Assessment overview
How this assessment usually works
Vision impairment follows a specific NSW exception. An ophthalmologist must assess the visual system using AMA4 Chapter 8 as adopted by NSW Chapter 10, rather than applying a generic AMA5 percentage.
For vision and eye, the assessor gives a medical opinion about permanent impairment under the NSW workers compensation guidelines; the assessor does not decide legal liability. Once the body-system method and percentage are understood, separate advice may be needed about Section 66 compensation, weekly payments, medical-expense time limits or work injury damages.
Injuries and diagnoses assessed in this body system
The referral and report should identify the accepted diagnosis precisely. Similar symptoms can use different assessment methods depending on the injured structure.
- traumatic loss of visual acuity from corneal, lens, retinal, macular, optic-nerve or other accepted eye injury
- permanent visual-field loss after eye, optic-nerve or brain injury
- diplopia, ocular-motility or binocular-vision disturbance after an accepted injury
- post-surgical loss, enucleation or another permanent visual-system consequence supported by ophthalmological findings
When a permanent impairment assessment can occur
For vision and eye, assessment should occur only after maximum medical improvement (MMI). NSW Guidelines paragraph 1.15 describes a condition that is well stabilised and unlikely to change substantially during the next year, with or without treatment.
For vision and eye, if adequate treatment or rehabilitation could materially change the impairment, paragraph 1.16 says the assessment should be deferred. The report should explain why the timing is appropriate.
For vision and eye, the ophthalmologist should consider whether surgery, optical correction or other treatment could still materially change acuity, field or ocular alignment before finalising the impairment.
The NSW and AMA5 assessment method
The NSW Workers Compensation Guidelines prevail over AMA5 wherever the two differ. The method is a medical assessment framework, not a self-scoring exercise.
NSW Guidelines Chapter 10 requires assessment by an ophthalmologist and adopts AMA4 Chapter 8 for the visual system. This is a specific NSW exception: AMA5 Chapter 12 is not the controlling visual-system method.
The ophthalmologist must perform or review all necessary tests and must assess visual-field impairment personally. Orthoptist or optometrist results can be supporting material but do not replace the ophthalmologist assessment.
Testing is undertaken with prescribed spectacles or contact lenses that were normal before injury. If the work injury first required, or changed, that correction, the ophthalmologist accounts for the change under paragraph 10.4.
The adopted AMA4 process considers central visual acuity, visual fields and, where applicable, ocular motility or diplopia. The controlling AMA4 Chapter 8 source has been checked; this page explains the method without reproducing its tables or inviting self-calculation.
What the assessor actually measures
For vision and eye, the percentage should be traceable to relevant, stable and reproducible findings.
- best-corrected visual acuity for each eye using the ophthalmologist-approved testing method
- formal monocular visual fields, with reliability and consistency reviewed by the ophthalmologist
- ocular alignment, motility and the position or persistence of diplopia where relevant
- the anatomic diagnosis, operation or treatment outcome and whether the test pattern matches that diagnosis
- pre-injury acuity, field or correction where a deduction or comparison is proposed
How the measurements are converted to WPI
The ophthalmologist converts the measured acuity, field and any applicable motility loss under AMA4 Chapter 8 as adopted by NSW Chapter 10.
NSW paragraph 10.7 clarifies that the expression "additional 10% impairment" in AMA4 section 8.5 means 10% WPI, not 10% impairment of the visual system.
Each component must be expressed in the correct unit and checked for overlap before any permitted visual-system combination. A raw acuity or visual-field percentage is not automatically the final WPI.
No AMA5 visual value should replace the NSW-adopted AMA4 result, even if an AMA5 vision table is easier to locate.
Verified category and table examples
These short examples show how the published method works. They do not predict an individual assessment.
| Finding or category | Published value or method | Source |
|---|---|---|
| AMA4 section 8.5 "additional 10% impairment" | Means 10% WPI | NSW Guidelines paragraph 10.7 |
Worked illustrations
How the assessment method can operate
These paraphrased illustrations explain the published method. They are not estimates of another worker's WPI.
Illustration: field loss must be measured through the NSW visual pathway
Assumed findings: A worker has a stable accepted optic-nerve injury. Best-corrected central acuity remains useful, but formal testing shows a consistent permanent visual-field defect. Recent optometry results are also available.
Method and arithmetic: The ophthalmologist reviews or performs the acuity and field tests, applies AMA4 Chapter 8 as adopted by NSW Chapter 10, and explains any permitted combination. The optometry figures are evidence, not a substitute WPI calculation.
What the illustration shows: The example shows why apparently good central acuity does not dispose of a supported field-loss claim, and why the wrong AMA edition must not be used. No percentage is stated because the controlling AMA4 visual table was not supplied for verification.
Method source: NSW Guidelines paragraphs 10.1-10.7; AMA4 Chapter 8
What does not establish WPI by itself
These matters can remain medically and practically important, but they do not replace the measurements or category requirements in the applicable method.
- blurred vision, headache, light sensitivity or eye strain without a stable accepted diagnosis and the required ophthalmological tests
- an optical prescription or visual-screening result reported as WPI
- a visual-field interpretation not performed or reviewed by the assessing ophthalmologist
- an AMA5 vision percentage substituted for the NSW-adopted AMA4 method
- a deduction for prior vision loss without reliable pre-injury records or explanation
Evidence checklist
The assessor should receive enough material to test the accepted injury, stability, measurable impairment and any deduction.
- the accepted injury or disease description and any insurer liability decisions
- contemporaneous GP, hospital and treating-specialist records
- relevant investigations, pathology, procedure reports and treatment history
- earlier impairment assessments and evidence about any pre-existing impairment
- a current clinical opinion explaining stability and whether material improvement remains likely
- ophthalmology reports identifying the accepted visual diagnosis and stable treatment outcome
- formal best-corrected visual-acuity, visual-field and ocular-motility results where relevant
- operation, imaging, orthoptic, optometry and hospital records reviewed by the ophthalmologist
- pre-injury prescriptions, acuity or field records where prior impairment is in issue
Common insurer or report disputes
A disagreement about vision and eye WPI may concern the accepted diagnosis, the body-system findings, the selected method, a deduction or the way another impairment was handled. The report should identify the disputed step rather than leave the percentage unexplained.
- the report relies on an optometry result without the required ophthalmologist assessment
- the wrong AMA edition or body-system method is used
- testing is incomplete, inconsistent or performed before stability
- pre-existing visual impairment is deducted without adequate reasoning
Sources for this assessment guide
The public NSW Guidelines control where they modify AMA5. AMA5 table references below identify the method without reproducing the proprietary table in full.
- NSW Guidelines Chapter 10, paragraphs 10.1-10.7: ophthalmologist requirement, correction, test supervision, visual fields and the NSW clarification.
- AMA4 Chapter 8, sections 8.1-8.5: controlling visual-system measurements and conversion adopted by NSW; tables are not reproduced because an ophthalmologist must apply the method to the measured findings.
- AMA5 Chapter 12: background only; not the controlling NSW visual-system method.
Questions to ask when the report comes back
These questions help identify whether the report explains its method and evidence. They do not replace medical or legal advice about the particular assessment.
- Did an ophthalmologist assess the impairment?
- Which AMA4 section and NSW paragraph were applied?
- Are acuity and visual-field results clearly recorded?
- Is any deduction supported by earlier records?
How this connects to thresholds and strategy
In a vision and eye claim, SIRA's permanent impairment thresholds must be applied to the accepted injury and the supported body-system percentage. The general thresholds are 11% or more permanent impairment for physical injury and 15% or more for primary psychological injury; secondary psychological injury is treated differently. A threshold is an eligibility checkpoint, not a promised payment.
A low vision and eye WPI opinion may affect weekly-payment planning, treatment time-limit issues, dispute posture and whether work injury damages threshold advice is required. Before the opinion is relied on, check the relevant measurements, body-system method, deduction and practical consequences.
Questions workers often ask
Who can assess vision impairment for NSW workers compensation?
NSW Guidelines paragraph 10.1 requires the visual system to be assessed by an ophthalmologist.
Does NSW use AMA5 for eye impairment?
No. NSW Chapter 10 adopts AMA4 Chapter 8 for the visual system. The NSW Guidelines still prevail where they modify that method.
Is blurred vision enough to establish WPI?
Not by itself. The assessment requires the accepted diagnosis and the ophthalmological measurements required by the visual-system method.
When should eye impairment be assessed?
Only after maximum medical improvement, when the condition is well stabilised and unlikely to change substantially during the next year.
General information only
This information is general in nature and is not legal advice. You should obtain advice about your own circumstances before relying on a WPI percentage, accepting a lump sum offer, or responding to an insurer decision.
Reviewed by NSW Work Injury Claims - a branch of Stephen Young Lawyers.
Related injury and impairment pages
Need a WPI assessment checked?
If the percentage does not match the accepted injury, treatment history, imaging, surgery, work duties or current restrictions, get the report checked before accepting the insurer position.