Drivers with visual field loss in one Australian licensing jurisdiction
Keywords: Old Road Users
Submission Date: 2007
In Australia, the presence of a visual field deficit condition requires assessment by an optometrist or
ophthalmologist before an individual can be considered fit-to-drive. However, there are currently
limitations in the validity of tests and criteria used for assessing vision for safe driving. This paper
examines the scope of the problem in one Australian jurisdiction by identifying the prevalence of visual
field loss (VFL) amongst drivers referred for medical review and describing the current practices for
managing their licence review. A random sample of medical review cases was extracted from the
VicRoads Medical Review database to identify cases involving VFL conditions: glaucoma, age-related
macular degeneration, diabetic retinopathy, hemianopia/ quadrantanopia and retinitis pigmentosa.
Data on demographic information, visual field loss conditions and the referral process were collected
for all identified cases.
A total of 170 cases (2.0% of 8295 total medical review cases) with visual field deficits were identified.
Of these, 23 (14.7%) were involved in crashes and referred to VicRoads on this basis. Of these cases,
124 (72.9%) were assessed by either an optometrist or ophthalmologist. The most commonly used
ophthalmological tools for assessing field loss included the Humphrey Field Analyzer (n=42, 26%);
Esterman (n=16, 10%) and Goldman (n=7, 4%) visual field tests. In 89 (55%) cases, licences were
continued unconditionally, 42 (26%) were discontinued, 14 (9%) were made conditional, and in 18
(11%) the decision was pending further review.
Drivers with visual field loss tended to be older and the majority had co-morbid conditions. There was
considerable variation in the methods for assessing visual deficits. Despite the Austroads Fitness to
Drive recommendations, 27.1% of cases were not referred for further assessment by an optometrist or
ophthalmologist. Though some of these drivers may have surrendered their licences or had them
discontinued on the basis of other reasons, 22 (13.9%) of these drivers had their private car licences
continued and one driver had a commercial licence continued on a conditional basis without specialist
vision assessment. Five cases had their private licences discontinued based on static perimetry alone.
In two of these five cases, the drivers were contesting the decision made by VicRoads. These
findings are discussed in the context of the current medical review guidelines in Australia.