Determining whether a patient can continue to drive is not an easy task. NERYLA JOLLY explains the role opthoptists play in assessing and communicating driving standards.
The vision standards required to obtain a driver’s licence are laid out in Assessing Fitness to Drive 2016, a publication authorised by Austroads and the National Transport Commission. The document, which is available to download freely online, clearly states that ophthalmologists and optometrists have the role of authorising documents that support or refuse a driver continuing to hold a driver’s licence.
The roles orthoptists play in licensing decisions include conducting clinical tests, offering an independent opinion and, in some circumstances, being involved in an on-road assessment of a driver. An example of these circumstances might be a driver who is currently driving within a conditional licensing standard but is seeking to extend it in some way, such as driving in reduced light levels.
Additionally, orthoptists also work with occupational therapists (OT) to set up safe vision functions in a driving environment, such as adding convex mirrors to a vehicle. It is not legal to take an unlicensed driver out on-road. If the driver is legal there has to be a good additional reason to go on-road, such as a request from an OT.
Testing the patient and feedback
There are three standards of vision function that drivers must meet to hold an unconditional licence: visual acuity of at least 6/12 in one or both eyes; single vision within a central range of 20 degrees; and a binocular field of 110 degrees within 10 degrees above and below the horizontal meridian, plus within 20 degrees of central fixation loss of no more than 4 contiguous points.
A conditional licence can be granted on submission of a slightly lesser standard. One example is an intact field of 90 degrees across and within 10 degrees above and below the horizontal meridian may enable a restricted licence for a driver. The restriction could, for example, enable the driver to travel within a radius of 20 km from their home, allowing them to meet essential personal needs such as medical appointments, shopping and visiting relatives. Commercial license standards have a higher requirement.
Some patients do not accept the outcome of an assessment. These patients are best referred to an independent orthoptist for an overall assessment and discussion about the outcome. Sometimes this independent assessment will be seen as separate advice and encourage the patient to continue their treatment for ocular conditions with their regular ophthalmologist.
Once the patient has been tested by an orthoptist they then receive feedback about how their current vision standard compares against the Austroads standard. It is this feedback that provides useful information to the patient about the level of their vision, the likelihood of change and the likelihood of the driving authority in their state allowing them to continue to drive.
Patients usually strongly believe that they can see as well as any other driver, however when deficiencies are pointed out they may reluctantly accept the decision.
Drivers that are of a standard that allows them to apply for a conditional licence often do not understand how a licence limited in kilometres from home can be any safer. When it is explained to them that driving close to home is familiar territory, so they can concentrate on the drivers and other vehicles rather than where they are going, they often calm down and accept the proposed restriction.
Reporting about the patient
Reports are written to the referring practitioner, who then may add an additional letter and send it on the licensing authority. Outcomes are varied and depend largely upon the vision level and the request to drive.
ABOUT THE AUTHOR: Neryla Jolly is an orthoptist with specific expertise in off and on-road assessments for drivers with vision defects. She has over 20 years of experience at Sydney University, School of Orthoptics, as well as numerous publications, conference presentations and educational seminars.
ORTHOPTICS AUSTRALIA strives for excellence in eye health care by promoting and advancing the discipline of orthoptics and by improving eye health care for patients in public hospitals, ophthalmology practices, and the wider community. Visit: orthoptics.org.au