Australia’s Fitness to Drive criteria has been updated with input from the ophthalmic sector. NERYLA JOLLY details key changes and how to deliver a negative outcome to patients.
Vision is essential for driving. In the government document ‘Assessing Fitness to Drive’, under ‘Medical Standards for Licensing’, a chapter is devoted to vision and eye disorders. In 2021 the document was reviewed with input from RANZCO, Optometry Australia and Orthoptics Australia. The revised 2022 document was recently released, with many of the standards remaining the same and some points being clarified.
Revisions made to the criteria related to vision disorders and driving include a clarification to the visual field criteria for scotomas, monocular vision standards for commercial drivers, the inclusion of orthokeratology as a means to meet visual acuity standards, further guidance related to diplopia and the inclusion of additional evidence and rationale for the use of telescopic lenses.
The entire chapter needs to be read to gain more details of the assessment guidelines and specific requirements. This is important because, for example, in regard to visual fields, the revision now defines a significant loss when there are more than four contiguous spots missed in the central 20 degrees. It also states “a person is not fit to hold an unconditional licence if the binocular field does not have a horizontal extent of 110 degrees within 10 degrees above and below the horizontal midline”.
There is reference to a conditional licence but no specific details.
As an orthoptist working with patients who require vision assessment for fitness to drive, my role has been to conduct many of the tests detailed in the report required by the Driver Licencing Authority. Orthoptists may be involved in this testing either as part of the overall assessment of a patient in a general consultation, in public hospitals or as an independent orthoptic practitioner providing an overview report. The latter may occur because some patients value their license so highly that they seek another opinion, don’t understand the issue or reject that they have a problem. They may also need to understand the significance of a restricted licence.
Although providing patients with a negative outcome when it comes to their driver licence can be difficult, I have found that when they are shown their defective results and are compared to a normal result, then, the significance of the reduction is understood and they can better accept the reason.
For example, having double vision when looking right makes it difficult to correctly judge the position of a car on your right or a pedestrian on a crossing. Yes, you can turn your head but that takes extra time and you have to also look for the left side, then back with head correction. It takes extra time which often isn’t available in busy traffic conditions.
In the presence of peripheral field loss, showing the patient the two measurements of:
1. “Within 10 degrees above and below the horizontal meridian 90 degrees of clear vision is required” and;
2. “Within a radius of 20 degrees from central fixation up to four contiguous points can be missing”, can help them to accept their position.
Patients also often don’t understand that the purpose of a restricted licence is to ensure they are traveling in familiar territory and know the markings, dangerous traffic spots and can concentrate on other drivers and their behaviours. Often once this is explained they accept that perhaps a licence to travel 20km from home to do essential tasks is appropriate and the interstate visit to see the beloved cousin twice removed can wait.
Being able to drive means independence, freedom and greater quality of life. To have a practitioner such as an orthoptist explain the vision standard does not solve the problem but often the patient understands why they cannot drive and surprisingly often says: “Thank you – I now know why!”
Click here to read the updated fitness to drive criteria.
ABOUT THE AUTHOR: Neryla Jolly MA (Macq) DOBA (T) is a registered orthoptist working in independent private practice. She has had over 20 years of research and experience in the field of vision and driving.
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