Information for optometrists assessing fitness to drive
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Information for optometrists assessing fitness to drive Updated 25 February 2020 Please note, while every effort has been made to ensure this information is accurate, current and complete, it is general in nature and must not be treated as advice, clinical or otherwise, because errors, omissions and changes to the law can occur. This member resource should be treated as an adjunct to, and not a substitute for, reading the latest version of Assessing Fitness to Drive for Commercial and Private Vehicle Drivers produced jointly by Austroads and the National Transport Commission Australia. © Optometry Victoria South Australia 2020
Information for optometrists assessing fitness to drive - updated 25 February 2020 Contents
1
Contents
1. Introduction 2
2. Obligations of drivers and optometrists 3
2.1 Duty of drivers to self-report 3
2.2 Reporting drivers to VicRoads (Vic) or mylicence (SA) 3
3. The applicable vision standard 5
4. Vision standards for driving 6
4.1 Visual acuity 6
4.2 Visual fields 7
4.3 Monocular drivers 8
4.4 Colour vision 8
4.5 Progressive conditions 8
5. Key resources 9
6. Contact information 9
Appendices 10
Appendix A: Application of standards (VIC/SA) 10
Information for optometrists assessing fitness to drive - updated 25 February 2020 Introduction
2
1. Introduction
Optometrists have a vitally important role to play in the
assessment of vision as it relates to the task of driving.
This guide has been developed to assist Optometry Victoria
South Australia (OV/SA) members in the assessment of
their patients’ fitness to drive, and to offer guidance on the
obligations of both optometrists and patients.
This resource commences with a discussion of the roles and
responsibilities of optometrists and patients in the context
of fitness to drive. Attention is then given to the potentially
complex question of which visual standard applies in what
circumstances. Updates have been provided in order to reflect
recent changes to legislation, including in the area of rideshare
services such as ‘Uber’.
The guide then turns to the vision standards themselves,
and includes a visual acuity management chart highlighting
the circumstances in which a conditional licence might be
considered. Visual fields standards are also outlined, taking
account of recent alterations and clarifications made by
Austroads.
Where there are different requirements for Victorian and South
Australian optometrists, these are clearly highlighted throughout
the document.
Finally, a number of helpful links and resources are provided in
order to assist OV/SA members in their assessment of visual
fitness to drive.
Information for optometrists assessing fitness to drive - updated 25 February 2020 Obligations of drivers and optometrists
3
2. Obligations of drivers and
optometrists
Optometrists, drivers and driver licence authorities have specific roles and responsibilities.
For a full discussion of these roles and responsibilities, it is recommended that
members review Austroads’ publication Assessing Fitness to Drive for Commercial
and Private Vehicle Drivers, Section 3.
2.1 Duty of drivers to self-report
Table 1: duty of drivers to self-report
Road Safety (Drivers) Regulations 2009 (Vic) R 67(2) Motor Vehicles Act 1959 (SA) s 98AAF
Drivers who are affected by a permanent or long-term Drivers who, during the term of their licence or permit,
injury or illness that may impair their ability to drive safely suffer an illness or injury that may impair their competence
must notify VicRoads as soon as possible after becoming to drive a motor vehicle without endangering the public
aware of the injury/illness. must notify mylicence in writing within a reasonable time
after the occurrence of the injury/illness.
In both Victoria and South Australia, drivers can be fined Although an optometrist cannot tell a patient’s family
for failing to report their condition to the relevant agency about the patient’s condition without the patient’s
or agencies. Drivers should also be aware there may be consent, sometimes it can be helpful to have family in the
long term financial, insurance and legal consequences if room at the time of the eye test, as long as the patient
they fail to self-report to their driver licence authority.1 has no objection. If the patient still chooses not to self-
report, it is important for members to understand what to
2.2 Reporting drivers to VicRoads (Vic) or do next.
mylicence (SA)
While members practising in Victoria can use their
Sometimes drivers do not self-report when required. discretion as to whether to report a patient in these
The first step in this case is to ensure the patient is circumstances, when practising in South Australia,
aware of the legal duty to self-report, and the potential members are required by law to report a patient who
consequences of failing to report. The patient should is unfit to drive. For more information on the content of
be fully informed as to why the information needs to be the duty in each state, please see table 2 (over page).
disclosed, and should have an opportunity to consider This information applies to both private and commercial
this information.2 drivers.
1. Austroads and the National Transport Commission, Assessing Fitness to Drive 2016 (as amended up to August 2017) (7 January 2017) Austroads ≤https://austroads.com.au/publications/
assessing-fitness-to-drive/ap-g56≥ 17.
2. Ibid 18.
Information for optometrists assessing fitness to drive - updated 25 February 2020 Obligations of drivers and optometrists
4
Table 2: Reporting drivers to VicRoads or mylicence
Victoria (Discretionary reporting) South Australia (Mandatory reporting)
Road Safety Act 1986 (Vic) ss 27(4)–(5) Motor Vehicles Act 1959 (SA) s 148
Content of duty If a patient is unfit to drive, or it may be s 148(1): If a health professional has ‘reasonable
dangerous to allow the patient to drive, the cause’ to believe that a patient who drives has a
optometrist must weigh patient confidentiality ‘physical or mental illness, disability or deficiency’
against public safety considerations. which would be ‘likely to endanger the public’ if the
Ordinarily, OV/SA and OA advise that if a patient drove, the health professional has a duty to
patient continues to drive despite being inform the Registrar in writing of the patient’s name
fully aware of the duty to self-report and and address, as well as the illness, disability or
the reasons for the existence of this duty, deficiency.
the optometrist should report the patient to
VicRoads (preferably with patient consent or
at least knowledge).
Duty to tell the All reporting should ideally be done with the s 148(2): When a health professional makes a report
patient knowledge, and preferably the consent, of in these circumstances, the health professional
the patient. However, for various reasons, must notify the patient, and tell the patient the
this may not always be possible. nature of the information given to the Registrar.
Legal protection s 27(5): No action may be taken against s 148(3): A health professional incurs no civil or
for optometrist a person who, in good faith, reports to criminal liability when they carry out their duty to
VicRoads any information suggesting a mandatorily report a patient.
person is unfit to drive or that it may be
dangerous to allow that person to drive.
To report the holder of a South Australian driver’s Reports can be made anonymously and the protections
licence, send the report by fax to the ‘Medical Review described above are applicable. For more information,
Team - Driver Licences’ at the Department of Planning, visit ‘Know Your Responsibilities’ on the VicRoads
Transport and Infrastructure. Their fax number is (08) website.
8402 1977. Optometrists may also wish to refer older
drivers to DPTI’s ‘Moving Right Along’ fact sheet and/ VicRoads (Victoria only) recommends that
or to the ‘Moving Right Along’ webpage (see ‘Key optometrists submit a report to the patient’s GP
Resources’ at the end for webpage addresses). whenever visual fitness for driving is specifically
assessed. This should be done with the patient’s
To report the holder of a Victorian driver’s licence,
consent.
contact VicRoads’ Medical Review Team by telephone on
(03) 8391 3226 or via email at medicalreview@roads.vic.
gov.au.
Information for optometrists assessing fitness to drive - updated 25 February 2020 The applicable vision standard
5
3. The applicable vision standard
There are two different vision standards for driving: private and commercial.
The applicable standard depends on the type of vehicle (e.g. car) as well as the purpose for which it will be driven (e.g.
for remuneration or privately). The commercial standard is more stringent than the private standard.
For more information on when to apply each standard, including how to treat taxi and ‘Uber’ drivers, please see
Appendix A. The table in Appendix A provides detailed information that will assist OV/SA members in determining
whether the private or commercial standard applies to their patients.
For occupational standards including emergency services, defence and aviation, please visit Optometry Australia’s
occupational standards webpage.Information for optometrists assessing fitness to drive - updated 25 February 2020 Vision standards for driving
6
4. Vision standards for driving
4.1 Visual acuity However, a driver licence will not be issued when visual
acuity in the better eye is worse than 6/24 for private
Visual acuity should be tested using a Snellen or LogMAR vehicle drivers. For further information, please see the
chart or equivalent with five letters on the 6/12 line. management flow chart below.
More than two errors in reading the letters of any line is
regarded as a failure to read that line. It is important to remember that the decision to
In the case of a private vehicle driver, if the person’s grant a conditional licence ultimately rests with the
visual acuity is just below that required by the standard driver licence authority. The role of the optometrist
but the person is otherwise alert, has normal reaction is to suggest to the driver licence authority whether
times and good physical coordination, an optometrist can a conditional licence might be suitable and why.
recommend the granting of a conditional licence. The use However, the final decision belongs to VicRoads (in
of contrast sensitivity or other tests may help in the Victoria) or mylicence (in SA).
assessment.
Visual acuity standards - management flow chart
If the patient is monocular (or effectively monocular), members should also read section 4.3.
Uncorrected visual acuity Outcome A
Private: ≥ 6/12 with one or both eyes Optometrist may support a conditional licence if
the following conditions are met:
Commercial: Better eye ≥ 6/9 and worse eye ≥ 6/18
1- Patient is visually fit to drive based on clinical
assessment (e.g. contrast sensitivity). Report
should specify proposed conditions; AND
Pass Fail
2- Visual acuity in the better eye is ≥ 6/24 for
private licences OR ≥ 6/9 for commercial
licences (noting monocular drivers are not
Fit to hold an Corrected visual
normally fit to hold a commercial licence;
unconditional licence acuity
please see 4.3 for more details).
Private:
≥ 6/12 with one or both The decision to grant a conditional licence rests
eyes with the driver licence authority. If condition (2)
is not met, the standards do not allow flexibility
Commercial:
and optometrists should advise the driver
Better eye ≥ 6/9 and
licence authority that a conditional licence is not
worse eye ≥ 6/18
recommended (see below).
Pass Fail Outcome B
Optometrist may recommend that a patient not be
Fit to hold a conditional granted a conditional licence. The final decision
Optometrist to perform
licence (conditional rests with the driver licence authority.
clinical assessment
upon wearing (e.g. contrast sensitivity)
corrective lenses) with regards to driving,
leading to two possible
outcomes
Adapted from Assessing Fitness to Drive (2016) and with permission of Austroads.Information for optometrists assessing fitness to drive - updated 25 February 2020 The applicable vision standard
7
4.2 Visual Fields –– a vertical defect of only a single point width but of any
length, unattached to any other area of defect, which
If there is no indication of a visual field impairment or touches or cuts through the horizontal meridian.
a progressive eye condition then it is satisfactory to
screen for any defects by confrontation field testing, 4.2.2 Central visual field requirements for private
although it should be borne in mind that this is an inexact and commercial unconditional licences
test. Any person who has, or is suspected of having, The general principle is that there must be no significant
a visual field defect should have a formal perimetry- defect in the binocular field coming within a 20 degree
based assessment; in the first instance, it is appropriate radius of foveal fixation.
to perform monocular automated static perimetry. If
monocular automated static perimetry shows no defects, The following defects are regarded as significant and
this information is sufficient to confirm the standard is met. therefore not acceptable:
–– a cluster of four or more adjoining points that is either
All automated static perimetry testing must be
completely or partly within the central 20 degree area;
performed with fixation monitoring. For results to
be regarded as valid, the false positive score must –– loss consisting of both a single cluster of three
be ≤ 20%. adjoining points up to and including 20 degrees from
fixation, and any additional separate missed point/s
All patients, whether they reside in Victoria or South within the central 20 degree area;
Australia, with any significant field defect and/or a –– any central loss that is an extension of a hemianopia
progressive eye condition require either the Medmont or quadrantanopia of size greater than three missed
Binocular Driving Test or the binocular Humphrey points.
Esterman test.
The following defects are regarded as insignificant and
VicRoads (Victoria only) does not generally accept therefore do not preclude an unconditional licence:
the Medmont Binocular Driving Test unless –– scattered single missed points; or
optometrists have ensured that:
–– a single cluster of up to three adjoining points (but a
1- Under the ‘Display’ tab, the ‘Level’ map type is loss of three adjoining points up to and including 20
selected, as well as ‘numeric’ data view; and degrees from fixation plus any additional separate
missed points in the central 20-degree area is
2- They have checked the boxes ‘Numeric Tick Marks’ unacceptable – see above)
and ‘Annotations’.
One of the upshots of this is that homonymous and
When these parameters are specified, the ‘seen bitemporal defects coming close to fixation are not
points’ attribute will be displayed, as preferred by normally acceptable for driving, regardless of whether the
VicRoads. Note that results printed in grayscale defect is hemianopic or quadrantanopic.
format are not ordinarily accepted by VicRoads.
4.2.3 Private conditional licences
4.2.1 Horizontal visual field extent for private and
commercial unconditional licences If the private standard applies but the above visual
fields standards are not satisfied, the optometrist
To meet either the private or commercial visual standard may support the granting of a conditional licence as
for an unconditional licence, the horizontal extent of the long as the horizontal extent of the visual field is ≥
visual field must be ≥ 110 degrees with no significant 90 degrees. Additional testing may help inform the
defect in the binocular field encroaching within 20 recommendation/s. The driver licence authority is
degrees above or below the horizontal midline. required to consider results from any of the following
tests (if supplied):
The following defects are regarded as insignificant and
therefore do not preclude an unconditional licence: –– kinetic fields conducted on a Goldmann;
–– a single cluster of up to three adjoining missed points, –– ‘roving’ binocular visual field test (i.e. a binocular
unattached to any other area of defect, lying on or visual field test performed without fixation monitoring;
across the horizontal meridian;Information for optometrists assessing fitness to drive - updated 25 February 2020 Vision standards for driving
8
the Medmont Binocular Driving Test or the Binocular the same factors as those listed under 4.2.3, then a
Esterman test are acceptable); two consecutive tests conditional licence may be considered by the driver
must be performed with ≤ 1 false positive on each, licence authority, subject to at least a two-yearly review.
and results should be supplied in the numeric field
format; and In a monocular patient with no symptoms, family
–– contrast sensitivity and glare susceptibility. history or risk factors for visual field loss, it
is appropriate in the first instance to conduct
The driver licence authority is additionally required to monocular automated static perimetry. If the result
consider the following: is not suggestive of any defects, this information
may be sufficient to confirm the standard is met.
–– Relevant health history including the following about
If monocular testing suggests a defect then
any condition/s present: duration, prognosis, nature
binocular visual field testing should be conducted.
(progressive / not progressive), rate of progression
if applicable and effectiveness of treatment and
management; 4.4 Colour Vision
–– Driving history prior to and since the occurrence of the There is not a colour vision standard for drivers, either
defect; private or commercial. Optometrists should, however,
–– Nature of the driving task (e.g. type of vehicle, advise drivers who have a significant colour vision
distances to be travelled etc.); deficiency about how this may affect their responsiveness
–– Concomitant medical conditions including cognitive to signal lights and the need to adapt their driving
impairment or impaired rotation of the neck. accordingly. Any advice given to patients should be
documented in the patient record. Note that some
4.2.4 Commercial conditional licences occupations may have a colour vision standard; for more
information see Optometry Australia’s list of occupational
In cases where the commercial visual standard for driving
standards.
applies, the flexibility discussed under 4.2.3 in relation to
visual fields does not apply. 4.5 Progressive Conditions
4.3 Monocular drivers Optometrists should monitor progressive eye conditions
regularly and advise the patient in advance of any
For private vehicle drivers, a conditional licence may be
potential future impact on driving ability. All advice given
considered if the horizontal visual field extent is ≥ 110
to patients should be documented in the patient record.
degrees and the visual acuity is satisfactory in the better
Progressive conditions include, for example, cataract,
(or only) eye. The health of the better (or only) eye must
glaucoma, optic neuropathy and retinitis pigmentosa.
be reviewed every two years.
Monocular drivers are not normally fit to hold a
commercial licence. However, if the optometrist believes
the person may be safe to drive after consideration ofInformation for optometrists assessing fitness to drive - updated 25 February 2020 Key resources & contact information
9
5. Key resources
National resources Licence Categories (VicRoads)
Assessing Fitness to Drive for Commercial and Private Eyesight Report (VicRoads)
Vehicle Drivers
Driving and Pharmacy Medications (Transport Accident
Optometry Australia’s webpage on occupational vision Commission Victoria)
standards
South Australian resources
Victorian resources
MyLicenceSA
–– Health and Driving (VicRoads) including:
MyLicenceSA Drivers’ Handbook – Fitness to Drive
–– Medical Review Process (including reporting driving
conditions that could affect driving safety) MyLicenceSA Safe Driving Tips – Older Drivers
–– Medical Conditions and Driving (including vision
impairments, diabetes and neurological conditions) MyLicenceSA Drivers’ Handbook – Drugs, Medicine and
Driving (including prescription drugs)
–– How Ageing Can Affect Your Driving
–– Information for Health Professionals Moving Right Along: Obligations and Opportunities for
Click ‘Know Your Responsibilities’ and click on Older Drivers (fact sheet)
‘Fitness to drive information for Ophthalmologists and
‘Moving Right Along’ webpage
Optometrists’ to view VicRoads’ latest fact sheet
Medical Forms (including Eyesight Report) and Patient
Fact Sheets (including Diabetes and Driving, Glaucoma
and Driving, Getting Around Without a Car, Medical
Review Driving Test)
6. Contact information
Optometry Victoria South Australia
(03) 9652 9100
office.vicsa@optometry.org.au
Optometry Australia
(03) 9668 8500
national@optometry.org.au
Government of South Australia Department of Planning, Transport and Infrastructure
13 10 84
VicRoads Medical Review
(03) 9854 2390
medicalreview@roads.vic.gov.au
South Australian Driver Accreditation for commercial passenger vehicles
DPTI.ALConline@sa.gov.au
Commercial Passenger Vehicles Victoria
1800 638 802 (toll-free for fixed landlines only)
contact@cpv.vic.gov.auInformation for optometrists assessing fitness to drive - updated 25 February 2020 Appendices
10
Appendix A: Application of
standards (Vic/SA)
National licence class Vehicle/s Context Vision standard
Motorcycle (R) Motorbikes or motortrikes Vehicle to be ridden privately and Private
not for remuneration
Vehicle to be ridden commercially, Private
conveying food and/or other
items for reward (e.g. Uber Eats)
Vehicle to be ridden commercially, Commercial
carrying passengers for hire or
reward (e.g. Scooti)
Car (C) Any vehicle ≤ 4.5t Gross Vehicle Vehicle to be driven privately and Private
Mass (GVM) and seating ≤ 12 not for remuneration
adults incl. driver (including cars,
minivans meeting these criteria)
Light Rigid (LR) Any rigid vehicle with GVM > 4.5t
and/or which seats > 12 adults,
that has GVM ≤ 8t (plus trailer of
≤ 9t)
Car (C) Any vehicle ≤ 4.5t Gross Vehicle (i) Carrying passengers for hire Commercial
Mass (GVM) and seating ≤ 12 or reward (incl. taxis, rideshare
adults incl. driver (including cars, vehicles including ‘Uber’, vehicles
minivans meeting these criteria) driven by chauffeurs); and/or
(ii) Driver is undertaking a medical
Light Rigid (LR) Any rigid vehicle with GVM > 4.5t
assessment as a requirement
and/or which seats > 12 adults,
under an accreditation scheme;
that has GVM ≤ 8t (plus trailer of
and/or
≤ 9t)
(iii) Driver holds or is applying for
authority to hold a dangerous
goods licence.
Medium & heavy rigid Various heavy vehicles > 8t Any Commercial
(MR and HR) and Heavy GVM – includes larger buses & standard applies at
and Multiple Combination coaches ALL times
(HC and MC)You can also read
