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Ortho-k and diplopia pinpointed in proposed changes to fitness to drive guidelines

An initial review of medical standards and clinical management guidelines for driver licensing in Australia has clarified that orthokeratology therapy can be used to meet the standards for a conditional licence.

The National Transport Commission (NTC) is currently reviewing the Assessing Fitness to Drive guidelines. The authority’s interim report released on 3 May also flags a clarification on the criteria for experiencing diplopia within central fixation.

The document has set out the changes to diplopia and commercial licensing.

“Specialist advice confirmed that a person is not fit for a commercial licence, either unconditional or conditional, if they have double vision when looking up to 20 degrees from fixation,” the NTC’s Assessing Fitness to Drive 2021 review: interim report stated.

“If they have double vision when looking beyond 20 degrees of fixation they are still fit for a conditional licence. Diplopia within the central 20 degrees refers to 20 degrees from central fixation and not 20 degrees across fixation. Minor text changes have been made to clarify this point.”

During an initial consultation last year, the NTC said it received a request for guidance on the use of orthokeratology lenses to correct visual acuity. The agency said specialist advice on the use and licensing conditions for this therapy was provided.

“Orthokeratology lenses are considered safe to use when driving as long as treatment allows a person to meet the relevant visual acuity standard. Corrective lenses must be worn as per the existing standards if uncorrected visual acuity cannot be achieved through this treatment,” the interim report stated.

The interim report also includes a chapter to provide greater clarity regarding assessment requirements, licensing requirements and periodic review for orthokeratology therapy, visual fields and exceptional cases.

“This will assist in patient management and support consistency for fitness-to-drive assessments,” the commission notes.


Assessing Fitness to Drive is a joint publication of Austroads and the NTC, detailing the medical standards for driver licensing for use by health professionals and driver licensing authorities. The standards are approved by Commonwealth, state and territory transport ministers.

The National Transport Commission reviews the Assessing Fitness to Drive standard every three years. The most recent review was completed in 2016.

In September 2020, the NTC circulated an initial consultation paper requesting stakeholder feedback on the 2016 version of Assessing Fitness to Drive.

Following feedback, a draft of the updated guidelines is now available for public consultation and the commission is inviting any person with an interest in this work to have their say on the proposed changes by 11 June 2021.

The completed revised guidelines are expected to be published in December 2021.

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