Medical health assessment Q: Eye condition - anyone else? will it pass for Skilled migration?

[Lizzywills]

Hi everyone

I'm hoping someone here may have some knowledge and advice....My husband and I are looking to emigrate under skilled migration, we pass points test, very positive meeting today with our proposed migration agent...

 

However we realise that the medical assessment needed involves an eye test, and this also includes fundoscopy (which looks at the back of the eye)

 

My husband has an eye condition which is progressive. He was diagnosed with it 14 or so years ago during a routine eye test for his glasses. No cause for concern before this point, it was a huge surprise as he had not noticed any change in his vision. It is where pigment appears on the retina which worsens over time There is no known treatment, and no cure. There are certain things you can take which have been proven to slow its progression (which he does take). In severe cases, people can have seriously impaired vision. My husband however is one of the 'lucky' ones, and hasn't been seriously affected by this so far. Since he was diagnosed:

 

- the progression of his disease has been very VERY slow (compared to some with this condition who have it from childhood)- minimal changes each year, it is not going to get better however

- He needs no visual aids or assistance to live his life independently and actively

- It does not impair his capacity to do his job

- In the forseeable future, based on his medical history thus far and opticians monitoring - he has yearly eye examinations to monitor it - he won't need any assistance to live an independent life

 

We are concerned as you can imagine that this condition will mean we are refused a visa on health grounds. He does not have a condition which poses a threat to the people of Oz, he is not going to be a financial cost for Oz (there is no treatment), he can still do his job....

 

At the moment we are very very early in this process but we don't want to spend the £10k going through this visa process is there is a chance of us being refused at the final hurdle. I'm conscious that this retinal pigment will be picked up his eye test, the panel doc here in the UK will state it's 'abnormal' and 'further testing' is needed....

 

Our migration agent has recommended that we have a private consultation with a former panel doc in Manchester which he recommended (who doesn't do Oz medicals anymore but still does NZ ones), to see what he says, before we progress any further. He is not an ophthalmologist however, and probably won't know much about this condition. So should we try to find an ophthalmologist who can help? We can always ask the one who does my husband's current testing, we would need to anyway I'm sure in order to take a full report to a panel doctor if we had submitted our visa application. He would confirm my points above: Very slow progression, doesn't impact daily life, can still do his job etc - which I assume is what the MOC/DIAC want to know. Would we be able to go to him for the 'further testing' if needs be when the time comes, or does it have to be someone of the DIAC choosing?

 

I've searched for cases of others who have eye conditions in terms of visa approvals but have had no joy. Can anyone give us some advice please? I know we can't get an idea of what the MOC/DIAC would say (we can't even apply for an early medical to see if we're wasting our time) as they take into account your personal diagnosis....

 

Does anyone know of an ophthalmologist in the UK who has given them advice? And when considering implications financial and community services wise, when looking at an applicant's health condition, does anyone know how far in advance does the MOC/DIAC look?? Based on my hubby's history so far (14 plus years since diagnosis), we can safely say the slow progression will continue...but we cannot assume or predict anything with this condition....it affects everyone so very differently!

 

Am I right in understanding that when looking at health issues, the MOC/DIAC can only consider the next 5 years or so, and only provable facts (ie. Mr xx WILL need hospital treatment/community care/ etc) - not assumptions? As we can't say (and any ophthalmologist will say the same) exactly how this is going to progress....we don't have a crystal ball!!!

 

I'm so so sorry for the long post. Anyone who has got this far...I thank you for bearing with me. As you can imagine this has been whirling around our heads today since our meeting this morning.

[CollegeGirl]

They look at the next five years. I would definitely take a statement with you from your opthalmologist to your husband's panel exam. Make sure it explains everything you said on it, and have it speak specifically to the next five years. If your doctor can say that your husband will in all likelihood need no treatment and will not have his ability to work impacted over the next five years, I really doubt it will be a problem. Basically they want diagnosis, prognosis, treatment - and anything you can throw in there about potential costs (or lack thereof) over the next five years will be icing on the cake.

 

If you really want to consult a specialist, George Lombard is a registered migration agent who has a doctor on staff who is an expert on these things (not optical issues specifically, but medical issues) and George is always brought up here in relation to handling visas with medical issues. In all honesty I don't think you even need that - but if you want to be on the safe side, I'd email him. Another migration agent brought up here for similar cases is Peter Bollard.

Edited October 31, 2013 by CollegeGirl

[Lizzywills]

Thank you thank you thank you for your very swift reply! I appreciate your help so very very much. I'll make sure we do that and I'll get in touch with George too if needs be.

[Que Sera Sera]

Have they changed the medicals then? We only had to have a normal basic eyesight test , you know where you read out the letters on the board. That's it.

[Freesia]

look up the Instructions for panel Physicians, there is a section on eye conditions....I have a similarly long-standing & rare eye condition which will automatically lead to a referral of the medical, & found this at least a little reassuring, as where there is no known cure there cannot be a corresponding cost which would make your OH a liability to the Aus government it will be the long-term implications that will matter though- so it would be as well to obtain a thorough report from his current specialist as to his functional capacity- as this is what his referral will need to cover.

[Lizzywills]

Thanks Freesia and Que Sera Sera for responding

I did look up the instructions for panel physicians, it says that further assessment should be the procedure if anything 'abnormal' is found

 

Que Sera - interesting - the form via the link below (Form 26) - part D - says that the eye exam should include fundoscopy - where they shine that light into your eyes which magnifies the retina etc for examination. http://www.immi.gov.au/allforms/pdf/26.pdf....and this is where they would see the pigment on his retina

 

If he was just asked to read the letter chart then he can do that easily, his actual vision with his lenses in is very good!

[oppyddrum]

I dont know what exactly the condition you have described is called. it does sound like Glaucoma though and my dad was diagnosed with Glaucoma a while back. his medicals did get referred along with a report from his ophthalmologist and his prescription. He got his PR approved.

 

I hope that helps.

 

Hi everyone

I'm hoping someone here may have some knowledge and advice....My husband and I are looking to emigrate under skilled migration, we pass points test, very positive meeting today with our proposed migration agent...

 

However we realise that the medical assessment needed involves an eye test, and this also includes fundoscopy (which looks at the back of the eye)

 

My husband has an eye condition which is progressive. He was diagnosed with it 14 or so years ago during a routine eye test for his glasses. No cause for concern before this point, it was a huge surprise as he had not noticed any change in his vision. It is where pigment appears on the retina which worsens over time There is no known treatment, and no cure. There are certain things you can take which have been proven to slow its progression (which he does take). In severe cases, people can have seriously impaired vision. My husband however is one of the 'lucky' ones, and hasn't been seriously affected by this so far. Since he was diagnosed:

 

- the progression of his disease has been very VERY slow (compared to some with this condition who have it from childhood)- minimal changes each year, it is not going to get better however

- He needs no visual aids or assistance to live his life independently and actively

- It does not impair his capacity to do his job

- In the forseeable future, based on his medical history thus far and opticians monitoring - he has yearly eye examinations to monitor it - he won't need any assistance to live an independent life

 

We are concerned as you can imagine that this condition will mean we are refused a visa on health grounds. He does not have a condition which poses a threat to the people of Oz, he is not going to be a financial cost for Oz (there is no treatment), he can still do his job....

 

At the moment we are very very early in this process but we don't want to spend the £10k going through this visa process is there is a chance of us being refused at the final hurdle. I'm conscious that this retinal pigment will be picked up his eye test, the panel doc here in the UK will state it's 'abnormal' and 'further testing' is needed....

 

Our migration agent has recommended that we have a private consultation with a former panel doc in Manchester which he recommended (who doesn't do Oz medicals anymore but still does NZ ones), to see what he says, before we progress any further. He is not an ophthalmologist however, and probably won't know much about this condition. So should we try to find an ophthalmologist who can help? We can always ask the one who does my husband's current testing, we would need to anyway I'm sure in order to take a full report to a panel doctor if we had submitted our visa application. He would confirm my points above: Very slow progression, doesn't impact daily life, can still do his job etc - which I assume is what the MOC/DIAC want to know. Would we be able to go to him for the 'further testing' if needs be when the time comes, or does it have to be someone of the DIAC choosing?

 

I've searched for cases of others who have eye conditions in terms of visa approvals but have had no joy. Can anyone give us some advice please? I know we can't get an idea of what the MOC/DIAC would say (we can't even apply for an early medical to see if we're wasting our time) as they take into account your personal diagnosis....

 

Does anyone know of an ophthalmologist in the UK who has given them advice? And when considering implications financial and community services wise, when looking at an applicant's health condition, does anyone know how far in advance does the MOC/DIAC look?? Based on my hubby's history so far (14 plus years since diagnosis), we can safely say the slow progression will continue...but we cannot assume or predict anything with this condition....it affects everyone so very differently!

 

Am I right in understanding that when looking at health issues, the MOC/DIAC can only consider the next 5 years or so, and only provable facts (ie. Mr xx WILL need hospital treatment/community care/ etc) - not assumptions? As we can't say (and any ophthalmologist will say the same) exactly how this is going to progress....we don't have a crystal ball!!!

 

I'm so so sorry for the long post. Anyone who has got this far...I thank you for bearing with me. As you can imagine this has been whirling around our heads today since our meeting this morning.

Edited November 1, 2013 by oppyddrum

[Lizzywills]

Thanks Oppyddrum! It's not glaucoma, but glad to hear all went well for you Dad We are going to get a report from my OH optician (he was the one who diagnosed it all those years ago) - outlining Diagnosis, Prognosis, Treatment and Impact on Independent Living/Work (prediction of next 5-10 years). We're then going to take this when we see the former Panel Doctor recommended to us today by our migration agent. To see what he would do/advise based on the info we give him. He may have an understanding of how DIAC and MOC view these conditions which have no cost/ongoing treatment, but are a long-term health condition. Appreciate your reply, thanks again.

[CollegeGirl]

Here in the US Opticians are not actually doctors - are they in the UK? Here in the US optometrists and opthalmologists are doctors, but opticians are not. Just checking because I think it's likely important the letter is from an actual doctor.

[Lizzywills]

Excellent point CollegeGirl, thank you - yes my OH's 'optician' is an Optometrist, who has his own opticians and eye services clinic. So he's well qualified I would think to assess and comment, he was the one who diagnosed it and has been annually monitoring my OH ever since. No one understands his condition and its effect better than him

[Rupert]

Have they changed the medicals then? We only had to have a normal basic eyesight test , you know where you read out the letters on the board. That's it.

 

Yes me too, I have never heard of anything more than that. Still OP would need to declare it in the questionnaire so still needs the advice

[CollegeGirl]

Great - it sounded like that to me, but I just wanted to make sure! Didn't want you guys tripped up over something silly.

[Lizzywills]

Hi everyone

I'm in dire need of a boost....has anyone here been accepted for PR who has an eye condition. I've already posted a thread about my issues but in a nutshell, my husband has an eye problem which is permanent and progressive, in his case it's very slow progression and his actual eyesight in terms of a visa test is very good (reading the numbers chart).

 

But we will have to declare his issue as a pre-existing condition. There is no treatment, no cure. Some people have major eyesight issues with it, some do not. We are fully preparing ourselves at this very early stage in our process by getting in touch with an opthalmologist who can prepare a full report for us explaining diagnosis/prognosis/treatment/impact on independent living/work....along with any relevant tests we should include....

 

But I really would love to hear from folks who have had eye issues and been accepted for PR. I think their main concern in terms of immi will be whether he will ever become legally blind in his lifetime, which would make him eligible as a PR for benefits I assume.

 

I am wondering how any opthalmologist can predict such a thing...surely that's crystal ball territory! At the moment as it's so slow and there's been no change for the past 2 years (he's 42 now) I would say no....

 

I look forward to hearing from you all with your happy stories!

 

ps/ As an aside I've already been in touch with George Lombard, (who has been incredibly useful) and also a Panel Doctor here in the UK, who says the only thing we can do is submit a full and specialist report which allays immi's concerns and makes it clear he is independent and capable of a work/living with no assistance

[blossom]

As you already have a post going about this condition I have merged your new one so that people don't spend time writing out long replies which you may have already been given. Good luck.

[Lizzywills]

Good idea! Thank you!

[CollegeGirl]

Lizzy, it sounds like you're doing absolutely everything you can! I hope you get some replies from people who have similar conditions. I think it's rare enough that it might be a stretch, though. Best of luck!

[wrussell]

Good idea! Thank you!

 

The Australian medical authorities assess the likely cost of treatment/medications over the period of the visa. For permanent visas this is the lifetime cost. I have AMD and I pay $450 every 5 weeks for interocular injections.

[Lizzywills]

Interesting, thanks wrussell. My husband's condition doesn't have any treatment costs associated, as currently there is no available treatment...sadly.Sounds like they aren't adverse to granting PR to people with vision issues, just what we need to hear. Appreciate your response, thanks again. We are just going to go for it, it's the only option we have!

[CollegeGirl]

The Australian medical authorities assess the likely cost of treatment/medications over the period of the visa. For permanent visas this is the lifetime cost. I have AMD and I pay $450 every 5 weeks for interocular injections.

 

It is my understanding that they look at costs over your first 5 years in Australia for permanent visas, and that if they predict that cost will be more than $35,000 over those five years, then you have to go through the health waiver process if one is available for your visa type, or else be denied outright.

[wrussell]

It is my understanding that they look at costs over your first 5 years in Australia for permanent visas, and that if they predict that cost will be more than $35,000 over those five years, then you have to go through the health waiver process if one is available for your visa type, or else be denied outright.

 

[h=2]Significant health care and community service costs[/h]

Significant costs are assessed:

 

 

 

• for temporary visas applicants, by taking into account their length of stay in Australia

• for permanent visa applicants, over a five year period or three years for those aged 75 or older.

 

 

Exception: If you have a permanent or ongoing condition and the course of the disease is reasonably predictable, the MOC will determine the estimated costs over the period of your remaining life expectancy. This means that if you have a serious health condition you may meet the health requirement for a temporary visa, however, you may not meet the health requirement if you then apply for a permanent visa.

**************************************************************************************************************************************************************

My Note:

If a visa applicant (or a family member) had an untreatable medical condition that in the usual course of events would make them eligible for 'community services' which includes a disability support pension, it is possible that an adverse medical assessment would follow.

 

 

[Lizzywills]

Yes benefit eligibility, that's what we think they would be concerned about, however I'm not sure how they can expect any Dr to say with any certainty what is going to happen surely over the course of my husband's life for the next 40-50 years....he isn't a 'typical' case for this eye condition, every case has different presentations.

[CollegeGirl]

Well damn. Thanks Westly. I wonder what they consider a "permanent and ongoing condition..." Just when I think I have a pretty good handle on all this, it gets even more complicated. Glad I have a great RMA working with me.

[Lizzywills]

Tell me about it! 'Permanent and ongoing condition' is what we will have, so yes it will be a lifetime assessment that they will want reassurance of....not an issue I guess, our opthalmologist can only speculate, and use how it's progressed using past 14 years as a guide. However I am buoyed by the fact that I've read accounts through my research of ppl with Glaucoma and Macular Degeneration be accepted for PR.

 

What we want is a report from our opthalmologist which says my hubby given progress so far is unlikely ever to be 'legally blind' (defined in Oz as visual acuity of 6/60 and visual field of just 10%) and therefore highly unlikely to be eligible for disability benefit for blind ppl in his lifetime....ideally!

 

Apparently in many cases the case officer makes the decision and only refers to MOC if they need to. If we are providing a full report with all relevant tests, and of course additional comments from the panel doctor confirming his excellent eyesight for standard eye test reading chart, then we may just be ok. Stupid thing is that this prob wouldn't even be picked up if we didn't declare it as he is perfectly capable of reading the chart etc. It's such a big risk though. We could spend £10k and then be refused.....I'm not giving up. If that happened I'd be straight onto appeals and George Lombard! Positive mental attitude needed for the next 12 months....

[wrussell]

The ministers delegate MUST accept the opinion of the MOC as conclusive. If it is adverse a waiver might be available, depending on the class of visa, else you are up that well known creek.

 

our opthalmologist can only speculate

 

Legally it is a question of the likely cost if the condition follows its usual course.

 

You might ask your ophthalmologist to prepare a report that addresses the legal issues in the format required:

 

 

 

REQUIRED FORMAT OF SPECIALIST MEDICAL REPORT

 

 

To meet the legal requirements, the medical specialist’s must:

1) State that he or she has been provided with a copy of the Schedule 4 criterion. [Appendix B]

2) Describe your medical condition exactly.

3) Detail the medical treatment and medications that you have received.

4) Describe the treatment and medication that you are now receiving.

5) Describe the ‘usual course’ of your condition. If there is a wide range of possibilities, summarise them.

6) Describe your specific prognosis in terms of:

(a) The likely progress of your condition

(b) The expected cost and treatment, if any, if your condition follows the likely course.

7) CONCLUSION Will your condition result in a cost to the Australian government of $35 000 over five years with 65% certainty? 8) CONCLUSION Are you likely to require medical treatment within the next five years (with 50% certainty) and what is the likely cost? 9) CONCLUSION Are you likely to require medical treatment beyond this five-year period (with 50% certainty) and what is the likely cost? Please note that for each of the Conclusions it is important for your medical specialist to use this precise wording, because this is the actual legal test. The important word is likely.The test is not whether the events might take place, but, in the specialist’s opinion, whether they are likely. It is entirely a matter for your treating specialist to decide which tests are indicated.

 

 

Appendix B

 

[h=4]SCHEDULE 4 - PUBLIC INTEREST CRITERIA AND RELATED PROVISIONS[/h] (1) The applicant: (a) is free from tuberculosis; and

(b) is free from a disease or condition that is, or may result in the applicant being, a threat to public health in Australia or a danger to the Australian community; and

TRANSITIONAL PROVISIONS

© subject to subclause (2), is not a person who has a disease or condition to which the following subparagraphs apply:

(i) the disease or condition is such that a person who has it would be likely to:

(A) require health care or community services; or

(B) meet the medical criteria for the provision of a community service; during the period of the applicant’s proposed stay in Australia;

(ii) provision of the health care or community services relating to the disease or condition would be likely to:

(A) result in a significant cost to the Australian community in the areas of health care and community services; or

(B) prejudice the access of an Australian citizen or permanent resident to health care or community services;

regardless of whether the health care or community services will actually be used in connection with the applicant; and

(d) if the applicant is a person from whom a Medical Officer of the Commonwealth has requested a signed undertaking to present himself or herself to a health authority in the State or Territory of intended residence in Australia for a follow-up medical assessment, the applicant has provided such an undertaking.

(2) The Minister may waive the requirements of paragraph (1) © if.

(a) the applicant satisfies all other criteria for the grant of the visa applied for; and

(b) the Minister is satisfied that the granting of the visa would be unlikely to result in:

(i) undue cost to the Australian community; or

(ii) undue prejudice to the access to health care or community services of an Australian citizen or permanent resident.

 

 

Please do not take this a considered professional advice. I am only guessing what the medical condition in question might be and I am unable to advise about the usual outcome. The health criteria and policy are far more complex than this brief outline might indicate. May I suggest that you instruct your RMA to make relevant enquiries and advise you about steps you can take to minimise your costs?

[Lizzywills]

Thanks wrussell, that's a really useful guide for instructing our medical specialist. He will be a UK opthalmologist, we will be producing a full report from him for our medicals and we will ensure that it incorporates the above. Am I right in thinking however that as others have said, it's a 'lifetime' assessment they will want, not a 5 year period?

 

We do have a migration agency here on 'standby' for us as when we went for the initial assessment it was all positive in terms of being accepted re points/skills assessment, however they weren't sure re. the eye issue and told us to contact a former panel GP for advice. Which we did - but who hasn't contacted us back...we've since been making our own enquiries to see if this whole exercise is going to be a waste of time before we actually pay the migration agency to start the process...hence my posts! And I've been doing a lot of research myself.

 

I'm not sure I can actually ask the RMA we had our assessment with to look into this as I'm not actually a paying client until we tell them to start the process...seems its up to us to find out the answer, otherwise I'll be paying an initial £1.4k (part payment of full visa application service, the remainder upon completion and successful application) for them to research only...I'm not sure what to do to be honest.