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MEDICAL STANDARDS FOR FITNESS TO COMPETE

CAMS Medical Standards.docx Last Reviewed August 2009

CAMS Medical Standards of 22 © Confederation of Australian Motor Sport 2009

TABLE OF CONTENTS SECTION 1

1.1 Introduction ............................................................................................ 4 1.2 Assessment of Medical Fitness ........................................................... 5 1.3 Statement by Applicants .................................................................... 5 1.4 Classification of Standards ................................................................. 5 1.5 Mandatory Frequency of Examination ............................................ 6

SECTION 2 2.1 Physical State

2.1.1 Deformity ..................................................................................... 8 2.1.2 Obesity ......................................................................................... 8 2.1.3 Central Nervous system ............................................................ 8 2.1.4 Head Injuries ............................................................................... 9

2.2 General Medical and Surgical 2.2.1 Locomotor System ..................................................................... 9 2.2.2 Digestive System ........................................................................ 9 2.2.3 Urinary System .......................................................................... 10 2.2.4 Malignancy ............................................................................... 10

2.3 General Medical Considerations 2.3.1 Medication................................................................................ 10 2.3.2 Cardiovascular System ........................................................... 11 2.3.3 Respiratory System................................................................... 11 2.3.4 Endocrine System .................................................................... 11

2.4 Ear, Nose and Throat ..................................................................... 12 2.5 Eye .................................................................................................. 12

2.5.1 Visual Acuity ............................................................................. 12 2.5.2 Visual Fields ............................................................................... 14 2.5.3 Eye Movements ....................................................................... 17 2.5.4 Colour Vision ............................................................................. 17 2.5.5 Spectacles, Sunglasses and Contact Lenses .................... 19 2.5.6 Refractive Surgery ................................................................... 19

2.6 Epilepsy .......................................................................................... 20 2.7 Race Licence Applicants with restricted visual fields Attachment A


SECTION 1

GENERAL


1.1 INTRODUCTION

The aim of this manual is to provide a guide to accredited Medical Examiners and State Medical Assessors in making decisions in the assessment of the health of the individual applicants for a CAMS Competition Licence.

Many enthusiasts in the past may have been denied participation in motor sport because of disabilities and

diseases rendering them UNFIT to meet the full rigours of long distance high speed competition. However, they may be quite capable of participation in short events, such as hillclimbs, sprints and club meetings.

A high standard is maintained in those areas of physical fitness which have a vital relationship to the safety

of the individual’s performance. However, in areas not considered vital the Standards have been relaxed. Colour perception testing is required for every medical assessment test. An applicant who fails the Ishihara

test will require further tests of inquiry. The design of the modern helmet together with the hearing protection necessary, due to noise level

produced in racing, makes it unnecessary for a driver to rely on his auditory senses. CAMS therefore agrees that deafness should not exclude a driver from competing.

Injuries or illness resulting in a disability must be reported, and a confidential medical report of the

diagnosis and prognosis of the injury forwarded to the CAMS State Medical Assessor as soon as possible. This in turn will be attached to the driver’s medical history.

The FIA Medical Commission has introduced a mandatory requirement that for drivers in International

events, including rallies, an International Medical Card for recording details of an accident be required, as is a mandatory medical examination of those drivers who had been involved in an accident, at the circuit. The medical details should be forwarded to the Medical Assessor to be attached to the driver’s medical history.


1.2 ASSESSMENT OF MEDICAL FITNESS

This manual does not include detailed specifications to cover all individual conditions, thus many decisions relating to the assessment of medical fitness will be left to the discretion of the Medical Examiner concerned. Except where specific standards are set up (e.g. visual acuity) the criteria used in deciding an applicants acceptability is whether the disability is ‘likely’ to interfere with the applicants performance of those activities in respect to the grade of licence, or whether it presents a potential danger to other drivers, officials or spectators. The word ‘likely’ is to be taken as meaning ‘something more than a remote possibility’. In all doubtful cases, refer to your State Medical Assessor.

1.3 STATEMENT BY APPLICANTS

An applicant for a Competition Licence shall complete the Health Statement on the application, with a declaration as to its accuracy, on the Medical Record. All such information shall remain confidential. The Medical Record form must reach the CAMS Customer Service and Special Projects section in a sealed envelope from the Medical Examiner or with the application by the applicant.

1.4 CLASSIFICATION OF STANDARDS

An applicant’s medical fitness will be graded as ‘International’ or ‘National’ by the State Medical Assessor, his Deputy or by his authorisation, on the evidence of the completed Medical Record form together with any other information, specialist medical records including relevant laboratory investigation reports, medical reports following injuries sustained during competition or Stewards report.

The medical requirements, for an International Licence varies significantly to that of a National Licence. National medical fitness qualifies the applicant medically for all motor sport events at national level,

including Circuit Racing. Competency for the individual discipline is provided by the type of licence. International medical fitness qualifies the applicant medically for an International Licence. The holder of the

licence is then eligible to compete in international and national events according to the grade of licence held.


1.4 MANDATORY FREQUENCY OF EXAMINATION Application for renewal of a Competition Licence must be accompanied by a completed Medical Record

form. The frequency or renewal and the medical requirements are as follows;

International Licence: Annually, including an eyesight test. An exercise ECG (which is valid for two (2) years) is also applicable for applicants 45 years of age and over . National Licence: 16 – 44 years of age: on application, or more frequently if deemed necessary by CAMS. 45 years of age and over every two (2) years, or more frequently if deemed necessary by CAMS.

At all times the frequency of examinations and the imposition of special requirements may be determined

by the State Medical Assessor. Medical Examination Records are to be filed and retained for a period of seven years. Applicants under the

age of 18 years shall have records retained for a period of at least seven years from their 18th birthday. Medical fitness for provisional/national or international licences may be granted subject to further Medical

Specialists and CAMS Stewards reports. Reports from circuit Chief Medical Officers or CAMS Stewards will suffice for immediate suspension of

Competition Licence on medical grounds. The Medical Assessor shall advise withholding the issue or renewal of the Competition Licence if there is

any doubt, pending full details of the applicant's condition and medication, and the opinion of the Accredited Medical Examiner.


SECTION 2

MEDICAL STANDARDS

The medical assessment shall be based on the requirements of mental and physical fitness noted on the following pages:


2.1 PHYSICAL STATE

2.1.1 Deformity

Any congenital or acquired deformity causing loss of function in a limb may be considered likely to interfere with the safe handling of an automobile under racing conditions. The examining Doctor should give his opinion of the degree of disability. If the disability is likely to impair the applicant's driving ability under racing conditions, they may be required to demonstrate their ability to CAMS in the context of medical, sporting and technical criteria viz: Medical: Evaluation of the physical capacity of the applicant. Sporting: Evaluation of the driving ability of the applicant and an evaluation of their ability

to extract themselves from an automobile in a case of immediate danger (accident, fire etc).

Technical: Where appropriate CAMS may be able to issue the applicant with a certificate

indicating the modifications which must be made to the automobile.

2.1.2 Obesity

Although Body/Mass Index (BMI) should be interpreted within the context of the individual's overall physical condition, the measurement is valuable. BMI (mass in kilos divided by the square of the height in metres) over 30 is likely to indicate that the applicant may require further medical or sporting assessment (see 2.1.1above).

2.1.3 Central Nervous System

An applicant shall have no significant mental illness, nervous disorders or evidence of epilepsy. Any progressive or non-progressive disease of the nervous system which could interfere with the safe handling of an automobile under racing conditions shall be assessed as UNFIT.

An applicant on medication should be assessed with reference to the CAMS Anti-Doping Policy.


2.1.4 Head Injuries

Concussion or fracture of the skull without associated intracranial injuries shall be assessed as temporarily UNFIT until a satisfactory report, together with investigation results (X-rays, EEG, and CAT scan if indicated), is received by the Medical Assessor.

Intracranial injuries resulting in permanent brain damage or residual neurological deficit may be assessed as permanently UNFIT and will require assessment by a neurologist and/or neuropsychiatric specialist.

Any head injury or surgery resulting in loss of cranial bone may be assessed as UNFIT. However if the deficit is repaired with a plate, an assessment as FIT may be made provided that there is no neurological deficit and there is a satisfactory report from a neurologist or neurosurgeon. A Competition Licence may be issued or renewed, but not less than twelve (12) months after the operation or injury operation.

2.2 GENERAL MEDICAL AND SURGICAL

An applicant suffering from any wound, injury, recent surgery, having any part of their body immobilised by a cast or uses any orthopaedic appliance which is likely to interfere with the safe handling of an automobile under racing conditions, shall generally be assessed as UNFIT.

2.2.1 Locomotor System

Any active disease of the bones, joints, muscles or tendons, or gross anatomical defects, may be assessed as UNFIT. Functional deficit may result in the applicant being required to pass a sporting assessment (see 2.1.1 above).

2.2.2 Digestive System An applicant suffering from chronic disease or surgery of the digestive tract may be assessed as FIT provided that their general physical condition is satisfactory. Significant organomegaly will require assessment.


2.2.3 Urinary System

An applicant suffering from results of renal disease or surgery of the urinary tract may be assessed as FIT, provided that their general physical condition is satisfactory.

2.2.4 Malignancy

Neoplasia of any system whether operable or inoperable will be referred to the State Medical Assessor.

2.3 GENERAL MEDICAL CONSIDERATIONS An applicant shall not suffer from any disease or disability (congenital or acquired) which renders him likely

to suddenly lose control of an automobile under racing conditions. 2.3.1 Medication

An applicant under medical treatment for a sub-acute or chronic condition may be able to be satisfactorily controlled. However, the side-effects of the medications may make the applicant UNFIT or ineligible to hold a Competition Licence. An applicant on medication should be assessed with reference to the CAMS Anti-Doping Policy.

Additional medication such as the following may result in an UNFIT classification.

• Some anti-hypertensives • Some asthma preparations • Tranquillisers (major and minor) • Cardiac medications, including anti-arrhythmics • Narcotics and sedatives • Oral hypoglycaemics • Insulin • Psychoactive drugs

Further specialist opinion is required for an applicant taking the following medication:

• Anti-epileptics • Anticoagulants • Antiplatelet agents


It is required that an applicant for a Competition Licence shall give full details of the nature and dose of any medication that they may be taking at the time of attending for their medical examination. They are also required to notify CAMS of any regular medication that may be prescribed or any other change in existing medication.

Note: Some medications will require a Therapeutic Use Exemption (for some levels of

competition). Refer to the CAMS Anti-Doping Policy, at www.cams.com.au

For further information on Therapeutic Use Exemption applications see the Australian Sports Drug Medical Advisory Committee‘s website, at www.asdmac.gov.au

2.3.2 Cardiovascular System

Any abnormality of the heart, likely to interfere with the safe handling of an automobile under competition conditions, may be assessed as UNFIT. Any arrhythmia which may indicate underlying cardiac disease or be associated with hypotension or syncope may be assessed as UNFIT Any applicant 45 years of age and over will need to have their cardiac risk assessed, with reference to the CAMS CV Score. Coronary occlusion, ischaemic heart disease, valvular heart disease, coronary by-pass grafting and Percutaneous Transluminal Coronary Angioplasty (PTCA) affected applicants must have a cardiological assessment report for each medical.

If the blood pressure is noted to be above 150/90 and if it remains above this level in subsequent measurements during the examination, then further investigation to exclude significant cardiovascular disease is necessary.

2.3.3 Respiratory System Obstructive airways disease, acute and chronic asthma may be assessed as UNFIT.

2.3.4 Endocrine System An applicant with diabetes mellitus requiring oral hypoglycaemics may be issued with a licence provided that CAMS is provided with a report asserting that the individual has adopted a responsible and informed attitude towards their condition and that they have achieved good diabetic control. An individual with insulin dependent diabetes mellitus may be considered UNFIT to hold a licence.


CAMS may issue a Competition Licence if the individual has demonstrated a responsible and informed attitude towards the control of a diabetic condition that has been stabilised with insulin, provided that there is no evidence of any visual, cardiovascular or other relevant physical changes attributable to the diabetes. Such a licence would be initially issued subject to the individual undertaking to compete only in events of not more than 20 minutes duration and agreeing to report to the Chief Medical Officer at the commencement of each session of the meeting or at any other time as the track Medical Officer may direct. Licences issued subject to these conditions will be endorsed ‘Must report to Chief Medical Officer – maximum event duration 20 minutes’. Individuals demonstrating competence in their management may have these restrictions extended at the discretion of the National Medical Assessor. Licence holders with Type 1 diabetes mellitus, must undergo the medical examination annually.

2.4 EAR, NOSE AND THROAT

Applicants with acute or chronic disease of the mouth, nose or throat may be assessed as FIT. Applicants with severe, active, acute or recent Vestibular dysfunctions, including transient disturbance shall be assessed as temporarily UNFIT.

2.5 EYE

2.5.1 Visual Acuity

Visual acuity should be measured with a Snellen letter chart 1 located sic (6) metres from the person being tested. The chart should be well illuminated either by artificial room lighting or by internal illumination.

Each eye must be tested separately. The eye not being tested must be covered with an occluder or by the palm (not the fingers) of the hand.

Spectacle correction or contact lenses may be worn if needed to meet the visual acuity standard.

The smallest line that can be read should be recorded and the number of errors made in reading the line must be counted.

1 A LogMAR or Bailey Lovie chart is an acceptable, even preferred, alternative. The LogMAR chart is available from the National Vision Research Institute of

Australia 378 Cardigan Street Carlton Victoria. 2 Standard Snellen letter charts do not always have a 6/7.5 line between the 6/9 and 6/6 line. A person who reads the 6/6 line with no more than three errors

can be deemed to have 6/7.5 visual acuity. If a LogMAR chart is used, 6/7.5 is the LogMAR 0.1 line.


The result must be expressed in terms of metric Snellen2 notation with a note of the number of errors made. The recording notation should be in the form 6/6 –3, where the 6/6 is the Snellen notation of the smallest line read and –3 is the number of mistakes in reading that line of letters.

Whether spectacles or contact lenses were worn must be recorded as ‘with correction’ or ‘unaided’. Standard

FIA International Licence: at least 6/7.5 without any errors in that line for each eye 2

CAMS National Licence: at least 6/9 -2 in the better eye

at least 6/18 –2 in the other eye

A person who meets these standards only with the aid of spectacles or contact lenses must wear those spectacles or contact lenses during any competition.

A reduction in visual acuity is most often due to uncorrected refractive errors (short sight or myopia, long sight or hypermetropia or astigmatism) which can be corrected with spectacles or contact lenses usually restoring visual acuity to normal. Sometimes lowered visual acuity is the result of an eye disorder or disease. Those who fail to meet the visual acuity standard should be advised to have an eye examination.

A person with less than 6/18 in the worse eye may be issued with a national licence that limits the type of competition in which that person may participate. A person with less than 6/18 vision in the worse eye may be limited to single car start events such as hillclimbs, sprints and rallying. If the driver is monocular, he or she is required to wear a full visor in the down position when racing.

Justification

Visual acuity is a measure of the smallest detail that can be seen and is well accepted as the most important index of visual fitness.

FIA regulations require visual acuity (with or without correction) of at least 9/10 3. This is equivalent to 6/7.5 in metric Snellen notation as used in Australia. Australia is obliged to conform to FIA regulations for international licences.

It is widely accepted that poor visual acuity is a risk factor in driving although there is only limited accident evidence to support that widely held view4. Driver licensing authorities in all the developed countries have a visual acuity standard for the issue of drivers’ licences, usually with a more stringent requirement for commercial drivers.

3 The notation 9/10 used by the FIA is uncommon and obscure. It is the Armaignac system endorsed by Landolt in 1906. It is a ten step scale from 1 to 10,

where 10 is equal to normal visual acuity of 6/6 (or 20/20 in the imperial Snellen notation as used in the USA) and 6/60 (the largest letters on the Snellen chart) is equal to 1. The Snellen lines between 1 and 10 are each approximately 1.29 times larger than the smaller line below it and are given numbers 2 to 9.

4 The large sample study of Burg (see Hills and Burg 1977 ) showed a very low but statistically significant correlation of visual acuity with road accident history

as did the study of Crancer and O’Neall (1969). More recent studies of Davison (1985), Humphriss (1987) and Ivers et al (1999) show stronger associations between visual acuity and accidents but the evidence is still equivocal.


The standard of 6/9 in the better eye and 6/18 in the worse eye for national motor racing licences is the same visual acuity required of commercial automobile drivers in Australia 5 .

Since motor racing involves driving at speed and demands fast decision making, near normal vision (6/9) is a reasonable requirement since drivers should be able to see the longest possible distance ahead to give the greatest time for decision making. They should be able to see small objects on the track that may hazardous.

The requirement for some vision (6/18) in the worse eye is to ensure a full visual field (see below) and to provide a ‘spare eye’ in the event of sudden loss of vision in the better eye. Even with a full visor, there is a risk of dust, oil, metal particles or insects lodging in an eye and there is a small risk of loss of vision in the good eye during a race due to infection or occlusion of the retinal blood vessels. A driver with one eye becomes effectively blind in these circumstances.

2.5.2 Visual Fields

Visual fields are assessed in the general medical examination by the confrontation method for each eye separately. The eye not under test must be covered with an eye occluder or with the palm (not the fingers) of the patient’s hand.

If the confrontation test shows any indication of loss of visual field in either eye, the applicant will be referred for a full eye examination and full automated perimetry.

Applicants with a past history of serious head injury or a past or present history of any ocular disease that may be associated with visual field loss should also be referred for full perimetric examination of their visual fields. A person with only one eye does not have a full visual field. Standard

FIA International Licence: Visual fields shall be normal with a binocular horizontal extent of at

least 90 degrees to both the left and right.

CAMS National Licence: Visual fields shall be normal.

Note 1: For CAMS National Licences, if there is any visual field loss, including a limitation of visual field due to monocular vision, a conditional national licence restricting the applicant to single car start events such as hillclimbs, sprints and rallying may be issued provided – • the underlying cause of the loss is entirely stable and, in the opinion of an ophthalmic practitioner,

any further loss of visual field is unlikely, and

• the binocular visual field has a horizontal extent of at least 140 degrees within at least 15 0 above and below the horizontal meridian.

5 Medical Examinations of Commercial Vehicle Drivers National Road Transport Commission, Canberra, 1997


Note 2: Applicants who cannot meet the requirements noted above may be issued with a licence under the conditions noted in Attachment A (Applicants with reduced visual fields)

Justification

The visual field provides side vision while looking ahead. It enables ‘threats’ from the side to be detected. It is also important to spatial orientation. A person with restricted visual fields is likely to collide with lateral obstacles because of failure to see them in their peripheral vision. The visual field enables a driver to see the presence and position of barriers and other cars to the right and left while looking ahead down the track. This enables them to position their automobile safely in relation to other automobiles and to trackside barriers. It enables them to be aware of automobiles to the right and left when deciding on a change of direction.

Visual fields may be reduced as a result of head trauma, brain tumour, stroke or cerebral infection. Visual field losses also occur in eye diseases such as retinitis pigmentosa, a not uncommon inherited degeneration of the retina that causes significant visual field loss by the age of 30. Conditions such as glaucoma, optic atrophy, retinal detachment and localised retinal or choroidal infection also reduce visual fields.

FIA regulations require normal visual fields. Australia is obliged to conform to FIA regulations for international licences.

There are several studies6 which provide evidence that restricted visual fields are a risk factor in driving although as is often the case when attempting to identify risk factors in driving the evidence is equivocal, either because of methodological faults in the studies, sample size or the multi-factorial nature of accident causation. Some of the studies that did not find a relationship between visual field loss and accidents used crude methods of visual field assessment.

However, Johnston and Keltner7 who used sophisticated automated perimetry and had a sample of 10,000 applicants for a driver’s licence found that those with a field loss in both eyes had accident and conviction rates twice those for drivers with normal visual fields.

They found the incidence of visual field losses among applicants aged 16 to 60 years was 3%, half of whom were unaware of their visual field loss.

Fishman et al8 found a significant correlation between the extent of the visual field loss and number of road accidents for drivers with field loss due to retinitis pigmentosa even though their sample was only 21 subjects. Elkington and MacKean9 found drivers with visual field loss due to glaucoma showed increased accident rates.

6 See Charman WN Vision and driving – a literature review and commentary Ophthal Physiol Optics 17. 371-391, 1997 and

North RV The relationship between the extent of visual field and driving performance – a review Ophthal Phyiol Optics 5, 205-210, 1985.

7 Johnson CA and Kelttner JL Incidence of visual field loss in 20,000 eyes and its relationship to driving performance Arch

Ophthalmol 101, 371-375, 1983. 8 Fishman GA, Anderson RJ Stinson L and Haque A Driver performance of retinitis pigmentosa patients Brit J Ophthalmol 65,

122-126, 1981 9 Elkington AR and MacKean JM Glaucoma and driving Brit Med J 285, 777-778, 1982


Simulator studies show that artificially reducing visual fields affects automobile positioning and the ability to notice signs and obstacles 10 and will reduce reaction times in some subjects with field losses11.

The evidence as to whether the loss of visual field associated with the loss of one eye, where the visual field is restricted to about 140 degrees is equivocal. Two studies suggest monocular drivers are at higher risk of accident12,13 but other studies do not confirm this14,15. Artificial monocular vision did not effect the measures of driving performance in the Wood and Troutbeck 10 closed circuit trials. Despite this equivocal evidence it must be recognised that a loss of an eye inevitably restricts the visual field on the side of the lost eye. The loss is substantial: it is from 95 degrees to about 50 degrees. This means that a driver when looking straight ahead cannot be aware of automobiles and the road edge on the side of their lost eye. It is equivalent to blocking the door windows and part of the windscreen of a sedan car on the side of the lost eye. It is said that a person with one eye adapts to their loss although it is not clear what is meant by this. No doubt they cease to be aware of the loss and most likely use eye movements and head movements to see what is in the blind area on the side of the lost eye. However in motor racing, which involves high speeds and split second decision making, checking the blind area by eye and head movements means less attention can be given to the track ahead. The consensus of driver licensing and road safety authorities is that a loss of visual fields is a significant risk factor for road accidents. Most overseas licensing authorities have a visual field requirement for drivers16. In Australia, private drivers are expected to have normal visual fields but a conditional licence limiting the kind of driving that may be undertaken may be issued provided the binocular horizontal visual field is at least 120 degrees17. A commercial automobile driver5 is also expected to have normal visual fields but a conditional licence may be issued if the binocular horizontal visual field is at least 140 degrees. A monocular driver may not hold a commercial driver’s licence in Australia but may be issued with a conditional licence.

CAMS has considered the issue of monocular vision at length and believes that it is an acceptable risk for drivers, who have experienced the condition for at least 2 years and who demonstrate a visual acuity of a higher magnitude than the minimum required for binocular vision and without any colour deficiencies in their

10 Wood JM and Troutbeck R Effect of restriction of binocular visual field on driving performance Ophthal Physiol Optics 12, 291-

298, 1992 11 Lovsund P and Hedin A Effects on driving performance of visual field defects In: Gale AG et al Eds Vision in Vehicles

Elsevier, Amsterdam, 323-329, 1986 12 Keeney JL The realtionship between ocular pathology and driving impairment Am J Ophthalmol 82, 799-801, 1976 13 Liesmaa M The influence of drivers vision in realtion to his driving ability Optician 166, 10-13, 1973 14 Edwards MG and Schachat AP Impact of enucleation for choroidal melanoma on the performance of vision dependent

activities Arch Ophthalmol 109, 519-521, 1991 15 McKnight AJ, Shinar D and Hilburn B The visual and driving performance of monocular and binocular heavy ruck drivers

Accid Anal Prev 23, 225-237, 1991 16 Charman WN Visual standards for driving Ophthal Physiol Optics 5, 211-220, 1985 17 Assessing Fitness to Drive. Ausroads Guidelines for Health Professionals and their Legal Obligations. Sydney, Ausroads 1998


eye, and now have been able to successfully demonstrate their competence in driving in a limited 2-car competition environment to be assessed accordingly for the issue of a Provisional Circuit licence and then utilise the privileges of their licence under specified monitored conditions.

2.5.3 Eye Movements

A person with a past or present history of diplopia (double vision) shall be referred for a full eye sight examination and full assessment of their ocular motility. The purpose of the full eye examination is to establish that diplopia does or may occur, when it occurs, the reason for it occurring and the extent to which it may be a risk in motor racing.

Standard

FIA International Licence: Normal binocular vision CAMS National Licence: A person who experiences diplopia only in extreme lateral gaze may

be issued with a conditional national licence limiting them to single car racing and rally driving.

Strabismus is not a reason for refusing a national licence provided visual acuity requirements are met. Justification Diplopia (or double vision) arises when the two eyes fail to co-ordinate and two separate images are sent to the brain. This causes confusion because there in uncertainty about which of the two images properly locates the direction of objects seen. Also the two images may over lap out of synchrony reducing the ability to see. 2.5.4 Colour Vision Colour vision is tested only at the time of the first applying for a racing licence since inherited abnormal colour vision does not change through life. Colour vision deficiencies that may be acquired later in life as a result of eye disease will almost always be associated with loss of visual acuity and/or loss of visual fields which are always tested at annual or biennial CAMS medical examinations. Colour vision is tested with the Ishihara Test for Colour Blindness under “daylight” fluorescent light. The plates should be shown in random order to reduce the chance of an erroneous result because the correct answers have been learned. More than three errors (Four or more)_ is a FAIL. An applicant who fails should be referred to an optometrist for further assessment of their colour vision. The further assessment of colour vision shall include – • the Farnsworth D15 test, to test the severity of the colour vision defect, and


• the Medmont C100 test, to test whether the defect is protan (“red-blind”) or deutan (“green blind”).

An applicant who fails the Farnsworth D15 test by making two or more diametrical crossings and/or are shown to have a protan colour vision defect by the Medmont C100 are assessed as UNFIT. An applicant who fails the Farnsworth D15 test may appeal this assessment and request a practical test. The practical test shall involve showing all the flags used in motor racing except the chequered flag and asking the applicant to name each flag and to name the colours of the signal lights. The flags are shown one at a time in random order at a distance of 300 m. They each are held out motionless for three seconds. The test shall be conducted in daylight between the hours of 10 am and 4 pm. Each flag and signal colour shall be shown five times. If there is any error, the test is repeated and any error in the repeated test is a fail. Calling the blue flag black or the black flag blue is not counted as an error. Standard Normal colour vision, or if colour vision is not normal: • a deutan colour vision defect as shown by the Medmont C100 test and the ability to arrange the

colours of the Farnsworth D15 test with no more than one diametrical crossing, or • no more than one error in recognising racing flags in a practical test. Justification The FIA regulations require normal colour vision, or for those with abnormal colour vision, the FIA requires the defect to be sufficiently mild to enable them to pass a lantern test or a practical test of racing flags. Australia is obliged to conform to FIA regulations for international licences. Recognition of coloured flags is essential to the safe and orderly conduct of motor races. The colour code used in the flag system is complex involving six different colours, red, yellow, green, blue, white and black. Red tail lights are sometimes used in races run in bad weather to avoid rear end collision and occasionally signal lights are used instead of flags. It is well known that a person with the more severe forms of defective colour vision is unable to reliably use a colour code with more than two colours18,19. Those with the more common red-green colour vision defects tend to make mistakes identifying colours because they confuse red, yellow and green and green and white. They are also slower responding to colour signals20 and to colour coded information displays21,22.

18 Cole, B L Does defective colour vision really matter? In: Drum, B (Ed) Colour Vision Deficiencies XI Kluwer, Dordrecht, 67 –

86, 1992 19 CIE International Recommendations for Colour Vision Requirements for Transport. Draft Report of CIE Technical Committee

TC-4-31, 1999 20 Nathan, J, Henry, G H and Cole, B L Recognition of coloured road traffic light signals by normal and colour-vision defective

observers J Opt Soc Amer 54, 1041-1045, 1964 21 Cole, B L and Macdonald, W A Defective colour vision can impede information acquisition from redundantly colour coded

video displays Ophthal & Physiol Optics 8, 198-21, 1988 22 Scholz, R, Andrensen, Hofmann, H and Duncker, G Recognition performance of subjects with color-vision deficiencies on a

ploychromatic sonar screen for ship navigation. German J Ophthalmol 4: 103 – 106, 1995


In addition, 2% of men and 0.1% of women have a protan colour vision defect in which the red retinal receptor is absent or deficient. Protans are likely to confuse the red and black flags and will have difficulty seeing the orange disc on the black ground of the mechanical problems flag. They have a very much reduced visual range for red lights23 and have a significantly higher risk of rear end accidents or accident due to failure to see red tail and signal lights 24,25. 2.5.5 Spectacles, Sunglasses and Contact Lenses Spectacles should be fitted with CR39 or polycarbonate lenses. Glass lenses even if heat or chemically treated to enhance impact resistance are not acceptable. Sunglass lenses should be fitted with CR39 or polycarbonate lenses. They must be tagged at the time of purchase as complying with Australian Standard AS 1067 1990 Sunglasses and Fashion Spectacles. Contact lenses may be worn during racing provided the prescribing optometrist or ophthalmologist certifies in writing that – • contact lenses have been successfully worn for at least 12 months • they are worn daily • the lenses can be worn throughout the average day without the development of any major symptoms

or signs and without any loss of visual acuity during the day • the visual acuity standard is met while wearing the contact lenses.

2.5.6 Refractive Surgery A licensed driver must not undertake competitive driving for a period of three (3) months after refractive surgery. At the time of resumption of competitive driving, the attending surgeon must certify in writing that: • the eye is stable • the risk of rupture of the globe of the eye as a result of crash impact is minimal and that the risk has

been discussed with the driver • the visual acuity standard is met and whether or not spectacles or contact lenses must be worn to

meet the visual acuity standard, and • there is no other post surgical impairment of vision such as topographic irregularity, reduced low

contrast sensitivity or exaggerated susceptibility to glare that may impede vision to an extent that may be a risk in competitive driving.

23 Cole, B L and Vingrys, A J Do protanomals have difficulty seeing red lights? Compte Rendu Commission Internationale de

l'Eclairage 20th Session Paris, CIE Publ No E 04/1-3, 1983 24 Verriest, G, Neubauer, O, Marré, M and Uvijls, A New investigations concerning the relationships between congenital colour

vision defects and road traffic security. Int. Ophthal. 2: 87-99, 1980 25 Cole, B L and Maddocks, J D Defective colour vision is a risk factor in driving In: Cavonius, C R (Ed) Colour Vision

Deficiencies XIII Kluwer Academic, Dordrecht, 471 – 481, 1997


These vision standards were revised in November 2000. Professor Barry L Cole, Professorial Fellow in the Department of Optometry and Vision Sciences at the University of Melbourne assisted with the revision.

2.6 EPILEPSY Factors such as type of epilepsy, length of history, and pattern of seizures must be considered in individual cases. It is possible that an individual with controlled nocturnal seizures may be eligible for a Competition Licence however, a person with diurnal seizures requiring medication would be considered UNFIT. In any case, the opinion of a motor sport-aware Neurologist is essential and the frequency of assessment would be increased. An individual would need to be seizure free for a period of five years unless a neurologist report could clearly state otherwise.

The medication prescribed may render the applicant ineligible. Refer also to the CAMS Anti-Doping Policy.


ATTACHMENT A RACE LICENCE APPLICANTS WITH RESTRICTED VISUAL FIELDS

1. GENERAL Drivers who do not meet the requirements of CAMS Medical Standards in respect to visual fields (Article 2. 5.2) may be permitted to participate in motor races provided they:

• meet certain additional pre-licence conditions (in excess of those which are required for applicants who meet the requirements of CAMS Medial Standards at Articles 2.5.1 and 2. 5.2);

• comply with specific requirements in respect to mirrors on vehicles; • utilise specific controls in regard to helmets and visors; • demonstrate a compulsory amount of experience and be successfully observed in at least two specified

events, and • participate in on-going monitoring in respect of their driving performance when competing.

2 PRE-LICENCE REQUIREMENTS Applicants who meet the CAMS Medical Standards, save for the standards relating to applicants for racing licences mentioned in Article 2.5.2 (Visual Fields), may apply for a Provisional Circuit licence, however CAMS requires additional reports and assessment certification on each applicant to demonstrate that the additional risk which is considered to exist through the inability to meet the requirements of Article 2.5.2 is balanced out (controlled) by (a) additional assessment criteria and (b) confirmed experience in other events. CAMS requires applicants for a provisional circuit licence who do not meet the CAMS Standard for Visual Fields mentioned in Article 2.5.2 to be assessed as follows:

1 Provide evidence that the applicant has experienced the condition which has led to the reduced visual field for a minimum of 24 months (two years).

2 Minimum visual acuity (corrected or uncorrected) of at least 6/6 in one eye. 3 Colour vision: normal (in case of any anomaly, recourse to method of analysis: the Ishihara Table or

an analogous screening test. A Flag Test is not acceptable) 4 Static field of vision: Confirmation by an Optometrist or Ophthalmologist of the applicants visual field,

in the form of Computerised Perimetry (Driving test) or Goldman Perimetry, demonstrating a visual field of at least 120 degrees along the horizontal meridian and within 10 degrees above and below the horizontal. A “Confrontation” field test is not sufficient.

5 Sight correction: the wearing of contact lenses is permitted provided that: - these shall have been worn for at least 12 months and for a significant period every day. - they are certified as satisfactory for motor racing by the ophthalmic/optometric specialist who supplied them.

6 Proof of competence and of consistently safe driving in at least 2 Supersprint events (as a minimum type of event) in the previous 2 years. Previous proven history of racing with the condition which has led to the reduced visual field may be taken into consideration.


3 IF THE ABOVE CONDITIONS ARE MET If the above conditions are met, the applicant may be considered as eligible for a CAMS Observed Licence Test (OLT), which must be carried out by an independent official.

4 ADDITIONAL CONDITIONS

• If the OLT is passed, the driver is eligible for a Provisional Circuit Licence. Normal CAMS upgrading process will then commence.

• The applicant must use a full face helmet with the visor in the closed position at all times when driving. • The applicant’s vehicle must be fitted with two external rear vision mirrors, and if a two seat car, also an

“interior” rear vision mirror. • The applicant will be provided with a letter by CAMS which is to be given to the Stewards of the Meeting

before competing at each event which is undertaken when competing with a Provisional Circuit Licence. This letter will introduce the applicant and request the driver to be observed by the Stewards during the course of the Meeting. Should they have any concerns, they are to advise the driver and CAMS. If the driving is considered to be satisfactory, an acknowledgement is required and this is to be advised to the driver and CAMS. This will be required to be completed at each event and on at least two occasions prior to renewal of the licence each year.

medical standards cams website - confederation of ...docs.cams.com.au/cams forms/competitors/medical...

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