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AOP Position

Driving and vision

We believe vision screening should be introduced on licence application and as a legal requirement at least every 10 years

Key points

  • Good vision is crucial for driving safety, along with a number of other mental and physical capabilities

  • Optometrists’ main role is to maximise visual function and thus support people to drive safely

  • Individual drivers are responsible for ensuring that they are fit to drive in all respects, including that their vision is good enough, but some drivers are not aware of the standards and of their responsibilities

  • The AOP believes that the number-plate test at the beginning of the driving test is not an adequate check of vision

  • Everyone should have a sight test every two years, or more often if an optometrist recommends it. The AOP believes that, in addition, drivers should be legally required to prove that their vision meets the standards for driving at least every ten years (for example at license renewal), and more frequently as they get older

  • Unfortunately, optometrists sometimes have to notify patients that their sight may not meet the standards for driving.  They will provide counsel and advise them to inform the Driver and Vehicle Licensing Agency (DVLA)

  • Where drivers continue to drive contrary to advice and are therefore a threat to the safety of themselves and others, optometrists may need to report them to the DVLA and the AOP provides advice to members on this

  • The AOP is not in favour of compulsory reporting by medical professionals because it removes responsibility from the driver and could discourage some people from accessing eye examinations

Vision and safe driving

The ability to drive safely requires a number of mental and physical capacities. Obviously, a crucial one of these is good eyesight.

This is common sense, but it is hard to calculate the number of accidents due to poor vision alone. Accidents often have a range of causal factors, including alcohol, fatigue and distraction which may be the primary cause alongside sight problems.1 There is a category of ‘uncorrected, defective eyesight’ recorded by the Department for Transport in crash reporting statistics, but there is no requirement for vision to be checked at the time of an accident, which means that it is likely to be under-reported.  Studies also indicate that self-reporting of reasons for crashes is inaccurate.2

A study conducted in 2012 estimated that 2048 drivers in the UK were involved in road accidents due to poor vision, causing an estimated 2874 casualties, (assuming 2.4% of drivers have poor vision) and the relative risk of accident involvement from poor vision as 1.15.3 The same study estimated the total cost of UK road accidents due to poor driver vision to be £32.9 million in 2012.

Drivers’ responsibility

A driver is required to self-report to the DVLA if they believe their vision does not meet the requirement.

Changes to eyesight often come on gradually over time and deterioration of vision may not be immediately noticeable. People may not accurately estimate their own vision, for example, a study has shown that patients with glaucoma tend to overestimate their visual field.4 The DVLA advises drivers that they should check their vision with the support of an optician (optometrist) or doctor to ensure that they meet certain requirements for driving.

Older people have an increased risk of vision problems, the most common of which is cataract.5 Cataracts tend to form slowly over years and result in a gradual blurring of vision that is not corrected by spectacles. Cataracts cause contrast sensitivity loss even before visual acuity is reduced,6 and increases glare disability in older drivers, especially at night.  Several studies have shown that reduced contrast sensitivity affects driving performance, and mild to moderate cataract impacts on driver’s hazard perception skills,7,8 and an increased risk of involvement in a road accident.9

The current rules (2017)

The current legal vision check for driving is simply to be able to read – with glasses or contact lenses, if necessary – a car number plate made after 1 September 2001, at a distance of 20 metres. Drivers are given three attempts to meet this vision check by a driving examiner at the start of their practical driving test. In 2012, an additional standard was introduced that visual acuity, with the aid of glasses or contact lenses, if worn, must be at least 6/12 Snellen (decimal 0.5) with both eyes open, or with one eye if monocular. This, in the Government’s view, brought the UK into compliance with European Union directives on driving and vision.

No check is made of the other aspects of vision that play a part in the ability to drive, such as visual fields, contrast sensitivity, and twilight vision.

From the age of 70, drivers receive a licence renewal form every three years which requires them to state that they are fit to drive. Only drivers in particular professions, such as those who drive heavy goods vehicles (HGV) or buses, are routinely required to have a vision check on renewal of their licence.

The rules are not adequate

We believe that the current system of checking vision for driving which relies on self-reporting and a simple initial number plate test is not adequate. There are several reasons for this:

  • A number of studies have found that the distance number plate test is not a scientific way of assessing the adequacy of vision for driving.10, 11 It is neither standardised nor validated, meaning that results are not reliably repeatable. Environmental factors can affect an individual’s ability to complete the test
  • The number plate test and the Snellen scale of visual acuity are not comparable. The number plate test cannot be used to satisfactorily check if drivers meet the 6/12 (Snellen, decimal 0.5) standard and vice versa12
  • Many drivers are unaware of the standard of vision required for driving or the legal obligation to self-report inadequate vision to the DVLA. Unless they attend a sight test they may also not be aware of gradual deterioration in vision which may be otherwise symptomless. Studies have shown that even when drivers are aware of their poor vision they are reluctant to report it.13
  • Some drivers deliberately avoid their responsibilities. A survey of drivers by Brake shows that better awareness of vision for driving is needed.14 The key findings of the survey were:
    • 12% of drivers revealed that they had driven without their prescribed contact lenses or spectacles
    • 19% said that they had been put off going for a sight test when noticing vision problems for a variety of reasons

What we are calling for

We believe that everyone should have a sight test every two years, or more often if their optometrist recommends it.

In addition, for drivers, alongside our partners in the Optical Confederation we believe that a vision screening programme should be introduced that drivers undertake before they apply for a licence and as a legal requirement at least every ten years (for example upon licence renewal). This would be a proportionate way to ensure adequate vision amongst the majority of drivers and ensure good road safety.

A new screening assessment would include the checking of a driver’s distance vision using standard optical equipment. Anyone failing the initial screening should be required to undergo a further test.

The role of the optometrist

Optometrists play an important role in helping people drive safely by prescribing appropriate glasses or contact lenses to those that need them.

Attendance at a sight test can provide assurance that an individual has adequate vision for driving, particularly given the duty of drivers to self-report their fitness to drive. An optometrist can advise a patient of the legal vision standards for driving, if they are likely to meet them or how vision correction could support them in meeting the standard.

The current DVLA guidance on the role of healthcare professionals is:

Doctors and other healthcare professionals should:

  • Advise the individual on the impact of their medical condition for safe driving ability
  • Advise the individual on their legal requirement to notify the DVLA of any relevant condition
  • Treat, manage and monitor the individual’s condition with ongoing consideration of their fitness to drive
  • Notify the DVLA when fitness to drive requires notification but an individual cannot or will not notify the DVLA themselves15

When people persist in driving against advice

The DVLA guidance recognises that notifying the DVLA “may pose a challenge to issues of consent and the relationship between patient and healthcare professional.”16

The AOP’s own guidance17, as well as that of the General Medical Council18 and the College of Optometrists19, addresses this concern by describing a number of stages that a practitioner should go through before reporting someone who is driving against advice.

These include:

  • Explaining the situation to the patient and advising them that they must inform the DVLA
  • Suggesting that the patient seek a second opinion if they are unhappy with the diagnosis
  • Discussing the concerns with the patient’s relations or carers (if the patient agrees)
  • If a patient continues to drive, considering the risk of their doing so
  • Inform the patient (unless there is a compelling reason not to inform the patient) that the DVLA is being notified

Why we do not believe that reporting should be compulsory

Evidence and research suggests that the current vision standard for driving is not necessarily a good indicator of a person’s ability to drive safely. Research also suggests snellen acuity results are not always consistent and repeatable. Further, currently the number plate test remains a legal standard which is difficult to replicate in a test room. All of these variable reasons make compulsory reporting of a narrow failure to meet the 6/12 visual acuity score on one occasion difficult to justify.

In addition, compulsory reporting might lead to the unintended consequence that patients would not attend for a sight test – leading to worse consequences for their own and others’ health.

We believe that the legal responsibility should rightly remain with drivers to assure themselves of their fitness to drive. At the same time, we agree that medical practitioners, including optometrists, should retain the existing responsibility to consider public safety and to report patients who persist in driving after medical advice to stop.

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References

  1. Owsley C & McGwin G Jr (2010) Vision and driving.V ision Research 50:2348-661
  2. Arthur W Jr, Bell ST, Edwards BD, Day EA, Tubre TC, Tubre A H (2005) Convergence of self-report and archival crash involvement data: a two-year longitudinal follow-up Hum Factors 47(2):303-13
  3. RSA Group (2013) Fit to Drive: a cost benefit analysis of more frequent eyesight testing for UK drivers
  4. Smith ND, Crabb DP & Garway-Heath DF (2011) How Does Glaucoma Look? A Study Of Patient Perception Of Visual Field Defects. Investigative Ophthalmology & Visual Science, 52(14), 4414-4414
  5. Høeg TB, Ellervik C, Buch H, La Cour M, Klemp K, Kvetny J, Erngaard D, Moldow B (2016) Danish Rural Eye Study: Epidemiology of Adult Visual Impairment. Ophthalmic Epidemiology. Feb;23(1):53-62. doi: 10.3109/09286586.2015.1066396. Epub 29 January 2016
  6. Wood JM, Tyrrell RA, Chaparro A, Marszalek RP, Carberry TP, Chu BS (2012) Even moderate visual impairments degrade drivers’ ability to see pedestrians at night. Investigative ophthalmology & visual science. May 4;53(6):2586-92. doi: 10.1167/iovs.11-9083
  7. Marrington SA, Horswill MS, Wood JM (2008) The effect of simulated cataracts on drivers’ hazard perception ability Optometry and Vision Science Dec;85(12):1121-7. Doi 10.1097/OPX.0b013e31818e8d00.
  8. Owsley C, Stalvey B, Wells J, Sloane ME (1999) Older drivers and cataract; driving habits and crash risk. Journal of Gerontolo­gy: Biological Sciences and Medical Sciences. 54(4):M203-11
  9. Owsley C, et al. (2001) Visual risk factors for crash involvement in older drivers with cataract Archives of Ophthalmology, 119(6), 881-887
  10. Kiel AW, Butler T, Alwitry A (2003) Visual acuity and legal visual requirements to drive a passenger vehicle Eye, 17 579-582
  11. Charman WN (1997) Vision and driving – a literature review and commentary Ophthalmic and Physiological Optics, 17 371- 391
  12. Latham K, Katsou M, Rae S (2014) Advising patients on visual fitness to drive: implications of revised DVLA regulations British Journal of Ophthalmology
  13. Box E, Gandolfi J, Mitchell K (2010) Maintaining safe mobility for the ageing population RAC Foundation
  14. BRAKE (2014) Driver eyesight survey
  15. DVLA (2017) Assessing fitness to drive – a guide for medical professionals
  16. DVLA (2017) p9
  17. AOP (2016) Driving and the DVLA (member-only access)
  18. GMC (2017) Confidentiality: patients’ fitness to drive and reporting concerns to the DVLA or DVA
  19. College of Optometrists (2017) Examining Patients Who Drive