When is the right time to begin a conversation about driving and vision? Is it when extra scratches mysteriously appear on the car? Or passengers fumble for an imaginary brake at intersections and exits are missed in a hazy blur?
A family member’s visual fitness to drive can become an elephant in the room within individual households. On a national level, the issue has traditionally fallen within a political blind spot.
But a sign that this may be set to change came with the Road Safety Statement 2019, which saw the launch of a government research programme and literature review to assess the impact of vision on road safety.
“The reality is that a lot of drivers do not consider their vision or are poor judges of the quality of their vision”
The Department of Transport has also committed to considering whether there is a case for mandatory sight testing at the age of 70 and at regular three-year intervals afterwards in line with licence renewal.
At present, the only visual check for drivers in the UK is an individual’s ability to read a licence plate from a distance of 20m.
Following this, it is the responsibility of the individual to tell the Driver and Vehicle Licensing Agency (DVLA) if their vision falls below the required standard.
The AOP has campaigned for drivers to undergo regular vision checks as part of licensing requirements.
Its Don’t swerve at sight test campaign received 159 broadcast hits and reached 111 million listeners in 2017.
Time for change
AOP Councillor, Dr Julie-Anne Little, told OT that it is “heartening” that the Government has listened to conversations occurring within the profession.
“Optometrists know how important good vision is for driving,” she shared.
“We see people who we may have concerns about in practice and know that tragic situations do occur. Anything that we can do to prevent needless accidents is important,” Dr Little highlighted.
The latest figures from the Department of Transport reveal that there were three fatal accidents in 2018 where ‘uncorrected, defective eyesight’ was recorded as a contributory factor.
“Anything that we can do to prevent needless accidents is important”
Dr Little emphasised that introducing a mandatory vision check at the age of 70 would be a welcome development, adding that the current focus on self-reporting is flawed.
“The reality is that a lot of drivers do not consider their vision or are poor judges of the quality of their vision. If vision gradually declines over a number of years then it is a very difficult call for any individual to make,” Dr Little said.
The inadequacies of the UK system were brought home to Dr Little when she led work by the European Council of Optometry and Optics (ECOO) comparing vision standards for driving across different European nations.
“It really made me realise how the UK is out of step. Hanging on to the number plate test is unusual when compared to other countries,” Dr Little said.
The importance of evidence
She highlighted that the Government’s commitment to undertaking further research in vision and driving is also valuable.
At the moment visual acuity is the core standard when it comes to vision and driving, but Dr Little shared that there are other factors at play.
“We recognise that visual acuity is a fairly blunt tool when it comes to trying to measure how someone’s vision is for driving,” Dr Little observed.
“If we can modernise the test, and if any research can shed light on what the most critical components for driving are, that would be so valuable,” she added.
Twilight vision, visual fields and colour vision are among different aspects of sight that are assessed in other European nations.
The enhanced focus on vision and driving is also welcome in the context of an ageing population, where conditions such as cataracts, glaucoma, and age-related macular degeneration will become more common.
“We are going to have more and more people with those conditions in the next 20 years and these ocular conditions will affect visual performance,” Dr Little said.
Dr Little believes that optometrists can play a key role in assessing vision for driving.
“We are easily accessible on the High Street and we can see people on any day of the week. We have the appropriate skills, training and equipment to effectively measure and correct visual acuity and also to measure visual fields and other aspects of vision,” she shared.
She emphasised the importance of conveying a positive message to patients so that they see their optometrist as someone who is helping them to meet the standard for driving.
“We have to get past that barrier of people being worried that ‘If I go to the optometrist, I will be found out.’ It is about encouraging people to come in to a practice. In the vast majority of cases, we are able to correct vision so that patients can drive safely,” she said.
An international view
ECOO president Dr Cindy Tromans highlighted that the issue of vision and driving is one that is important for optical professionals across Europe.
ECOO represents optometrist and optician associations in 24 countries across Europe.
“We listen to our members and over the years many members have flagged that driving and vision is a really important topic in their country,” she shared.
“When vision isn’t at a good standard, not only is the driver putting themselves at risk of harm but they are also putting other people at risk,” she said.
ECOO is calling for clarity on the visual standards for driving as well as the way that those standards are measured.
“In the UK, we use the number plate test, as do other countries including Cyprus, the Netherlands and Norway. What we are saying is that the way vision is assessed really needs to be strengthened by using a standardised method,” Dr Tromans shared.
“Reading a number plate – if it is dark, raining or a dirty plate – is not an accurate assessment of visual acuity,” she emphasised.
Many countries, including the UK, have failed to fully implement a directive that aimed to improve consistency in the vision standards for driving across Europe.
Dr Tromans puts forward Ireland and Switzerland as examples of countries that have implemented adequate standards.
“They do very thorough and comprehensive eye tests before issuing statements that the patient is fit to drive,” she said.
The role of optometrists
At the moment the directive states that only a “competent medical authority” should assess vision for driving, which has been interpreted narrowly to exclude optometrists in some countries.
“The way vision is assessed really needs to be strengthened by using a standardised method”
ECOO is advocating for this to be changed to “appropriately trained and qualified eye care professionals.”
“Optometrists are one of the few professions that actually measure vision and provide corrective appliances to enhance vision. We are ideally placed to ensure that patients have the correct standard of vision for driving,” Dr Tromans said.
Like Dr Little, Dr Tromans welcomes the UK Government’s consideration of a vision check as part of licence renewal for those aged 70 and above.
“At the moment it is just a self-declaration on your health and vision but you don’t need to have an eye test. That would absolutely be a start and a step in the right direction,” she emphasised.
Image credit: Helen Musselwhite