Vision & Fitness to Drive

Vision is often an overlooked component of driving fitness assessment, yet GPs are usually the first point of contact for drivers with visual concerns. With an ageing population, age-related eye disease (glaucoma, AMD, cataracts) affecting driving safety is expected to increase.

The two determining visual parameters

Visual acuity (VA) — tested with a Snellen or logMAR chart at 6 m (or 3 m via mirror), each eye separately, uncorrected and corrected. Two or more errors on a line fails that line. If glasses/contacts/orthokeratology are needed to meet the standard, a conditional licence with corrective lenses applies.

Visual fields (VF) — total area seen while looking straight ahead (central + peripheral). Screened by confrontation in general practice; formal assessment (if indicated) uses a Humphrey Visual Field Analyser (monocular) or Esterman test (binocular). A modified “roving” Esterman (no fixation required, run twice with only one false positive allowed) is used for patients who can’t reliably fixate.

Standards by licence type

Group	Licence	Private standard	Commercial standard
Visual acuity	Unconditional	≥6/12 in one eye or both together	≥6/9 better eye, ≥6/18 worse eye
Visual acuity	Conditional	≥6/12 with corrective lenses, or ≥6/24 in the better eye after specialist review	≥6/9 better eye / ≥6/18 worse eye with corrective lenses
Visual fields	Unconditional	≥110° horizontal field (within 10° above/below midline); no significant central scotoma (20°)	≥140° horizontal field; no visual field defect
Visual fields	Conditional	Horizontal field 90–110°	≥140° horizontal field, static/non-progressive loss only

Private standards apply to motorcycle/car/light rigid licences (≤8t GVM + trailer to 9t); commercial standards apply above 8t GVM and to for-hire passenger driving (buses, taxis). Conditional licences carry restrictions (e.g. local-area-only, no night driving) or requirements (corrective lenses, treatment compliance, vehicle modification) and are only issued by the state/territory driver licensing authority (DLA — e.g. VicRoads).

Monocular vision and diplopia

Group	Licence	Private standard	Commercial standard
Monocular	Unconditional	Not fit	Not fit
Monocular	Conditional	VA ≥6/12 ± correction in the seeing eye, ≥110° field, 2-yearly review	VA ≥6/9, ≥140° field, no other significant loss, 2-yearly review
Diplopia	Unconditional	Not within 20° of central fixation	Not fit
Diplopia	Conditional	Within 20° of central fixation, managed with corrective lenses or an occluder, VA/VF criteria met	Not fit

After acute monocular vision loss or acute diplopia, a 3-month non-driving period is recommended to allow adaptation (regaining some stereopsis via monocular cues, or adapting to an occluder) before a conditional licence is considered.

Visual inattention / hemi-spatial neglect

Not a discrete visual disorder in the Austroads standard, but relevant after a right (non-dominant) parietal stroke — impaired visuospatial attention affects driving safety even when confrontation visual fields test normally in isolation (deficits may only emerge with bilateral simultaneous stimulation). Avoid driving for at least 4 weeks post-stroke; resumption depends on residual impairment. Self-report is unreliable given the frequent insight deficit — specialist (neurology/ophthalmology) assessment ± formal driving assessment guides return to a conditional licence.

The GP’s role

1. Awareness of the Austroads Assessing Fitness to Drive national VA/VF standards (updated 22 June 2022).
2. Screening — don’t rely on self-report; age-related cataract/glaucoma/AMD prevalence rises with age and patients may not notice gradual or peripheral loss. Useful screening questions: trouble with road signs at night/in rain; vision feeling less sharp; bumping into objects or falls; glare from headlights; avoiding night/rain/unfamiliar-area driving; any near misses or accidents. Examine with Snellen/logMAR (uncorrected, pinhole to assess refractive error) ± confrontation visual fields.
3. Referral — GPs aren’t expected to perform formal VA/VF testing. Optometrists can refract, assess binocular vision and contrast sensitivity (Melbourne Edge test), and refer on to ophthalmology or low-vision services (e.g. Vision Australia). Refer borderline/ inadequate VA or VF to ophthalmology.
4. Mandatory reporting to the DLA varies by state/territory:
   • Vic, WA, Tas, NSW, Qld — no legal mandate on doctors; the obligation lies with the driver.
   • ACT — mandatory for heavy vehicle licence holders/applicants within 7 days if a permanent/long-term condition likely impairs driving ability (must also inform the driver).
   • NT — mandatory to notify if a licensed driver is found physically/mentally unfit.
   • SA — duty to report and notify the driver if the doctor believes they would endanger the public.
   • Failure to report where legally mandated (ACT/NT/SA) can expose the doctor to breach of statutory duty, disciplinary action and civil liability if an accident follows.
   • Elsewhere, doctors retain the right (not duty) to report drivers who refuse referral, withhold information, lack insight, or refuse to stop driving when unsafe.
   • Routine age-based medical review for private licences begins at 75 in ACT/NSW/Qld, 80 in WA; Vic/Tas/NT/SA rely on condition-based review instead.

Related conditions with driving implications elsewhere on this site

• Diplopia from thyroid eye disease — see thyroid-eye-disease.md
• Glaucoma, AMD, diabetic retinopathy visual field/acuity implications — see the respective disease pages in this category
• The general Austroads framework (private vs commercial standards, conditional licences, the GP’s reporting duty by jurisdiction) — see Fitness to Drive (Austroads)