driving (and visual field defects)

Last edited 06/2019 and last reviewed 11/2020

Includes disorders such as severe bilateral glaucoma, severe bilateral retinopathy, retinitis pigmentosa and other disorders producing field defect including partial or complete homonymous hemianopia/quadrantanopia or complete bitemporal hemianopia

group 1 entitlement

• notify DVLA.
• driving must cease until able to meet the national guidelines for visual fields
• the minimum field of vision for safe driving is defined as - a field of at least 120 degrees on the horizontal measured using a target  equivalent to the white Goldmann III4e settings; the extension should be at least 50 degrees left and right
• in addition there should be no significant defect in binocular field which encroaches within 20 degrees of fixation above or below the horizonta meridian (this guidance means that homonymous or bitemporal defects which come close to fixation whether hemianopic or quadrantinopic are not normally accepted as safe for driving (1))
  
  
• If the DVLA needs a visual field assessment for determining fitness to drive, it:
  • requires the method to be a binocular Esterman field test
  • may request monocular full field charts in specific conditions
  • exceptionally, may consider a Goldmann perimetry assessment carried out to strict criteria
• The Secretary of State's Honorary Medical Advisory Panel for Visual Disorders and Driving advises that, for an Esterman binocular chart to be considered reliable for licensing, the false-positive score must be no more than 20%. When assessing monocular charts and Goldmann perimetry, fixation accuracy will also be considered
  
  
• Defect affecting central area only (Esterman within 20 degree radius of fixation)
  • Only for the purposes of licensing Group 1 car and motorcycle driving:
    • the following are generally regarded as acceptable central loss
      • scattered single missed points
      • a single cluster of up to 3 adjoining points
    • the following are generally regarded as unacceptable ('significant') central loss:
      • a cluster of 4 or more adjoining points that is either wholly or partly within the central 20 degree area
      • loss consisting of both a single cluster of 3 adjoining missed points up to and including 20 degree from fixation, and any additional separate missed points within the central 20 degree area
      • any central loss that is an extension of hemianopia or quadrantanopia of size greater than 3 missed points
        
        
• Defect affecting the peripheral areas - width assessment
  • Only for the purposes of licensing Group 1 car and motorcycle driving:
    • the following will be disregarded when assessing the width of field
    • a cluster of up to 3 adjoining missed points, unattached to any other area of defect, lying on or across the horizontal meridian
    • a vertical defect of only single-point width but of any length, unattached to any other area of defect, which touches or cuts through the horizontal meridian

Exceptional cases

GROUP 1 drivers who have previously held full driving entitlement, removed because of a field defect which does not satisfy the standard, may be eligible to reapply to be considered as exceptional cases on an individual basis, subject to strict criteria:

• defect must have been
  • present for at least 12 months
  • caused by an isolated event or a non-progressive condition
• there must be no other condition or pathology regarded as progressive and likely to be affecting the visual fields (panel's advice is that certain medical conditions, for example glaucoma and retinitis pigmentosa, would always be considered as progressive and so could not be considered as exceptional cases)
• sight in both eyes
• no uncontrolled diplopia
• no other impairment of visual function, including
• no glare sensitivity, contrast sensitivity or impairment of twilight vision
• clinical confirmation of full functional adaptation

Note:

• an individual who is monocular cannot be considered under exceptional case criteria

Up-to-date guidance should be obtained from the publication "At a Glance Guide to the Current Medical Standards of Fitness to Drive" and the website www.dvla.gov.uk.

Reference:

• (1) DVLA (March 2019). At a glance guide to the current medical standards of fitness to drive