Study. Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study[J]. Lancet Glob Health, 2021, 9(2): e130-e143.
[6]	XU T, WANG B, LIU H, et al. Prevalence and causes of vision loss in China from 1990 to 2019: findings from the global burden of disease study 2019[J]. Lancet Public Health, 2020, 5(12): 682-691.
[7]	World Health Organization. World Report on Vision[R]. Geneva: World Health Organization, 2019.
[8]	第二次全国残疾人抽样调查领导小组, 中华人民共和国国家统计局.2006年第二次全国残疾人抽样调查主要数据公报[A/OL]. (2006-12-01)[2025-01-06].https://www.gov.cn/ztzl/gacjr/content_459223.htm.
[9]	World Health Organization. Disability[EB/OL]. (2022-12-02)[2024-01-10]. https://www.who.int/zh/news-room/fact-sheets!detail/disability-and-health.
[10]	World Health Organization. International Classification of Functioning, Disability and Health[S/OL]. [2025-01-21]. https://icd.who.int/browse/2025-01/icf/zh#2048203604.
[11]	世界卫生组织. 国际功能、残疾和健康分类(国际中文增补版)[M]. 邱卓英,译. 日内瓦: 世界卫生组织, 2015.
	World Health Organization. International Classification of Functioning, Disability and Health-International (Chinese Supplement)[M]. QIU Z Y, trans trans. Geneva: World Health Organization, 2015.
[12]	国家市场监督管理总局, 国家标准化管理委员会.人身保险伤残评定及代码: GB/T 44893-2024[S]. 北京: 中国标准出版社, 2024.
[13]	国家市场监督管理总局, 国家标准化管理委员会. 老年人能力评估规范:GB/T 42195-2022[S]. 2022-12-30.
[14]	最高人民法院, 最高人民检察院, 公安部, 等. 人体损伤致残程度分级[S/OL]. (2016-04-22)[2025-02-18].https://www.moj.gov.cn/pub/sfbgw/zwxxgk/fdzdgknr/fdzdgknrtzwj/201908/P02 0210316701681025917.pdf.
[15]	中华人民共和国国家质量监督检验检疫总局, 中国国家标准化管理委员会.劳动能力鉴定职工工伤与职业病致残等级: GB/T 16180-2014[S]. 北京: 中国标准出版社, 2014.
[16]	民政部, 人力资源和社会保障部, 卫生部, 等. 关于印发«军人残疾等级评定标准»的通知:民发〔2011〕218号[A/OL]. (2011-12-27)[2025-02-18].https://tyjrsw.ln.gov.cn/tyjrsw/fwdt/fxyd/B2E4EE28FCAF4A69B76BADDA982B00AB/index.shtml.
[17]	中华人民共和国国家质量监督检验检疫总局, 中国国家标准化管理委员会. 残疾人残疾分类和分级:GB/T26341-2010[S/OL]. (2011-01-14)[2025-01-06].https://openstd.samr.gov.cn/bzgk/gb/newGbInfo?hcno=63A290EAC21F2A008AE1BEC3BE795A7E.
[18]	MADDEN R H, BUNDY A. The ICF has made a difference to functioning and disability measurement and statistics[J]. Disabil Rehabil, 2019, 41(12): 1450-1462. doi: 10.1080/09638288.2018.1431812 pmid: 29433362
[19]	邱卓英, 王朴, 王博. «国际功能、残疾和健康分类»的发展和应用进展[J]. 中国康复理论与实践, 2008, 14(1): 85-86.
[20]	邱卓英. «国际功能、残疾和健康分类»研究总论[J]. 中国康复理论与实践, 2003, 9(1): 2-5.
[21]	田益凡, 陈迪, 邱卓英, 等. 基于ICF架构比较4种残疾标准分类分级方法[J]. 中国康复理论与实践, 2025, 31(4): 382-390. doi: 10.3969/j.issn.1006-9771.2025.04.002
	TIAN Y F, CHEN D, QIU Z Y, et al. Comparison of classification and grading approach in four selected disability standards using ICF framework[J]. Chin J Rehabil Theory Pract, 2025, 31(4): 382-390.
[22]	杨亚茹, 邱卓英, 陈迪, 等. 主要残疾类别的定义、分类、分级以及评估研究:基于ICF和ICD-11的方法[J]. 中国康复理论与实践, 2025, 31(4): 373-381. doi: 10.3969/j.issn.1006-9771.2025.04.001
	YANG Y R, QIU Z Y, CHEN D, et al. Disability definition, classification, grading and assessment in disability eligibility: an ICF and ICD -11 framework perspective[J]. Chin J Rehabil Theory Pract, 2025, 31(4): 373-381.
[23]	杨亚茹, 杨剑. 基于ICD-11和ICF的活动和参与与生活质量测量工具的内容比较[J]. 中国康复理论与实践, 2023, 29(12): 1454-1464. doi: 10.3969/j.issn.1006-9771.2023.12.010
	YANG Y R, YANG J. Content comparison of assessment tools of activity and participation, and quality of life: based on ICD-11 and ICF[J]. Chin J Rehabil Theory Pract, 2023, 29(12): 1454-1464.
[24]	USTÜN T B, CHATTERJI S, KOSTANJSEK N. Developing the World Health Organization disability assessment schedule 2.0[J]. Bull World Health Organ, 2010, 88(11): 815-823.
[25]	World Health Organization. ICD-11 for mortality and morbidity statistics[S/OL]. [2025-01-21]. https://icd.who.int/browse/2024-01/mms/zh#1525792972.
[26]	World Health Organization. ICD-1l coding tool[M/OL]. (2025-01-30)[2025-03-29]. https://icd.who.int/ct/icd11 mmsen/release.
[27]	邱卓英, 李伦, 陈迪, 等. 基于世界卫生组织国际健康分类家族康复指南研究:理论架构和方法体系[J]. 中国康复理论与实践, 2020, 26(2): 125-135. doi: 10.3969/j.issn.1006-9771.2020.02.001
	QIU Z Y, LI L, CHEN D, et al. Research on rehabilitation guidelines using World Health Organization Family International Classifications: framework and approaches[J]. Chin J Rehabil Theory Pract, 2020, 26(2): 125-135.
[28]	姜静远, 邱卓英, 王国祥, 等. 世界卫生组织国际健康分类家族在康复中系统应用的方案与路线图[J]. 中国康复理论与实践, 2020, 26(11): 1241-1255. doi: 10.3969/j.issn.1006-9771.2020.11.001
	JIANG J Y, QIU Z Y, WANG G X, et al. Systematic implementation of World Health Organization Family of International Classifications in Rehabilitation: protocol and roadmap[J]. Chin J Rehabil Theory Pract, 2020, 26(11): 1241-1255.
[29]	SYKES C R, MARIBO T, STALLINGA H A, et al. Remodeling of the ICF: a commentary[J]. Disabil Health J, 2021, 14(1): 100978.
[30]	STUCKI G, CIEZA A, MELVIN J. The international classification of functioning, disability and health (ICF): a unifying model for the conceptual description of the rehabilitation strategy[J]. J Rehabil Med, 2007, 39(4): 279-285. doi: 10.2340/16501977-0041 pmid: 17468799
[31]	World Health Organization. ICF browser[EB/OL]. (2024-12-27)[2025-02-10]. https://apps.who.int/classifications/icfbrowser/.
[32]	杨亚茹, 邱卓英, 王忠彦, 等. 残疾数据政策、标准体系与数据应用研究[J]. 中国康复理论与实践, 2024, 30(12): 1365-1375. doi: 10.3969/j.issn.1006-9771.2024.12.001
	YANG Y R, QIU Z Y, WANG Z Y, et al. Research on policy framework, standards system and application of disability data[J]. Chin J Rehabil Theory Pract, 2024, 30(12): 1365-1375
[33]	杨亚茹, 邱卓英, 陈迪, 等. 运用ICF构建残疾标准的理论架构与方法体系[J]. 中国康复理论与实践, 2025, 31(7): 745-754.
	YANG Y R, QIU Z Y, CHEN D, et al. Constructing disability eligibility standards using ICF: conceptual framework, approaches and methodological systems[J]. Chin J Rehabil Theory Pract, 2025, 31(7): 745-754.
[34]	孟志勇. 运用WHODAS 2.0、CLVQOL和ICF-RS对低视力患者整体功能的评估研究[D]. 福州: 福建医科大学, 2022.
	MENG Z Y. Evaluation of functioning of patients with low vision using WHODAS 2.0, CLVQOL and ICF-RS[D]. Fuzhou: Fujian Medical University, 2022.
[35]	World Health Organization. WHO Disability Assessment Schedule 2.0 (WHODAS 2.0)[S/OL]. [2024-12-10]. https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health/who-disability-assessment-schedule.

ICF的相关分类和编码				ICD-11的相关分类和编码
身体功能(b)和结构(s)		活动和参与(d)	WHODAS 2.0	ICD-11的相关分类和编码
身体功能(b) 视觉功能(b210) 视敏度功能(b2100) 视野功能(b2101) 视觉品质(b2102) 身体结构(s) 眼、耳有关结构 s210眼眶的结构 s220眼球的结构 s230眼周的结构	看(d110) 学习阅读(d140) 自理(d5) 主要生活领域(d8)		认知基本学习(VD03) 自我照料盥洗自身(VD20) 穿着(VD21) 吃(VD22) 进行日常事务(VD23) 生活活动担负起家务的责任(VD40) 完成大多数重要的家务任务(VD41) 做家务(VD42) 有报酬的就业(VD43)	09视觉系统疾病视觉功能损害视野损害(9D41) 视野损害的特征(9D42) 视觉对比敏感度损害(9D43) 色觉受损(9D44) 光敏度损害(9D45) 双眼视功能损害(9D46) 其他特指的视觉功能损害(9D7Y) 未特指的视觉功能损害(9D7Z) 视力损害视力损害(包括盲)(9D90) 特定的视觉功能障碍(9D92) 复合型视觉功能相关障碍(9D93) 视觉敏锐度损害(9D94) 最佳矫正视力损害(9D95) 裸眼视力损害(9D96) 其他特指的视力损害(9D9Y) 未特指的视力损害(9D9Z) 创伤性眼球损伤(NA06.8) 眼球或眶组织挫伤(NA06.0)

Comparative study of six visual disability-related standards in China based on ICF and ICD-11

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