Occupational Visual Standards

Question 1

British Army vision requirements?

Answer 1

o In addition to regular army medical requirements applicants for Army Air Corps pilot training have to meet further criteria in order to be considered:
 Visual acuity without spectacles: 6/12
 Visual acuity with spectacles: 6/6, Lens power: -0.75 to +1.75 dioptres
 Astigmatism: Max of 0.75 dioptres
 Colour perception: Ishihara test pass
 Laser eye surgery is not currently accepted

Question 2

Royal Air Force Vision Requirements?

Answer 2

o Spectacle or CL correction must not be greater than -6 dioptres or +6 dioptres in any meridian.
o If px has impaired colour perception (colour blindness) it won’t prevent them from joining the RAF, but it may limit what roles you can choose.
o Patients with any of the conditions listed below, will not be able meet the current medical standard required to enter RAF service:
 Eye disease, for example glaucoma, keratoconus, retinitis pigmentosa Double vision (including ophthalmic migraine)
 Visual field defects or blind spots
 Corneal grafts or recurrent corneal ulcers
 Cataract or cataract surgery
 Detached retina
 Vision only in one eye
* Requires good stereopsis to be able to land
* Need good accomm to look at dashboard but also good distance vision to look into distance to see what’s ahead of them
 Squint surgery in the previous six months
 Laser eye surgery in the previous 12 months or below the minimum age of 22 at application
 Any eye disorder which causes a disability (including eye injury which reduces function)

Question 3

Royal Navy Vision Requirements?

Answer 3

o Minimum standards for uncorrected & corrected vision vary for different branches in Royal Navy and are determined by Royal Navy medical staff.
o As a guide, whatever branch px is applying for, excluding the role of chaplain, their spectacle or contact lens correction must not be greater than +/- 6.00 dioptres.
o For chaplains (pastors) the correction must not be greater than +/- 7.00 dioptres.
o Patients with impaired colour perception may be restricted the branches that are available to them.

Question 4

Police Vision Requirements?

Answer 4

• Always changing so keep up to date
• Common vision standards for police force:
  o Unaided vision in one eye: 6/36
  o Refractive surgery
  o Corrected distance vision in either eye: 6/12
  o Corrected distance vision binocularly:
   6/6
   LASIK, LASEK, PRK, ICRS and Epiflap are all acceptable six weeks post-op provided there are no residual side effects, & visual standards are met.
   Radial keratotomy, arcuate keratotomy and corneal grafts are not acceptable.
  o Colour vision:
   Monochromats & use of colour correcting lenses are not acceptable.
   Anomalous trichromats and dichromats are, but you’ll need to make appropriate adjustments and pxs that fall into these groups may be restricted to certain jobs.
   All the usual colour vision tests (Ishihara, City etc) are acceptable, though borderline cases will need to be assessed with the Farnsworth D15 test in future – Farnsworth D15 will be applied to people who were borderline on Ishihara, throughout their career to monitor their colour vision
  o Eye conditions:
   A hx of a detached retina or glaucoma is not acceptable (even if it’s been treated)

Question 5

Electrical Engineering Requirements?

Answer 5

• Electricians & telecoms engineers are routinely screened for colour vision defects
• Electricians are typically required to have ‘normal’ colour vision to be accepted, with some companies requiring no more than two incorrect plates using the Ishihara test
• Colour vision is important in profession because colour coding is widely used in electronics and electrical engineering and has significant safety implications
• Colour coding is used to differentiate most resistors and capacitors, and the telecommunications industry extensively use colour-coded wires, which means errors in identification can have serious consequences
• Occupational requirements:
  o While responsibility lies with potential employer to ensure their employees meet colour vision standards, if a px who is interested in entering electrical engineering or telecoms industry comes into your practice, they must take a colour vision test. Or they may bring a colour vision form issued by their college or employer that you may need to fill out.
• Testing for colour vision:
  o When there is an occupational need for the testing of colour vision, ensure that px is not wearing colour-enhancing appliance, e.g. X-Chrom or Chromagen lenses
  o In some instances, it may be difficult to differentiate these lenses from other, cosmetic tints being worn either as spectacles or contact lenses
  o Most occupational requirements do not permit use of such lenses to enable candidate to pass a colour vision test
  o If a colour vision test was passed with use of such an appliance, the optometrist should note this on the report form
  o In many places, standards require a Holmes-Wright or Giles-Archer lantern test for colour vision. Neither of these devices have been manufactured for many years and very few still remain in working order.
   The Clinical Aviation Marine (CAM) lantern test represents a modern alternative to these tests and has been calibrated to give similar results. The CAM lantern may be used in place of the above lanterns where appropriate. The CAM lantern is manufactured by Evans Instruments Ltd and comes with instructions to simulate the results of the older lantern tests.

Question 6

Describe driving & the DVLA?

Answer 6

• Patient confidentiality is the most important factor (GDPR)
  o But in some exceptional instances disclosing patient information is allowed
  o If patient no longer meets visual standard to hold a driving license, but refuses to stop driving, you may need to let the DVLA, but only once you’ve sought advice because protecting your patient’s confidentiality is paramount.
• Following eye test procedure:
  o During an eye test, if it becomes apparent a patient no longer meets the sight requirements to hold a driving licence, you should inform your patient and clearly advise them to cease driving with immediate effect.
  o Find list of visual disorders which disqualify person from holding driving licence in DVLA’s ‘At a glance guide to the current medical standards of fitness to drive’ and advice on specific conditions on gov website
• Keeping patients informed:
  o Patient is legally required to inform DVLA when they no longer meet requirements for holding a relevant licence.
  o If patient does not inform DVLA of their condition and continues driving, explain your findings and the affect on their ability to drive safely to your patient in writing. Send your letter recorded delivery and keep a copy of it with your patient’s medical records.
• Guidelines on disclosing patient information:
  o If you can’t persuade your patient to stop driving, or you are aware that they are still driving against your advice (ie the patient tells you they intend to drive, or if you see them driving), you must consider bringing it to the attention of the DVLA without the patient’s consent.
  o But, before you notify the relevant authority, seek legal advice because the decision should be taken as a last resort after all attempts to persuade your patient to disclose their condition voluntarily have been unsuccessful.
• Sharing patient information:
  o If public interest outweighs your duty of confidentiality towards your patient, and once you have sought advice, you can start taking the relevant steps to notify the DVLA.
  o Before taking action, inform patient and their GP of your decision, enclosing a copy of the letter you intend to send the DVLA, which is in line with the good practice under the General Optical Council’s (GOC).
  o When notifying DVLA of your findings, include copies of the relevant records that act as evidence.
  o Inform the patient once you’ve been in touch with the DVLA.
• Protecting patient records:
  o Whether you decide to disclose confidential information to the DVLA or not, it is important that you’re able to show that you have fully considered the issues involved and have good reasons to support your decision. It is important to keep full and detailed notes with your patient’s records explaining your decision

Question 7

Describe vision requirements for Group 1 Drivers?

Answer 7

• Drivers must be able to read (w/ glasses or CLs if necessary) a car number plate made after 1 September 2001 from 20 metres and have a VA of at least 6/12 measured on the Snellen scale (0.5 decimal), with glasses or contact lenses if necessary, using both eyes together.
• Sight in one eye:
  o Drivers may still be able to meet the minimum eyesight standard for driving if they have sight in one eye only. They must meet the above requirements in that one eye to meet the vision standard for driving.
• Standards for field of vision:
  o VF requirements for safe driving are defined as ‘a field of at least 120° on the horizontal measured using a target equivalent to the white Goldmann III4e settings
  o There should be no significant defect in the binocular field which encroaches within 20° of fixation above or below the horizontal meridian.
• Cataracts:
  o If cataract only affects one eye drivers do not need to tell DVLA provided they have no medical condition in the other eye and they are still able to meet the ‘visual standards for driving’.
  o If cataract affects both eyes, drivers should complete form V1V and send it to the DVLA.
  o Drivers must tell DVLA by filling in the form V1 and sending it to them
• Glaucoma:
  o If glaucoma only affects one eye drivers don’t need to tell DVLA provided they have no medical condition in the other eye and they are still able to meet the ‘visual standards for driving’
  o If glaucoma affects both eyes, drivers should complete form V1 and send it to DVLA

Question 8

Describe vision requirements for Group 2 (Category C&D) Drivers?

Answer 8

• Find out the vision requirements for group 2 HGV and bus drivers
• Specific requirements for patients interested in driving a lorry or a bus
• HGV, lorry and bus drivers must have a VA at least 0.8 (6/7.5) measured on the Snellen scale in their best eye and at least 0.1 (6/60) on the Snellen scale in the other eye.
  o Glasses or CLs can be worn to reach this standard but they can’t have a spec power >+8D (there is no restriction on CLs power).
• Patients must have a horizontal visual field of at least 160 degrees, the extension should be at least 70 degrees left and right and 30 degrees up and down. No defects should be present within a radius of the central 30 degrees.
• Anyone who drives a bus or HGV must tell Driver & Vehicle Licensing Agency (DVLA) if they have any problems with their eyesight that affects either eye.
  o Drivers must tell DVLA if they have cataracts in one or both eyes.
• Visit ‘Important AOP advice on completing the DVLA D4 medical form’ for more information on managing Group 2 drivers. You can also visit the DVLA’s health conditions and driving section

Question 9

Describe vision requirements for lifeboat crew members?

Answer 9

• Find out about the vision requirements for lifeboat crew members
• Due to the extreme conditions of going to sea, there are vision requirements for anyone who works in lifeboat crews, or as a lifeguard.
• Any applicants failing to meet the criteria are unlikely to be issued with a Royal National Lifeboat Institution (RNLI) medical certificate and be able to work in the role.
• VA requirements:
  o A px won’t qualify if they are unable to read 6/6 in the better eye and 6/12 in the worse eye on the Snellen Chart at six metres distance even with glasses or contact lenses, or if they are unable to read 6/60 with at least one eye without any visual aid. They can’t have defects in the field of vision in either eye, any evidence of any progressive disease in either eye, or suffer from any other eye condition that could limit vision, like double or tunnel vision, either now or within the next five years.
• Colour vision requirements:
  o Require good colour vision to be able to gain a medical certificate to perform role.
  o Lifeboat crew members are tested to see if they have a colour vision defect, using Ishihara plates, and patients taking the test can fail on up to two plates and still constitute as a pass

Question 10

Describe vision requirements for lift truck drivers?

Answer 10

• Fitness to operate:
  o Those with monocular vision may vary in their ability to compensate for their impairment in order to operate a lift truck safely.
  o Fitness to operate a lift truck cannot be assumed and should be determined following lift truck operating tests and relevant other medical assessments. This approach should also be adopted for any experienced operator who becomes monocular, after allowing a period of adaptation.
• Uncontrolled diplopia will disqualify individual from operating a lift truck.
  o Only once satisfactory control of symptoms have been achieved, they can resume their work assuming regular review of symptoms are taking place.
• Detailed advice on medical standards of fitness to drive can be found on the DVLA website.
• Find out about the vision requirements for lift truck operators
• As there are some risks in the work carried out by lift truck operators, certain vision requirements exist for employees of the profession, some of which can be adapted to individual circumstances.
  o While DVLA don’t have responsibility for licensing lift truck operators provided they don’t drive lift trucks on public roads, you can consult the DVLA website if want more information about an individual’s fitness to operate a lift truck.
• Vision requirements:
  o Operators must be able to read in good light, with the aid of glasses or contact lenses if required, a vehicle registration mark at a distance of 20.5 metres with both eyes together
   This corresponds to VA of between 6/9 and 6/12 on the Snellen chart

Question 11

Describe vision requirements for teachers?

Answer 11

• Find out the UK vision requirements for teachers
• According to the Department of Education (DoE), there are no visual requirements for becoming a teacher. Reasonable adjustments must be made by employers to assist anyone with sight-impairment or severe sight-impairment to teach effectively.
• Teachers are, however, required to be able to plan, prepare and assess lessons, communicate effectively and respond to the needs of their pupils, without putting at risk the health, safety and welfare of children.
• If a patient requires further information on the sensory requirements within teaching, they can find out more by contacting individual course providers. For more information visit the Get Into Teaching website.
• Quite inclusive profession compared with other professions e.g. have good hearing but partially sighted, quite easy to compensate to prepare good lessons