Medical Conditions and Driving: A Review of the Literature (1960 – 2000)
TRD Page
Foreword
Acknowledgements
Section1: Introduction
Section 2: Vision
Section 3: Hearing
Section 4: Cardiovascular
Section 5: Cerebrovascular
Section 6: Peripheral Vascular
Section 7: Nervous System
Section 8: Respiratory
Section 9: Metabolic
Section 10: Renal
Section 11: Musculoskeletal
Section 12: Psychiatric
Section 13: Drugs
Section 14: Aging Driver
Section 15: Anesthesia and Surgery
Appendix A
List of Tables
List of Figures
download PDF

Section 2: Vision

Table 1  Guidelines for Visual Conditions/Diseases

(Reproduced with permission)

Guidelines for Visual Conditions/Diseases (Drivers of Private Vehicles)

Conditions/ Diseases

Austroads (1998)

CMA (2000)

Acuity

Should not drive if binocular visual acuity is less than 6/12 (20/40).

Visual acuity must be measured with both eyes open while wearing any corrective lenses usually worn for driving. More than one error in reading the letters of the 6/12 (20/40) line is a fail.

Where a patient fails the test, eyesight must be corrected before the patient is fit to drive.

Where corrective lenses are prescribed for the first time, the practitioner MUST advise the Driver Licensing Authority (DLA) which will endorse the license with the following: ‘must wear corrective lenses when driving’.

Eye sight requirements:
Not less than 20/50 (6/15) with both eyes open and examined together.

Aphakia

May drive if meets the acuity criteria. Specialist opinion recommended.

Not addressed.

Cataracts

Must meet the visual acuity criteria and other criteria and be aware that they may have difficulty with glare.

Optometrist’s or ophthalmologist’s opinion recommended.

Listed as a medical condition that may require further assessment. If vision problem is suspected, the recommendation is for the individual to be referred to an ophthalmologist or optometrist for further assessment of visual function.

Color Vision Defects

No restriction. Patients with red color defects should be cautioned about hazardous situations - especially traffic lights, brake lights, and parked cars at night.

No required standard.

Conjunctivitis/ Other Anterior Eye Infections

Should not drive if severe and affecting eye comfort or vision.

Not addressed.

Contrast Sensitivity

Not addressed.

Individuals with reduced contrast sensitivity may experience difficulty with driving. However, it is unclear at this time what level of reduction in contrast sensitivity represents an unacceptable risk for driving. Individuals should be made aware of any significant reduction in contrast sensitivity.

Diplopia

Should not drive if has diplopia. The DLA may issue a conditional license if patch on eye and meets ‘loss of vision in one eye’ conditions.

Diplopia within the central 40 degrees (i.e., 20 degrees to the left, right, above, and below fixation) of primary gaze, is incompatible with safe driving.

Individuals who have uncorrected diplopia within the central 40 degrees of gaze should be referred to an ophthalmologist or optometrist for further assessment.

If the diplopia can be completely corrected with a patch or prisms to meet the appropriate standards for visual acuity and visual field, the individual may be eligible to drive. Prior to resuming driving, there should be an adequate adjustment period of 3 months or sufficient to satisfy the treating ophthalmologist or optometrist that adequate adjustment has occurred.

Glaucoma

May drive if meets the acuity criteria. Specialist opinion recommended.

Not addressed.

Monocular Vision

Should not drive for 3 months after loss of binocular vision. May then drive if vision in good eye is at least 6/12 (20/40). Should have mirrors on both sides of car or motorbike.

A driver who has recently lost the sight of an eye may require a few months to recover the ability to judge distance adequately.

Nystagmus

Should not drive if binocular visual acuity is worse than 6/12 (20/40).

Not addressed.

Poor Night Vision

Should not drive. The DLA may issue a conditional license for daylight driving. Specialist opinion recommended.

Currently there are no standardized tests or procedures that can be recommended for assessing dark adaptation and glare recovery.

Post Surgery

Should not drive for 4 weeks following surgery to the eye that will alter visual acuity of the eye unless cleared by an ophthalmologist.

Listed under medical conditions that may require further assessment for vision problems. If a vision problem is suspected, the recommendation is referral to an ophthalmologist or optometrist for further assessment of visual function.

Telescopic Spectacles

Not addressed.

The use of telescopic spectacle, hemianopia aids, and other low-vision aids is incompatible with safe driving.

Visual Field Defects

Hemianopia (total and partial): Should not drive if total hemianopia. A conditional license may be issued to a person with partial hemianopia or other defects provided on ophthalmologists or optometrist’s report is obtained stating that the remaining visual field is no less that 120 degrees along the horizon meridian when measured with a Goldman IV4e target or its equivalent.

Recommended standard: 120 continuous degrees along the horizontal meridian and 15 continuous degrees above and below fixation with both eyes open and examined together.

If a field defect is suspected, the patient should be referred to an ophthalmologist or optometrist for a full assessment. When a full assessment is required, the binocular visual field should be assessed using a III4e Goldman type target or the closest equivalent (e.g., the Esterman Functional Vision Test, the Humphrey Visual Field Analyzer, or kinetic perimetry on the Goldman perimeter) are recommended. Some automated testing devices used in driver testing centres are often insensitive to many types of visual field defects and thus may not be adequate for screening purposes.

Quadrantanopia

Should not drive. In the case of quadrantanopias, regardless of the extent of the remaining visual field, an ophthalmologist’s report should be submitted to the DLA which may then consider a conditional license.

See Visual Field regulations.

Ptosis

Not addressed.

Not addressed.

DLA = Driver Licensing Authority

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