Coordinating Committee (Ophthalmology) Doc No.

: COCOPH-GE-1
Version: V1
Guideline on the Assessment of Visual Page: Page 1 of 6
Impairment Effective 25 Jun 2009
date:

BACKGROUND
At the 61st meeting held on 14 January 2009, the Coordinating Committee in
Ophthalmology recommends referring to the 4th edition (1993) of the Guides to the
Evaluation of Permanent Impairment of the American Medical Association for the
assessment of visual impairment where appropriate.

In the computation on loss of earning capacity requested by the Labour Department

and Social Welfare Department, compliance with the First Schedule of the Employee’s
Compensation Ordinance (Cap.282) should be observed.

A stepwise approach is detailed below to aid computation.

PROCEDURE
Step 1 Determine the causal relationship between the impairment and the alleged
incident.
The doctor is required to state this in the assessment for work related injuries and
occupational diseases.

Step 2 Determine whether the condition is stable for assessment.

Assessment is to be deferred for cases receiving active treatment or rehabilitation.
It is required to state in the report that such visual impairment is permanent or
temporary.

Step 3 Determine the visual efficiencies (VEs)

VE is the degree or percentage of competences of the eyes to accomplish their
physiologic functions:-
• VA : corrected for distance & near
• VF
• Ocular motility, with absence of diplopia
 Coordinating Committee (Ophthalmology) Doc No.: COCOPH-GE-1
Version: V1
Guideline on the Assessment of Visual Page: Page 2 of 6
Impairment Effective 25 Jun 2009
date:

a. VEs are determined for each eye separately.

b. If medical (ophthalmic) information is available, the VE before the incident is
calculated from such information. The amount of visual impairment is the
difference of VEs before and after the alleged incident.
c. The eye is assumed to possess a VE of 100% before the alleged incident if no
information regarding its condition before the incident is available and it is the
opinion of the ophthalmologist such visual impairment is due to the alleged
incident.
3.1 Assessment of visual acuities
The best corrected visual acuities (BCVA) for distant and near are recorded. The
mean VEacuity for distant BCVAdistant and near BCVAnear are obtained.
Impairment
Metric VA Decimal VEacuity Impairment Classes
Rating (%)
20/12.5 110 0
6/5 20/15 105 0 Range of
6/6 20/20 1.0 100 0 Normal Vision
6/7.5 20/25 0.8 95 5
6/9 20/30 0.6+ 90 10
6/12 20/40 0.5 85 15 Near-Normal
6/15 20/50 0.4 80 20 Vision
6/18 20/60 0.3 65 35
6/24 20/80 55 45
6/30 20/100 0.2 50 50 Moderate
6/36 20/125 40 60 Low Vision
20/160 30 70
6/60 20/200 0.1 20 80
20/250 Severe
20/320 Low Vision
6/120 20/400 0.05 10 90
20/500
20/630 Profound
6/240 20/800 5 95 Low Vision
20/1000 0.02
20/1250
20/1600
Near-Blindness
20/2000
or less
NLP 0 100 Total Blindness
 Coordinating Committee (Ophthalmology) Doc No.: COCOPH-GE-1
Version: V1
Guideline on the Assessment of Visual Page: Page 3 of 6
Impairment Effective 25 Jun 2009
date:

a. Note the non-linear relationship between VA and VEacuity.

b. The VEacuity for BCVAdistant is used for assessment if the BCVAnear is not
available.
c. The VEacuity for the aphakic or pseudophakic eye is reduced by 50%.

3.2 Assessment of visual fields

The visual field is defined as the most peripheral extent along 8 principal
meridians at which the stand stimulus is seen.

Direction Normal extend field (º)

Temporally 85
Down Temporally 85
Direct Down 65
Down Nasally 50
Nasally 60
Up Nasally 55
Direct Up 45
Up Temporally 55
Total 500

The monocular VEfield is plotted with a white target of the appropriate target size.

Perimeter Phakic Aphakic

Goldmann III4e IV4e
Airmark 3W/330 6W/330
Humphrey 10 dB 6 dB

a. For kinetic perimetry, the target size for static perimetry is doubled (6W/330 or
IV4e).
b. For static perimetry with the Humphrey perimeter,
 Coordinating Committee (Ophthalmology) Doc No.: COCOPH-GE-1
Version: V1
Guideline on the Assessment of Visual Page: Page 4 of 6
Impairment Effective 25 Jun 2009
date:

• a sensitivity of 10 dB or better is regarded as seen; a brighter target is

defined for testing aphakic eyes.
• Only use the 30º central field plot if there is no vision beyond 20º.

Calculation of VEfield:
c. Take the sum of remaining extend of field along 8 standard meridians;
d. Divide the sum by 5.

3.3 Assessment of ocular motility

The field of binocular single vision is plotted along each of the 8 major
meridians without coloured lenses or correcting prisms, using an arc perimeter
or bowl perimeter.

The impairment for loss of ocular motility due to diplopia in the meridian of maximum
impairment is combined with other visual impairment.

Diplopia within central 20º (diameter) of fixation is regarded as total (or 100%) loss of
VE of one eye.
 Coordinating Committee (Ophthalmology) Doc No.: COCOPH-GE-1
Version: V1
Guideline on the Assessment of Visual Page: Page 5 of 6
Impairment Effective 25 Jun 2009
date:

The VEmotility is 100% if

• there is no diplopia, e.g. suppression – pre-existing or developed after the
incident.
• diplopia is experienced outside 30º superiorly or 40º inferiorly.

Step 4 Calculation of VE loss

The VEtotal of each eye is computed from the product (not the sum) of the VEs of
each eye:
VEtotal = VEacuity × VEfield × VEmotility

The difference in VEtotal of the involved eye is computed if its condition before the
incident is known, e.g. from old medical records.
VEloss = 100% - VEtotal

Step 5 Calculation of Earning Capacity

Apply the conditions 4 and/or 38 of the First Schedule of the Employees
Compensation Ordinance (Cap.282).

“Sight” is quantified with VEtotal; “loss of sight” is expressed as VEloss.

Employees Compensation Ordinance (Cap.282)

First Schedule
[4] Total loss of sight = 100% loss of earning capacity
[38] Loss of sight of one eye = 50% loss of earning capacity

Loss of earning capacity = 50% × VEloss(OD) + 50% × VEloss(OS)

The VEloss is 0% for the non-involved eye or the impairment is not caused by the
alleged incident.
 Coordinating Committee (Ophthalmology) Doc No.: COCOPH-GE-1
Version: V1
Guideline on the Assessment of Visual Page: Page 6 of 6
Impairment Effective 25 Jun 2009
date:

Step 6 Other conditions

The following factors are not quantified with VE:-
• Colour vision
• Light & dark adaptation
• Contrast Sensitivity
• Glare:
– discomfort glare
– disability glare
• Metamorphopsia
• Anisometropia
• Accommodation
• Epiphoria
• Pain
• Cosmesis

Impariment of these factors may or may not have been taken into account in the
assessment of VEacuity , VEfield , or VEmotility., e.g. impaired VA with metamorphopsia.

These should be detailed in the medical reports for the consideration of the Assessment
Board(s) where appropriate. The Assessment Board(s) has the discretion to give
additional impairment ratings or to determine the patient cannot work in the original
occupation or profession.