Visual standards for Driving in

Europe

Dr Cindy Tromans

Vice President

European Council of Optometry and Optics

Context

• Driving and visual standards important for optometry and

optics

• The EC Directives on driving licenses (EC Directives

2006/126/EC and 2009/113/EC) were updated in 2009 and

member countries were required to align national standards

to the directive by 2013

• In the Medical Annex of the 2009 directive, minimum visual

standards are stated to ensure drivers meet a safe visual

standard for driving

• ECOO Vision and Driving working group

EU: over 440 million people with a driving

licence (over 60% EU population)

Image from www.vidiani.com

What are the Vision and Driving

standards?EC Directives 2006/126/EC and 2009/113/EC

• For Group 1 drivers, the visual acuity standard is binocular vision of

at least 0.5 decimal (0.3 logMAR, 6/12 Snellen equivalent) and a

visual field extending to 120 degrees in the horizontal meridian.

• For Group 2 drivers, the visual acuity standard is binocular vision of

at least 0.8 decimal (0.1 logMAR, 6/7.5 Snellen equivalent) in the

better eye, with a VA of at least 0.1 decimal in the other eye (1.0

logMAR, 6/60 Snellen equivalent), and a visual field extending to

160 degrees in the horizontal meridian

Visual Acuity

• Decimal Scoring

• What test?

– Equivalence between tests?

– Repeatability?

• Number plate test

– Still used in some countries as a proxy for a visual acuity measure

– Recent work in the UK highlights the inconsistency ‘double-

standard’ of 0.5 decimal & the number-plate test (Latham et al. 2016)

Visual Fields

Directive states (for Group 1 Drivers):

• Group 2: 160 degrees

• However, Self-reporting relied on

• Estermann visual field test

(binocular)

Stanojcic et al. 2010

“Moreover, the horizontal visual field should be at least 120 degrees, the

extension should be at least 50 degrees left and right and 20 degrees up

and down. No defects should be present within a radius of the central 20

degrees.”

Contrast Sensitivity, Glare and Twilight Vision

Directive states:

“…attention shall be paid, in particular, to the following: visual acuity,

field of vision, twilight vision, glare and contrast sensitivity, diplopia and

other visual functions that can compromise safe driving.”

• But how do clinicians assess/measure this?

• E.g. Legislation in Ireland

Contrast Sensitivity

• Research strongly indicates that contrast sensitivity better real-

world measure for having ‘good’ vision for driving

• Pelli-Robson popular test

• BUT, for driving - lack of evidence of what’s good enough

• What would be appropriate cut-off?

Glare and Twilight Vision

• Testing vision under Mesopic and Photopic conditions

• How dark is dark? Lin, Ng & Nguyen (2015) suggest need to

be 2.0 log units lower (0.75cd/m2)

Disk Halo Size

assessment – for

examination of glare

sensitivity

(Puell et al. 2015)

Vision and Driving standards

• Directive does state a visual acuity measure, and also visual

fields and other aspects of vision

• BUT, lack of detail about how this would be assessed, when

this would be assessed and who assesses this?

Is there inconsistency across European

countries?

YES*

• There remains a large variation in how these visual standards

are interpreted and implemented

• Some countries require these standards to be measured in-

person for a driver, while others rely on self-reporting

* Group 1 drivers

COUNTRY National Visual

standards

Visual assessment at time of licence acquisition: what test(s) are conducted?

Group 1

(Decimal VA)

VA, Visual Fields and

additional measures

VA and Visual Fields

only

VA only Licence plate self-test

Austria 0.5 Binocular

Belgium 0.5 Binocular

Bulgaria 0.6 Binocular

1.0 Monocular

Ishihara

Croatia 0.5 Binocular

Cyprus

Czech Republic 0.7 Bioncular

1.0 Monocular

Denmark 0.5 Binocular

Estonia 0.5 Binocular

Finland 0.5 Binocular

France

Germany 0.5 Binocular

0.7 Monocular

Greece

Hungary

Ireland 0.5 Binocular

Italy 1.0 Binocular

Latvia 0.5 Binocular

Lithuania

Malta

The Netherlands 0.5 Binocular

Norway* 0.5 Binocular

Poland 0.5 Binocular

Portugal 0.5 Binocular

Serbia*

Slovakia

Slovenia 0.5 Binocular

Spain 0.5

Sweden 0.5

Switzerland* 0.63

Turkey 0.5

United Kingdom 0.5

Who assesses the visual standard?

“Competent medical authority” is the phrase in the EC directive

In reality, a wide variety of persons:

• Medical doctor

• Ophthalmologist

• Optometrist

• Optician

• Technician

• Driving licence personnel

What level of vision is needed

for driving?

• Despite the fact that driving is unarguably a visual task, there is

little evidence that a particular threshold is critical to

determine ‘safe’ driving (Owsley & McGwin 2010)

• Decimal score is a selected number

• States in Canada have revised their visual standards for driving

upwards to 6/15

What are the risks of poor vision

on driving performance?

What kinds of evidence exists?

Range of studies conducted:

• Direct measures of performance

– On-road versus closed-circuit driving

– Simulated visual acuity or visual field loss

Reduced contrast sensitivity correlated with poorer driving

performance (Higgins and Wood 2005, Marrington et al. 2008, Owsley & McGwin 2010)

• Another approach is to look at accident and vision statistics

– Cataract surgery – decreased accident rates after (Owsley et al. 2002)

What is the risk?

What do policymakers evaluate?

• Road traffic accident statistics often used to base government

policy

• However, studies have shown that vision is an often

overlooked variable in accident investigations (Arthur et al. 2005)

Vision and accidents

• Crashes are more common for younger drivers, but when this is

adjusted for experience (i.e. exposure to driving), it becomes

evident that older drivers are more frequently involved in

accidents (Wood & Black 2016 review)

• EC road safety work: want to halve road deaths from 2010 to

2020

Vision and accidents

• Recent research from College of Optometrists and Road Safety

partners investigated what factors are recorded by police officers

in the UK at the time of a road traffic accident (n=1 million).

Data from STATS19, 2006-2013

(Bowen et al. ARVO May 2016)

• Reported that common Contributory factors listed included:

– Failed to look properly

– Failed to judge other person’s path or speed

– Dazzling sun

– Illness or disability, mental or physical

– Dazzling headlights

– Uncorrected, defective eyesight

• Found that significantly higher rate of recording these factors in

people over 60 years of age.

Vision and accidents

• Most commonly reported factor was ‘failed to look properly’

• “Uncorrected, defective eyesight” rarely listed –

Why?

failed to look

failed to judge path/speed

dazzling sun

illness, physical/mental

dazzling headlights

uncorrected, defective

eyesight

How can the risk be mitigated?

• Require re-assessment at renewal

• In-person assessment: rather than self reporting

• Do European countries require visual assessment at renewal?

– Not all….

COUNTRY Visual assessment throughout life of licence?

Every 10

Years

Description of requirements when older No

requirement40’s 50’s 60’s 70’s 80’s

Austria

Belgium

Bulgaria

Croatia At 80+ years; 2-yearly

Cyprus At 70 years

Czech Republic

Denmark At 70 years

At 74+ years; 2-yearly

Estonia Yes At 65+ years; 5-yearly

Finland At 45 years At 70+ years; 5-yearly

France

Germany

Greece

Hungary

Ireland At 70+ years; 3-yearly

Italy Yes At 50+ years; 5-yearly At 70+ years; 3-yearly At 80+ years- 2-yearly

Latvia Yes At 50+ years; 5-yearly At 65+ years; 3-yearly

Lithuania

Malta

The Netherlands At 70+ years; 5-yearly

Norway*

Poland At 75 years

Portugal At 60 years

Serbia* At 60 years

Slovakia At 70+ years;

1-yearly

Slovenia At 80 years

Spain Yes At 65+ years; 5-yearly

Sweden

Switzerland* At 50 years

Turkey Yes At 50+ years; 5-yearly At 65+ years; 3-yearly

United Kingdom

Conclusions

•Wide variation across EU countries in the implementation of the

Medical Annex of the EC 2009 directive with regard to visual

standards for driving

•Urgent need to consider the meaning of the other aspects of visual

function, i.e. contrast sensitivity and twilight vision, on driving

performance and safety if the current Directive is to be

implemented appropriately.

•Significant gaps in the scientific literature about the influence of

vision on driving, and a need for more research and evidence to

ensure policymakers are making informed decisions.

•Policymakers and other stakeholders should come together to

explore how best to raise public awareness of visual standards for

driving.

ECOO - Call to action

• Standardise the visual acuity assessment method to ensure

consistency in application of visual standards for driving.

• Engage with member states to recognise that the licence

plate test is not a measure of visual acuity

• Ensure assessment is carried out by an eye care professional

• Lobby for the requirement of assessment of visual standards

upon renewal of driving licence in Medical Annex of the EC

directive

• Promote effective assessment of vision, visual fields, contrast

sensitivity and twilight vision

• Encourage more research in effective assessment tools for

measurement of visual functions.

• Increase public awareness of fitness to drive.

The Future?

Google driver-less car

Acknowledgements

Driving and Vision working group:

Julie-Anne Little

Martin O’Brien

Ann Blackmore

Thanks to: Mark Nevin

Michael Bowen

ECOO Members

Cindy.tromans@college-optometrists.org