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Assessing Fitness to Drive

Table of Contents

From 22 June 2022 there have been changes to the fitness to drive criteria for vision and eye disorders including:

  • Visual fields
  • Monocular vision (commercial vehicle drivers)

The visual acuity criteria remain unchanged, however there is new guidance regarding orthokeratology treatment.

See Summary of changes and Orthokeratology Fact Sheet for more details.

10.3 Medical standards for licensing

Requirements for unconditional and conditional licences are outlined in the following tables.

Medical standards for licensing – vision and eye disorders

Health professionals should familiarise themselves with the information in this chapter and the tabulated standards before assessing a person’s fitness to drive.

Condition

Private standards

(Drivers of cars, light rigid vehicles or motorcycles unless carrying public passengers or requiring a dangerous goods driver licence – refer to definition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger vehicles or requiring a dangerous goods driver licence – refer to definition in Table 3)

Visual acuity

Refer to section 10.2.1. Visual acuity and Figure 17.

Private standards

A person is not fit to hold an unconditional licence:

  • if the person’s uncorrected visual acuity in the better eye or with both eyes together is worse than 6/12.

A conditional licence may be considered by the driver licensing authority subject to periodic review if the standard is met with corrective lenses*.

Some discretion is allowed in application of the standard by the treating optometrist or ophthalmologist. However, a driver licence will not be issued when visual acuity in the better eye is worse than 6/24.

* Refer to section 10.2.7. Orthokeratology therapy for information on meeting the standard using orthokeratology therapy.

Commercial standards

A person is not fit to hold an unconditional licence:

  • if the person’s uncorrected visual acuity is worse than 6/9 in the better eye; or
  • if the person’s uncorrected visual acuity is worse than 6/18 in either eye.

A conditional licence may be considered by the driver licensing authority subject to periodic review if the standard is met with corrective lenses*.

If the person’s vision is worse than 6/18 in the worse eye, a conditional licence may be considered by the driver licensing authority subject to periodic review, provided the visual acuity in the better eye is 6/9 (with or without corrective lenses*) according to the treating optometrist or ophthalmologist.

The driver licensing authority will take into account:

  • the nature of the driving task; and
  • the nature of any underlying disorder; and
  • any other restriction advised by the optometrist or ophthalmologist.

* Refer to section 10.2.7. Orthokeratology therapy for information on meeting the standard using orthokeratology therapy.

Visual fields

Refer to section 10.2.2. Visual fields.

Private standards

A person is not fit to hold an unconditional licence:

  • if the binocular visual field does not have a horizontal extent of at least 110 degrees within 10 degrees above and below the horizontal midline; or
  • if there is any significant visual field loss (scotoma) within a central radius of 20 degrees of the foveal fixation or other scotoma likely to impede driving performance; or
  • if there is any significant visual field loss (scotoma) with more than four contiguous spots within a 20-degree radius from fixation.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating optometrist or ophthalmologist.

Commercial standards

A person is not fit to hold an unconditional licence:

  • if the person has any visual field defect.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating optometrist or ophthalmologist as to whether the following criteria are met:

  • the binocular visual field has an extent of at least 140 degrees within 10 degrees above and below the horizontal midline; and
  • the person has no significant visual field loss (scotoma, hemianopia, quadrantanopia) that is likely to impede driving performance; and
  • the visual field loss is static and unlikely to progress rapidly.

Monocular vision

Refer to section 10.2.2. Visual fields.

Private standards

A person is not fit to hold an unconditional licence:

  • if the person is monocular.

A conditional licence may be considered by the driver licensing authority subject to 2-yearly review, taking into account the nature of the driving task and information provided by the treating optometrist or ophthalmologist as to whether the following criteria are met:

  • the visual acuity in the remaining eye is 6/12 or better, with or without correction; and
  • the visual field in the remaining eye has a horizontal extent of at least 110 degrees within 10 degrees above and below the horizontal midline.

Commercial standards

A person is not fit to hold an unconditional licence:

  • if the person is monocular.

A conditional licence may be considered by the driver licensing authority subject to 2-yearly review, taking into account the nature of the driving task and information provided by the treating optometrist or ophthalmologist, as to whether the following criteria are met:

  • the visual acuity in the remaining eye is 6/9 or better, with or without correction; and
  • the visual field in the remaining eye has a horizontal extent of at least 140 degrees within 10 degrees above and below the horizontal midline; and
  • there is no other significant visual field loss that is likely to impede driving performance.

Diplopia

Refer to section 10.2.3. Diplopia.

Private standards

A person is not fit to hold an unconditional licence:

  • if the person experiences any diplopia (other than physiological diplopia) within 20 degrees from central fixation.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating optometrist or ophthalmologist as to whether the following criteria are met:

  • the condition is managed satisfactorily with corrective lenses or an occluder; and
  • the person meets other criteria as per this section, including visual fields.

The following licence condition may apply if corrective lenses or an occluder prevents the occurrence of diplopia:

  • Corrective lenses or an occluder must be worn while driving. A 3-month non-driving period applies for use of occluders, in order to re-establish depth perception.

Commercial standards

A person is not fit to hold an unconditional licence or a conditional licence:

  • if the person experiences any diplopia (other than physiological diplopia) within 20 degrees from central fixation.

IMPORTANT: The medical standards and management guidelines contained in this chapter should be read in conjunction with the general information contained in Part A of this publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing, suspending or cancelling a person’s driver licence (including a conditional licence) lies ultimately with the driver licensing authority. Licensing decisions are based on a full consideration of relevant factors relating to health and driving performance.

Conditional licences

For a conditional licence to be issued, the health professional must provide to the driver licensing authority details of the medical criteria not met, evidence of the medical criteria met, as well as the proposed conditions and monitoring requirements. The presence of other medical conditions While a person may meet individual disease criteria, concurrent medical conditions may combine to affect fitness to drive – for example, hearing, visual or cognitive impairment (refer to Part A section 2.2.7. Older drivers and age-related changes and section 2.2.8. Multiple medical conditions).

The nature of the driving task

The driver licensing authority will take into consideration the nature of the driving task as well as the medical condition, particularly when granting a conditional licence. For example, the licence status of a farmer requiring a commercial vehicle licence for the occasional use of a heavy vehicle may be quite different from that of an interstate multiple combination vehicle driver. The examining health professional should bear this in mind when examining a person and when providing advice to the driver licensing authority.

Reporting responsibilities

Patients should be made aware of the effects of their condition on driving and should be advised of their legal obligation to notify the driver licensing authority where driving is likely to be affected. The health professional may themselves advise the driver licensing authority as the situation requires (refer to section 3.3 and step 6).

References and further reading

  1. Wood, J. M. Aging, driving and vision. Clinical and Experimental Optometry 85, 214–220 (2002).
  2. Owsley, C., Wood, J. M. & McGwin, G. A roadmap for interpreting the literature on vision and driving. Survey of Ophthalmology 60, 250–262 (2015).
  3. Wood, J. M. & Black, A. A. Ocular disease and driving. Clinical and Experimental Optometry 99, 395–401 (2016).
  4. Delaey, J. & Colenbrander, A. Visual standards: vision requirements for driving safety with emphasis on individual assessment. www.icoph.org/standards. http://www.icoph.org/downloads/visionfordriving.pdf (2006).
  5. van Rijn, L. & Members of the Eyesight Working Group to the European Driving Licence Committee. New standards for the visual functions of drivers: report of the Eyesight Working Group. (2005).
  6. Owsley, C. & McGwin, G. Vision and driving. Vision Research 50, 2348–2361 (2010).
  7. Charlton, J.L., Di Stefano, M., Dow, J., Rapoport, M.J., O’Neill, D., Odell, M., Darzins, P., & Koppel, S. Influence of chronic Illness on crash involvement of motor vehicle drivers: 3rd edition. Monash University Accident Research Centre Reports 353. Melbourne, Australia: Monash University Accident Research Centre. (2021).
  8. Wood, J. M., Black, A. A., Anstey, K. J. & Horswill, M. S. Hazard perception in older drivers with eye disease. Translational Vision Science & Technology 10, 31 (2021).
  9. McGwin, G., Wood, J., Huisingh, C. & Owsley, C. Motor vehicle collision involvement among persons with hemianopia and quadrantanopia. Geriatrics (Switzerland) 1, (2016).
  10. Sample, P. A. et al. Imaging and Perimetry Society standards and guidelines. Optometry and Vision Science 88, 4–7 (2011).
  11. Wood, J. M., Lacherez, P. F. & Anstey, K.J. Not all older adults have insight into their driving abilities: evidence from an on-road assessment and implications for policy. Journals of Gerontology – Series A Biological Sciences and Medical Sciences 68, 559–566 (2013).
  12. Bohensky, M., Charlton, J., Odell, M. & Keeffe, J. Implications of vision testing for older driver licensing. Traffic Injury Prevention 9, 304–313 (2008).
  13. McKnight, A. J., Shinar, D. & Hilburn, B. The visual and driving performance of monocular and binocular heavy-duty truck drivers. Accident Analysis & Prevention 23, 225–237 (1991).
  14. Bullimore, M. A. & Johnson, L. A. Overnight orthokeratology. Contact Lens and Anterior Eye 43, 322–332 (2020).
  15. Wood, J.M. et al. Impact of vision disorders and vision impairment on motor vehicle crash risk and on-road driving performance: A systematic review. Acta Ophthalmol doi: 10.1111/aos.14908 (2021)
  16. Swain, T.A. et al. Naturalistic driving techniques and association of visual risk factors with at-fault crashes and near crashes by older drivers with vision impairment. JAMA Ophthalmol 139, 639-645 (2021)