Deficiência visual, judicialização e economia da saúde: uma análise de perícias médicas oftalmológicas na Justiça Federal do Ceará (2010–2022)

Abstract

Introduction: Visual impairment is a major cause of functional disability, with direct repercussions on work capacity, social protection, and health-related costs. In Brazil, health judicialization has become a frequent pathway for access to social assistance and social security benefits, particularly in contexts of socioeconomic vulnerability. Objective: To analyze the epidemiological, clinical, functional, and socioeconomic profile of individuals assessed in judicial ophthalmic medical examinations of the Federal Justice of Ceará, as well as their associations with public benefit claims and the main diagnoses of visual impairment. Methods: An observational, retrospective, and analytical study based on 1,761 judicial ophthalmic medical examinations analyzed, conducted between 2010 and 2022 in Fortaleza, Ceará, Brazil. The variables included sociodemographic, occupational, and clinical data, ophthalmologic etiologies according to ICD-10, degree and temporality of work incapacity, and type of benefit requested. Descriptive statistics, association tests (chi-square or Fisher’s exact test), and binary logistic regression were applied to identify factors associated with more severe forms of visual impairment. Results: Among the analyzed cases, a predominance of male individuals, a mean age of 47.9 years, and low educational attainment were observed. The most frequent conditions were monocular blindness (H54.4), binocular blindness (H54.0), and monocular blindness with contralateral low vision (H54.1). Glaucoma, retinopathies, cataract, and ocular trauma were among the main associated etiologies. Most cases presented permanent work incapacity, with a significant association between more severe subtypes of visual impairment and greater functional limitation. Conclusion: In the group of individuals assessed in the analyzed examinations, visual impairment predominantly affected socially vulnerable populations, was mainly associated with potentially preventable or treatable ophthalmologic diseases and imposed a relevant impact on health judicialization and public expenditure, reinforcing the need for integrated policies focused on prevention, early diagnosis, and visual rehabilitation.