Driven to Distraction

So finally, we have in place a DVLA visual standard that makes some sense. Drivers may not drive a private vehicle with corrected binocular VA of less than 6/12 (Snellen) and an Esterman pass.

At our practice, optoms are required to record binocular vision for every patient. Not only is this good practice, it informs our dispensing and our advice about driving. Yet we never cease to be amazed by some patients’ approach to the need for distance correction.

Many of you will have frightening tales about patients driving without correction. I recall a gentleman in his mid-80s with +4.50 / -4.50 R&L, swearing blind that he didn’t need glasses for driving, and he didn’t care what the optometrist or the DVLA said. When asked what he would do in the event of a crash, he said “If that happened, I would quickly put my glasses on so the police would never know”!

Or a lady who brought her children in for examination. She’d never had an eye exam herself before…. and turned out to be -9.00 / -3.00 R&L! She was offered a complete pair of specs on an emergency basis for just £25; she said she’d think about it, and then drove her children home again…

For patients such as these, the rewards (freedom, independence) of driving outweigh not only the risk of causing harm by driving with poor vision, but also the risk of being caught. What is it that makes these patients so resistant to wearing vision correction? Since when has it been acceptable to pilot 1.5 tonnes of metal around, sometimes at motorway speeds, with no thought or care for themselves or other road users? And why are some people content to drive around with vision that is ‘borderline’, or ‘just about good enough’?

I’m not suggesting that making the DVLA standard stricter, or requiring eye examinations for all drivers at regular intervals, would transform road safety in this country overnight. Safe driving is a highly complex process that requires many co-existing skills and abilities, of which good vision is but one element. But 6/12 is the VA one might expect from a young patient with +1.00 blur (it’s called ‘blur’ for a reason!), or perhaps an older patient with moderate cataract. Is this really good enough?

If you drive a Class 2 vehicle it isn’t good enough (the DVLA now require binocular VA of 6/7.5) – but is this a valid distinction? Given the choice of being mown down at 40mph by a 40-tonne juggernaut or a Nissan Micra, I’m not sure the end result would differ hugely…

Until recently, the UK had a driving standard roughly comparable to 6/10 (Snellen), so this new standard appears to be a slight relaxation of the rules. The number plate test does give the police a roadside tool and is easy for patients to self-monitor; but for me, the real questions include:

Is the best-corrected acuity requirement sufficient to enable the driver to read road signs and spot hazards – at a distance which allows them to process the information and to react, regardless of the ambient light conditions?

Is the visual field full enough for effective and useful hazard perception, and sufficient for more general awareness and judgement?

Do we have a system that ensures all drivers’ vision is regularly assessed, and is there a clear and effective pathway for sharing our findings with the relevant authorities for the prevention of harm?

Are the penalties for ignoring the visual standards a sufficient deterrent?

Consistency in applying the standards is another issue. A patient of mine was a driving instructor who had a significant vascular event, leaving him with 6/24 vision in his better eye (he was amblyopic in the other). Esterman was an ‘epic fail’. His ophthalmologist said he probably shouldn’t drive a car any more… but he was OK to ride a motorbike!

However, the biggest issue – and the most controversial – is where the responsibility lies for communicating visual concerns to the DVLA. The responsibilty is currently the patient’s… meaning we expect patients to sign the death warrant for their own driving license.

The problem is the issue of medical confidence. There are guidelines in place which allow practitioners to contact the DVLA when it is believed that the patient may pose a danger, either to themselves or others. The advice is to contact the AOP before taking such action, and to ensure that the patient’s GP is informed.

I know the ‘Jolly Green Giant’ receives, shall we say, mixed press amongst their fellow professionals. But Specsavers’ ongoing campaign to raise awareness of drivers’ vision through roadshows etc., should be lauded.

This latest development provides a welcome update to the driving standard, but to me it still falls short, and feels as though we’re lagging behind some of our more progressive neighbours (even the French have a legal requirement to carry spare specs in your car at all times, if you are required to wear correction for driving). Is this an example of our professional bodies being insufficiently robust in their lobbying?

To stimulate further conversation, there are some interesting comments toward the end of this consultation document.