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

Alain M Bron¹, Ananth C Viswanathan², Ulrich Thelen³, Renato de Natale⁴, Antonio Ferreras⁵, Jens Gundgaard⁶, Gail Schwartz⁷, Patricia Buchholz^8
1Department of Ophthalmology, University Hospital, Dijon, France; ²Glaucoma Research Unit, Moorfields Eye Hospital NHS Foundation Trust and Department of Genetics, University College of London Institute of Ophthalmology, London, UK; ³Private Practice, Munster, Germany; ⁴Ospedale Civile di Monselice, Monselice, Italy; ⁵Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain; ⁶COWI, Kolding, Denmark; ⁷Wilmer Eye Institute, Johns Hopkins University, Glaucoma Consultants, Baltimore, MD, USA; ⁸Patricia Buchholz Consulting, Karlsruhe, Germany

Objective: Low vision that causes forfeiture of driver’s licenses and collection of disability pension benefits can lead to negative psychosocial and economic consequences. The purpose of this study was to review the requirements for holding a driver’s license and rules for obtaining a disability pension due to low vision. Results highlight the possibility of using a milestone approach to describe progressive eye disease.
Methods: Government and research reports, websites, and journal articles were evaluated to review rules and requirements in Germany, Spain, Italy, France, the UK, and the US.
Results: Visual acuity limits are present in all driver’s license regulations. In most countries, the visual acuity limit is 0.5. Visual field limits are included in some driver’s license regulations. In Europe, binocular visual field requirements typically follow the European Union standard of ≥120°. In the US, the visual field requirements are typically between 110° and 140°. Some countries distinguish between being partially sighted and blind in the definition of legal blindness, and in others there is only one limit.
Conclusions: Loss of driving privileges could be used as a milestone to monitor progressive eye disease. Forfeiture could be standardized as a best-corrected visual acuity of <0.5 or visual field of <120°, which is consistent in most countries. However, requirements to receive disability pensions were too variable to standardize as milestones in progressive eye disease. Implementation of the World Health Organization criteria for low vision and blindness would help to establish better comparability between countries.

Keywords: driver’s license requirements, glaucoma, health outcomes, progressive eye disease