Current ophthalmological norms for drivers – how does Poland compare with other countries?

INTRODUCTION

Wilhelm II Hohenzollern, the last German Emperor and King of Prussia, famously said “The automobile is no more than a transitory phenomenon. I do believe in the horse”. He was mistaken. Cars have become an object of common use rather than a fleeting fad. Driving a car is fast and comfortable, and after internal border controls within the European Union were lifted, countries that seemed far away became easier to reach. We tend to travel more, and over longer distances. We clock up hundreds or even thousands of kilometers behind the wheel. However, to do this, we must meet certain health conditions, especially with regard to the organ of vision. The development of fair minimum requirements with regard to the visual standards that must be met by drivers in order to be able to drive safely on the road has been an age-old dilemma [1, 2]. Each country has its own specific requirements applicable to drivers [3]. In Poland, the issue is regulated by the Ordinance of the Minister of Health of 30 August 2019 on the medical examinations of applicants for a driving licence and drivers (Polish Journal of Laws 2019, item 1659) [4]. Since one of the priorities of the European Union (EU) was to harmonize the laws of the Member States, an attempt was made to develop joint recommendations in a number of areas. One of them is transport – including road transport. In order to systematize the driving licence regulations in different EU Member States, on 20 December 2006, the European Parliament and the Council of the European Union adopted Directive 2006/126/EC [5].

DISCUSSION

In Poland, the ophthalmic examination in applicants for a driving licence should include:
– detailed ocular history (prior eye diseases, injuries, surgical procedures; wearing glasses or contact lenses),
– visual acuity with and without correction,
– binocular visual acuity after correction,
– visual field,
– color vision,
– binocular vision.
In justified cases, additional ophthalmic examinations may be required, including:
– mesopic vision,
– glare sensitivity,
– contrast sensitivity.
Annex 2 to the Ordinance of the Minister of Health of 29 August 2019 on the medical examinations of applicants for a driving licence and drivers (Polish Journal of Laws 2019, item 1659) precisely defines the ophthalmic standards in this area [4].
Detailed ophthalmologic criteria related to licensed drivers and applicants for driving licences are listed in Tables I and II (for different driving licence categories).
In the European Union, all matters relating to driving licences are set out in detail by Directive 2006/126/EC of the European Parliament and of the Council of 20 December 2006 on driving licences (with subsequent amendments, the latest adopted on 22 July 2018). Annex III of the Directive contains a precise specification of the minimum standards of physical and mental fitness for driving power-driven vehicles [5]. Detailed ophthalmic parameters recommended by the EU for licensed drivers and applicants for driving licences are presented in Tables III and IV.
It is important to note that the EU does not impose unified health requirements applicable without exception to licensed drivers and applicants for driving licences across the EU’s Member States. What is more, section 5 of the above-mentioned Annex provides that the standards set by Member States for the issue or any subsequent renewal of driving licences may be stricter than those set out in the Annex [5]. In view of the above, I have collected in Table V the legal vision requirements in force in the largest EU countries (Germany, France, Italy and Spain), in the United Kingdom, which was an EU Member State until 31 January 2020, and in Switzerland [3, 6-8].
How does Poland compare against the largest European powers in this field? It must be stressed that the ophthalmic examination which is mandatory in applicants for driving licences in Poland is very detailed. In addition to visual acuity, visual field and binocular vision tests, a color vision test is also required, and in justified cases mesopic vision and glare sensitivity are additionally evaluated [4]. In most EU countries (Poland included), the required binocular visual acuity for category A and B vehicle drivers is 0.5 on the Snellen eye charts [3, 4, 6, 7]. Only Italy deviates significantly from this value, requiring full visual acuity in the better eye [3]. Globally considered, this is quite unique, with only Turkey having such strict regulations [9]. It is interesting to note that the UK has a dual standard of visual acuity assessment. Drivers must be able to read a number plate from a distance of 20 meters or, a more professional option, have a binocular visual acuity of at least 6/12 [7, 10]. In addition, it is worth noting that under the EU recommendations it is common for Member States to allow individuals with monocular vision to apply for a category A and B driving licence [3-7]. Poland has also implemented these guidelines by enacting the Ordinance of the Ministry of Health of 23 December 2015 [11]. Before that, normal binocular vision was a mandatory requirement for drivers of category A vehicles [12].
Currently, cars are a popular means of transport at all latitudes, but each country individually determines the minimum visual requirements for drivers [3, 9, 13]. The requirements in place in six selected US states, as well as in Canada, Japan, Australia, Israel, Mexico and India, are summarized in Tables VI and VII.
In the United States, there are no federal recommendations applicable to drivers akin to the EU regulations. Each US state has its own requirements for drivers [3, 13]. Most commonly, the minimum visual acuity should be 20/40 (0.5 decimal), though in some states it may be lower, subject to meeting additional requirements. A visual field test is not mandatory in every US state, one such example being California. Normal color perception may be required in some states (Texas, DC), but only in applicants for a driving licence [3, 13]. It is important to note that there are considerable differences in the minimum visual acuity requirements applicable to drivers across the world’s major countries, ranging from 6/18 in India to 20/50 (0.4 decimal) in Canada and 0.7 in Japan, an even 20/25 (0.8 decimal) in Mexico [9, 13]. Substantially less variation is seen in the requirements for visual field. Typically, the horizontal visual field should be at least 120°, though in Japan it must be wider, at least 150° [13].

CONCLUSIONS

The minimum legal visual requirements for drivers which are currently in place in Poland are set out in the Ordinance of the Minister of Health of 30 August 2019 on the medical examinations of applicants for a driving licence and drivers, and are aligned closely with the recommendations of the European Union laid down in the latest amendment to Directive 2006/126/EC of the European Parliament and of the Council on driving licences. With few exceptions, the requirements applicable to drivers in other European countries are similar to those in force in Poland, which is directly related to the current EU recommendations. However, considerable variation can be observed across other countries of the world, which may be due to different prevailing cultural traditions.

DISCLOSURE

The author declares no conflict of interest.