Had the visual field test and I still cannot work out whether my upper lids count as funded or cosmetic

I am 61 and the skin on my upper lids now rests on my lashes. I am not chasing a rested look, I am tilting my chin up to read road signs and getting a dull ache in my forehead by mid afternoon from holding my eyebrows up all day without realising I am doing it.

Got referred, had the visual field test, the one where you click the button when you see the little lights. They did it once with my lids as they are and once with the skin taped up out of the way. Nobody explained the result to me on the day beyond "we will write to you." So I am sitting here not knowing whether I am about to be told this is a medical problem that gets treated, or a cosmetic one I pay for myself.

What actually decides it? Is there a number they are looking for? And does the taped version needing to be much better than the untaped one work in my favour or against me?

The taping better is the point of the whole test. They are showing that lifting the skin gives you back field you currently do not have. If taping changed nothing, the hooding would not be what is blocking you.

The forehead ache is such a giveaway and I wish more people knew it. My mother did the eyebrow-holding thing for years and swore blind her eyes were fine, she was just "a frowner." She was compensating without knowing it.

No help on the funding question I am afraid, mine was purely cosmetic and self-funded and I never went near a field test. Just wanted to say the symptoms you are describing sound like the functional end rather than the vanity end, for whatever a stranger's opinion is worth.

I can set out how the distinction is drawn, though I cannot tell you which side of it your own result falls on, since I have not seen your fields or your lids.

The direct answer first. The line between funded and self-funded is not drawn on how heavy the lids look. It is drawn on documented obstruction of the upper visual field by the hooding skin, which is why you were tested twice. The untaped run records the field you actually have; the taped run records the field you would have if the skin were lifted off the lashes. The comparison between them is the evidence, and a meaningful improvement on taping is what supports a functional case rather than undermining it. That is why the person who tapes your lids is not being fussy: without both runs there is no comparison to submit.

What the thresholds are varies, and I want to be precise about that rather than vague. Different health systems and insurers set their own criteria, and they typically also want the picture to hang together: photographs showing the skin resting on or below the lash line, a symptom history like the chin lifting and the brow ache you describe, and often a note that the problem is the eyelid skin rather than a droopy lid margin or a descended brow, because those are different operations with different funding rules. Our articles on functional versus cosmetic blepharoplasty and on blepharoplasty and ptosis repair set out that difference in more detail.

Two honest caveats. Meeting criteria is not the same as the surgery being funded quickly, and being turned down is not a judgement that your symptoms are imaginary. If the letter is unclear, ask the clinic directly which criteria were applied and what the two field results were, and it is reasonable to ask for that in writing.

Thank you, that is the clearest explanation anyone has given me including the people who did the test. I did not realise the two runs were being compared against each other, I assumed the taped one was some sort of practice go.

Worth bracing yourself for the possibility of a no, not to be gloomy but because it happens to people whose lids genuinely bother them. A friend of mine was refused, waited a year, got worse, was tested again and got it approved the second time. So a no now is not necessarily a no forever.

Closing the loop for anyone searching this later. Letter came, approved, and the deciding factor was exactly what was described above, a clear difference between the taped and untaped fields plus the photographs. Nobody mentioned a number to me and I did not push for one.

One thing I will flag because it surprised me: it was made very clear that this was the upper lids only, on the field evidence, and that anything about the bags underneath was a separate and self-funded conversation. Which is fair enough, but if you have been quietly hoping the whole eye area gets sorted in one go, it may not.