Vision

Question 1

Can monocular drivers be certified for interstate commerce without the need for an exemption?

Answer 1

yes

Question 2

Is the vision standard discretionary or nondiscretionary?

Answer 2

Nondiscretionary
medical examiners have no discretion at all when applying the vision standard.

Question 3

What are the required tests to check vision?

Answer 3

1. Visual acuity (Snellen chart, Titmus)
2. peripheral horizontal visual fields
3. color vision
   you have to check all three of these things for a driver, and the driver has to meet the standards for each in order to be certified.

Question 4

Who can do the vision testing?

Answer 4

-Medical examiner
-ophthalmologist
-optometrist

If the ophthalmologist or optometrist does the vision test, they must sign and date the report. The report must also have the printed name, phone number, professional license number, and state of issue of the specialist.

If the driver does the vision test using corrective lenses, then the driver certificate must indicate that corrective lenses were used; the driver must wear corrective lenses while driving if they use the corrective lenses to meet vision test qualifications.

Question 5

What’s the minimum standard for central visual acuity?

Answer 5

20/40 in each eye and both eyes together

Question 6

What’s the minimum standard for field of vision in the horizontal Meridian?

Answer 6

Driver must have at least 70 degress in horizontal meridian for each eye.
If test results are inconclusive, send pt to optometrist or ophthalmologist.

Question 7

What are telescopic lenses, and why do they matter for DOT testing?

Answer 7

Telescopic lenses redirect peripheral vision to compensate for losses central vision.

They are not acceptable corrective lenses for meeting commercial driving qualification requirements.

Question 8

What’s the minimum standard for color recognition?

Answer 8

Driver must be able to distinguish between green, amber, and red
driver does not have to have true color perception

Question 9

What is retinopathy?

Answer 9

-Noninflammatory damage to the retina
-the most common cause is diabetes-
-retinopathy usually indicates that a systemic disease is present, most often diabetes
-presents with splotchy vision loss

Question 10

How does retinopathy affect DOT certification?

Answer 10

If the patient is able to become certified, they must have:
-annual medical exam
-annual eye exam by ophthalmologist or optometrist
patient is disqualified if they have diagnosis of unstable proliferative retinopathy.

Question 11

What is the process by which cataracts distorted vision?

Answer 11

-The lens becomes cloudy
-cloudiness of the lens distorts passage of light to retina
-vision then becomes cloudy or hazy, and night glare is common

Question 12

Can a patient who has cataracts become certified?

Answer 12

They may be certified after surgical correction of the cataracts.
Treatment involves surgical removal of the cataracts and then placement of intraocular lenses.

Question 13

What is aphakia?

Answer 13

-lens is absent
-causes person to be able to see UV ligt wavelengths not normally seen by the eye
-leads to loss of accommodation and hyperopia (nearby objects look blurred, while the distant objects are more clearly visible)

Question 14

How does glaucoma damage vision?

Answer 14

-Glaucoma simply means increased pressure in the eye city; it causes atrophy of optical nerves
-can because the diabetes
-can cause loss of peripheral vision, which cannot be restored
-side effects of agents to treat glaucoma may interfere with safe driving

Question 15

What is the leading cause of untreatable blindness in the US?

Answer 15

macular degeneration

Question 16

How does macular degeneration alter vision?

Answer 16

-Damages detail in the person’s central vision
-does not normally affect peripheral vision

Telescopic lenses can be used to help these patients. They redirect the peripheral vision to compensate for loss of central vision. However, telescopic lenses are not acceptable for driving.

Question 17

What does it mean to say somebody has monocular vision?

Answer 17

They meet vision requirements in only one eye. Monocular vision is disqualifying. However, if the driver is otherwise medically qualified, they do have the option to apply for a federal vision exemption.

Monocular vision is a problem in part because it causes a decrease in peripheral vision and in the depth of the field of vision.

Question 18

Name the four different visual problems that would disqualify a driver from being certified.

Answer 18

1. Monocular vision (patient meets vision requirements in only one eye)
   Note: a driver with monocular vision who is otherwise medically qualified can apply for a federal vision exemption.
2. Driver fails any of the vision tests with one or both eyes
3. Driver uses contact lenses specifically designed such that one corrects for distance and one corrects for near acuity
4. Driver wears telescopic lenses

Question 19

The federal vision exemption program applies to drivers with monocular vision. Exemption is issued for a maximum of of how many years?

Answer 19

-The exemption is issued for two years and is renewable; however, the driver can be certified only for ONE year at a time
-the exemption is renewable
-driver must have an annual eye exam by an ophthalmologist or optometrist
-driver must show valid exemption certificate and required specialist medical report to the medical examiner
-driver must meet all other physical requirements
-driver’s better eye must meet all vision requirements

Question 20

Who is responsible for ensuring that the driver has the required documentation?

Answer 20

The motor carrier

Question 21

When taking the health history, what must you document and explain?

Answer 21

-eye disorders
-any visual impairments (not including corrective lenses)

Question 22

If a pt has a condition causing visual impairment, what should you ask?

Answer 22

-what sxs are related to or caused by the eye dz?
-if the pt is using eye drops/eye meds, discuss:

*possible side effects (e.g. stinging, blurring,HA, allergic rxn, photosensitivity, decr night vision, etc)
*req waiting time betw administration of ophthalmic preparations/eye drops and driving
*is treatment having the desired effect?

Question 23

What details should you mention in the physical exam?

Answer 23

-are pupil sizes equal and react to light? accommodation?
-ocular motility
-ocular muscle imbalance
-extraocular movements
-nystagmus
-exophthalmos
Mention any abnl findings, even if not disaqualifying.

Discuss importance of regular eye exams.

Question 24

When taking the PMH, what should you ask about with regards to eye health?

Answer 24

retinopathy
cataracts
aphakia
glaucoma
macular degeneration

Question 25

What regulation addresses the monocular vision study?

Answer 25

49 CFR 391.64

Question 26

Describe the perk that a person who participated in the monocular vision study receives, especially if such a person has monocular vision.

Answer 26

-these participants have been given a one time letter by the FMCSA and are grandfathered into the Federal Exemption Program
-driver must carry the letter while driving and must show it to the medical examiner
-the driver’s better eye must continue to meet the vision requirements
-the driver must meet all physical qualification requirements
-driver receives a 2 year renewable exception
-the examiner marks the medical examiner’s certificate with “Qualified by operation of 49 CFR 391.64 checkbox”. Document this on both the Medical Exam Report Form and the Medical Examiner’s Certificate.