WCB Nova Scotia uses this two-page report to assess the level of impairment, if any, after a worker's traumatic eye injury. The ophthalmologist describes the injury and the eye's condition, records visual acuity, intraocular pressure, visual fields and motility, says whether the worker has reached maximum medical recovery, and estimates how much of the current deficit relates to a pre-existing condition versus the compensable injury.
An eye specialist (ophthalmologist) must complete, sign and date the report, adding their name and address in the health care provider section. Worker details at the top include the WCB claim number and health card number.
Download the current version from the source each time; forms change without notice.
Eye Injury Report
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Only an eye specialist. The form states it must be completed, signed and dated by an ophthalmologist, and WCB uses it to assess the level of impairment, if any, from the worker's traumatic eye injury. The provider section asks for the ophthalmologist's name and address, signature, phone and fax.
Near and far central visual acuity in Snellen 20-foot equivalents with and without correction, intraocular pressure in mmHg, visual fields marked normal or abnormal, diplopia and percentage decrease in ocular motility. It also asks about aphakia, pseudophakia, capsular opacification, photophobia, disfigurement, epiphora and metamorphopsia, with mild, moderate or severe ratings where relevant.
WCB asks you to describe the eye's condition before the injury and what changed as a result of the compensable injury, then estimate what portion of the current deficit relates to each. WCB uses these answers to assess the level of impairment once you confirm the worker has reached maximum medical recovery.