International vision requirements for driver licensing and disability pensions: using a milestone approach in characterization of progressive eye disease

Figures & data

Table 1 Driver’s license requirements in Europe

Country	Visual acuity	Visual field	Monocular vision	Other characteristics
EU	0.5 both eyes and with corrective lenses	No less than 120°	VA ≥0.6 if monocular vision	Exceptions can be made by medical opinion
UK	Number plate test (≈6/10 to 6/15)*	At least 120° horizontally (no significant loss within central 20°)	Monocular vision if normal visual field	License must be revoked if standards not met (exceptions possible under EU standards)
Germany	Corrected VA not below 0.5 in the best eye, 0.2 in the worse eye	At least 120° horizontally (perfect within 30°)	If monocular or worse eye below 0.2: best eye at least 0.6 VA
France	Binocular acuity not lower than 0.5	Horizontal: 60° right and left; vertical: 30° above and below	If monocular or worse eye below 0.1: best eye at least 0.6 VA	Night vision necessary; can be exceptions for restricted daytime licenses
Spain	Best-corrected VA of at least 0.5	Visual field has to be normal	Monocular vision not allowed; exceptions if at least 0.6 VA	Restrictions can be determined by medical experts
Italy	Best-corrected binocular VA at least 1	Normal field of vision (such as 120°)	Worse-seeing eye at least 0.2	Sufficient chromatic sense and nocturnal vision

* Note: 0.4 to 0.6 in decimal fraction.

Abbreviations: VA, visual acuity; EU, European Union.

Table 2 Driver’s license requirements in the US

State	Visual acuity	Visual field	Monocular vision	Other characteristics
All states	Most states: 20/40 (one or both eyes)*	Some states: none; most states: 110° to 140°	20/40 to 20/100*** (20/40 in most states)	Most states allow for restrictive licenses
California	20/40 with or without corrective lenses	No visual field requirements	Tested for both eyes together and for each eye separately	A vision specialist can determine ability to drive
New York	20/40 vision in at least one eye with or without corrective lenses	If VA between 20/40 and 20/70**: 140° field of vision		A vision specialist can determine restrictions
Iowa	At least 20/40 vision in at least one eye, with or without corrective lenses	140° or better		20/40–20/50****: no headlights driving; 20/50 but at least 20/70: no driving over 35 mph

* Notes: Decimal fraction equivalent: 20/40 = 0.5;

** 20/70 = 0.3;

*** 20/100 = 0.2;

**** 20/50 = 0.4.

Abbreviation: VA, visual acuity.

Table 3 Eligibility for disability pension benefits

Country	Partially sighted	Blind
UK	VA of 3/60 to 6/60 with a full field, or 6/24 with field contraction, aphakia, or opacities blocking vision	VA of 3/60 or 1/18, or 6/30 to 3/60 with a very restricted visual field, or 6/18 or better with marked contraction of visual field
Germany		Central BCVA of 1/50 in the better eye
France	VA <3/10 and >1/20	Central vision ≤1/20 of one eye, and VA of the fellow eye below 1/20, with peripheral visual field deficiency when the visual fields do not exceed 20° in the largest area
Spain	1/10 on a Wecker scale, visual field reduced to 10° or less	N/A
Italy	1/20 or lower for both eyes	Absolute blindness
US	BCVA of 20/200 in the better eye, or limitations in the fields of vision no greater than 20°	N/A

Abbreviations: VA, visual acuity; BCVA, best-corrected visual acuity; N/A, not applicable.

Figure 1 Example of how revocation of the driver’s license and entitlement to disability pensions could be considered milestones. The downward-sloping line represents progression of visual impairment over time.

Figure 2 Driver’s license forfeiture and entitlement to disability pensions can be used as endpoints in clinical trials. The results may be reported as time saved due to delaying milestones.