Driving and Visual Field Loss
Driving and Diabetes
Driving and the EU law
News release: EU changes night-time hypos driving rules for people with diabetes
Driving and hypoglycaemia – what are doctors being advised to do?
Test Strips – Department Of Health Warning For Doctors And Pharmacists
Vehicles You Can Drive
Insulin and Driving Taxis
Hypoglycaemia and Driving
Driving and Medicines
Driving and Visual Field Loss
Driving and Visual Field Loss
IDDT’s July 2002 Newsletter drew attention to the DVLA implementing more stringent standards for visual field assessment and driving. This has resulted in greater numbers of people losing their driving licence because of reduced visual fields after laser treatment for retinopathy. IDDT wrote to the DVLA for clarification on this matter.
Jackie Banks had laser treatment for her retinopathy 25 years ago and there was no need for further treatment. She has been classed as fit to drive ever since – that is until these stringent regulations came into effect. She led almost a one-woman campaign for several years which resulted in her retaining her licence, as well as helping many other people to do the same.
The seriousness of the new regulations was brought home to us when IDDT member Stephen, applied to renew his driving licence as a matter of routine and he visited a DVLA nominated optometrist for a field test. Then like a bolt from the blue, a letter arrived from the DVLA informing him that he could no longer drive because of his visual field loss. Stephen had laser treatment some years ago but his retinopathy was non-progressive and in the opinion of his ophthalmologist, had never interfered with his visual fields to prevent him driving. So what had changed – certainly not the state of Stephen’s eyes, at his last routine check with his ophthalmologist. The answer – the system!
The visual field test
Visual fields are measured on instruments called perimeters and there are two types:
- A manually operated perimeter eg Goldmann using a system on moving lights.
- An automated perimeter that uses static flashing lights and automatically prints out the results. This is widely used because it requires less skill on the part of the operator.
The manually operated Goldmann type is often easier to use for the person being checked and may well give better results. Clearly your results could be different according to which perimeter is used. The results of these tests will influence the renewal of your licence.
These are very difficult to interpret, even for qualified people. There are several problems with this system which IDDT raised with the DVLA:
- perimeters were never designed to be a definitive test on which to base vital decisions about whether or not to issue a driving licence.
- The DVLA has commissioned research to look at the best way of testing for visual field defects and driving which will be available in 2-3years time. We have therefore queried the appropriateness of this stringent interpretation of the EU Directive BEFORE the results of the research are known.
- The DVLA perimeter uses a static fixation point ie your eye has to be fixed on a central point while trying to recognise the flashing lights in the peripheral field. Actually no one drives like this, the eyes are moving all the time and therefore minor defects in the peripheral field are not noticed because of the eye movements.
The response from the DVLA:
As simply as I can put it, the DVLA only accept the results of automated perimeters and not the Goldmann. However, where there is some doubt as to the width of the visual field, then they may request a further test on a Goldmann to ‘avoid erroneously refusing or revoking the entitlement’ to drive. However, they also acknowledge that the automated perimeter was recommended as the standard for consistency of quality of testing and accessibility, ie the ability of the tester and the fact that not many optometrists possess a manually operated perimeter. Is this a good enough reason for choosing one particular instrument, the Goldmann, the results of which could affect the lives of so many people?
Application for renewal of driving licence
- In the past, a report from your own ophthalmologist was sufficient information for the DVLA but now people are being requested to attend a DVLA nominated optometrist [optician] for a field test, apparently to speed up the process. The optometrist’s report goes to the DVLA and they make the decision. However, you can choose to have this cheque with your own ohthalmologist instead.
- IDDT is aware that in some cases, the visual field test is not carried out by the optometrist but by an ‘operative’ in the shop and we have reported this to the DVLA. When the future of your licence is at stake, you should try to ensure that the test is carried out by the nominated optometrist, who actually receives the fee for this, and NOT by an unqualified person.
- It is important to note that if you have recently seen your ophthalmologist for your routine visit, then you can request that his/her report is sent to the DVLA and so avoid using the optometrist system. This may be preferable because not only is your history known but hospitals are more likely to have both types of perimeters. Sound advice would be to try to organise your routine eye check within weeks of your licence being up for renewal. This requires a bit of forward planning but it may be worth it.
So what happened to Stephen?
On receipt of the letter from the DVLA, he immediately went to see his ophthalmologist who was very supportive and confirmed that his visual fields had not deteriorated over the years since his laser treatment. He carried out field tests with BOTH types of perimeters and Stephen appealed against the decision to revoke his licence. Several months later he received his new driving licence. But in the meantime, he had to have taxis to work everyday because he starts early in the morning and he had several months of unnecessary stress and worry to say nothing of the inconvenience and costs. The key points in Stephen’s case was that his retinopathy had remained stable for several years and he had received no further laser treatment. Other people have not been so fortunate. Clearly if there is significant visual field loss, then it is unsafe to drive but if the loss is borderline by the DVLA standards, then it is important to be aware that you do not simply give up.
But it looks as if this situation may improve…
DVLA Expert Consensus Workshop, March 2006
This workshop made various recommendations although it is not clear whether these have been adopted officially but if you are facing this situation it is well worth using them in the meantime. The Workshop recommendations show greater understanding that [a] retinopathy is not always progressive and can stabilise and [b] that some people can learn to adapt to field loss without being unsafe drivers.
The recommendations state:
- Before having the Esterman field test, you should be given full information on the procedure and appeals system. You should also be familiarised with the Esterman test before taking it and if you fail, you should be offered a repeat test on the same day.
- If you fail the Esterman test you could be offered a Goldmann test [a different instrument].
- If you fail the Goldmann test but you could show that you meet the criteria to be considered an exceptional case, you could be allowed to re-apply and have the chance to demonstrate that you have compensated sufficiently for your field loss by taking an on-road driving assessment. To be classed as an ‘exceptional case’ you would need to supply a medical opinion that your condition has stabilised and that you have learned to compensate sufficiently for your field loss.
- These alternatives should be made available so that people do not have their driving licences removed unnecessarily. However the burden of proof in showing that the retinopathy has stabilised rests with the person and not the DVLA.
- Visual fields should not be re-tested for at least 3 months after laser treatment as vision may be affected immediately after it.
- The current 3 yearly visual field testing may be too frequent for some people where there is evidence of a stable condition and a mechanism would need to be in place to identify the people where this applies.
There is a need for more evidence and further research.
Note: It appears that other EU countries have not adopted the same stringent interpretation of the EU Directive as the UK [what’s new?]. In most EU countries, it is the ophthalmic consultant that tells people whether or not they should be driving following laser treatment.