Visual field assessment and driving licence eligibility in India: A hospital-based cross-sectional study

To determine the prevalence of visual field (VF) defect among Indian driving licence (DL) holders and to evaluate their eligibility according to UK Driver and Vehicle Licensing Agency (DVLA) visual fitness standards.

Design: This hospital-based cross-sectional observational study included individuals holding a valid Indian DL who were actively engaged in driving and visiting a tertiary care center in Western India. Participants underwent detailed demographic and driving history assessment, visual acuity (VA) evaluation, comprehensive anterior and posterior segment examination, and binocular Esterman visual field testing using the Humphrey Field Analyzer. VF results were interpreted according to UK-DVLA criteria due to the absence of defined national standards. Data were analyzed using descriptive statistics.

A total of 1900 participants were included in the analysis. The mean age was 47.6 years (range, 18-82 years), and 93% were male. The best corrected visual acuity in the better eye was ≥6/18 in 99% of participants. Binocular VF defects were detected in 86 individuals (4.5%). All 86 participants with VF defects failed to meet the more stringent DVLA Group 2 criteria. Of these, 31 participants (1.6% of the total sample) also failed to meet the Group 1 criteria. VF defects were most frequent in 61-70 years (29%). Glaucoma (46.8%) was the leading cause, followed by retinal diseases (25.5%) and cataract (10.6%). Night-driving glare was reported by approximately one-third of participants.

A measurable proportion of active drivers were found to have VF defects that would disqualify them under international standards, despite having normal VA. Incorporating standardized VF testing into driver licensing and periodic renewal, with stricter reassessment beyond 40 years of age, could substantially improve road-traffic safety.