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