Last week, 72-year-old John Place was jailed for four years after he killed three-year-old Poppy-Arabella Clarke and injured her mother Rachel at a pelican crossing. Place, who was not wearing his glasses and only stopped when flagged down by another driver, had been told his eyesight was so poor that he should not drive, even while wearing glasses. Two optometrists had advised him not to drive and he unequivocally said he would keep driving until his wife retired in the months following.
A truck driver with poor eyesight was jailed last month after ploughing his 44-tonne lorry into a JCB digger on the A1, killing flying instructor Stephen Clarehugh. John Rogerson, 72, said he did not see the vehicle, which was doing 20mph in front of him on the road in Northumberland at sunset. Less than three weeks before the crash, an optometrist had said his vision was below the required standard for driving.
Diabetic bus driver Stephen Thompson, 49, who knocked down and killed a great-grandfather after repeatedly lying to bosses about his vision problems was jailed for 12 months in February. The court heard Thompson was diagnosed with type 2 diabetes in 1999 and suffered deteriorating health problems, including with his eyes and feet, which were not disclosed to the DVLA or his bosses.
All three cases highlight that patient self-certification for vision-related issues is no longer working.
Tighter regulation
Road safety organisation GEM Motoring Assist (GEM) is the latest to call for better regulation of eyesight testing for drivers and said new measures would cut collisions and make Britain’s roads safer. GEM said a detailed test of a driver’s visual acuity and visual fields should be required every 10 years.
The call followed a survey of more than 1,000 of its members, 87% of which said compulsory eye testing would lead to safer roads.
GEM road safety officer Neil Worth said: ‘The time has come to accept that the current driver eyesight test simply isn’t fit for purpose. What’s more, it is certainly no longer acceptable for drivers to self-certify.
‘If you can’t see effectively, you shouldn’t be driving, but the truth is that there are many drivers whose eyesight has deteriorated to very dangerous levels.’
The organisation said it would ideally like to see compulsory eyesight tests every two years, particularly for drivers 40 and above. However, it deemed the most practical measure would be a test of visual acuity and field of view every 10 years, which would fit in with licence renewal. This, GEM said this would make the revisions ‘practical and enforceable.’
Worth continued: ‘Even DVLA guidelines to medical professionals state that eyesight can decline gradually and unnoticed, with people losing up to 40% of their visual acuity without being aware of deterioration.’
‘Many more people are staying behind the wheel into their 80s and beyond. This, coupled with the greater volume of traffic and an increase in distractions, both inside and outside the vehicle, points to the clear need for more regular and detailed eyesight testing.’
The Association of Optometrists said the issue was on the GOC’s agenda at recent meetings that it would refresh its own guidance soon.
Henry Leonard, clinical and regulatory officer at the AOP, said: ‘The fact that a 17-year-old who can read a number plate when they take their driving test may continue driving for the rest of their life with no further vision checks means drivers can fall below the required standard as their eyesight changes over time, often without realising.
‘In the UK there is currently no requirement for drivers to have regular sight tests, and we believe that making this compulsory for all motorists would help ensure drivers’ vision meets the required standards, reducing the risk of these types of incidents.’
Privacy in practice
College of Optometrist guidance (see panel opposite) outlines that it is the legal responsibility of the patient to tell the DVLA if he or she is unfit to drive, as well as offering advice on telling the patient that their vision falls below the minimum standards.
In practice, explaining this to patients can be troublesome, as OO Vivian Bush (pictured left), of Bush the Opticians, outlined: ‘In community practice, where one might have a close relationship with patients, often formed over many years, the predominance is among people with borderline vision.
‘They may be “the only driver” upon whom a wife or husband has become dependent. They may “just use the car for a weekly shop,” and “never go far,” and they may plead, “don’t tell me I can’t drive, I don’t know what we’ll do living where we are,” shifting the burden onto the optometrist’s shoulders.
‘Therefore it is essential to be sure about their best possible vision, and have a go at reading some number plates on the street. If those are plainly impossible, it brings the message home loud and clear. Questions about whether the family have any concerns are well worth asking. It often transpires that relatives are worried, not only about vision, but general alertness and ability to cope on busy roads.
‘Usually, with time and patience, the gravity of the situation becomes increasingly apparent, even to the most stubborn patient. However, given a worst-case scenario of someone whose sight makes them a hazard to human life, my view is that our duty to society exceeds anything else.’
In the event of the patient failing to adhere to advice from an optometrist, the AOP said practitioners could advise the DVLA if the public interest or safety outweighs the duty of confidentiality, but they may wish to advise their professional body before doing so.
‘We advise our members that in exceptional instances, where a patient is no longer fit to drive due to their vision but refuses to stop, practitioners should seek legal advice from the AOP.’
For BBR Optometry OO Nick Rumney (pictured right), reporting a patient to authorities raises the issue of contravening the General Optical Council’s Standards of Practice. ‘GOC standards 3 (Obtain valid consent) and 14 (Maintain confidentiality and respect your patients’ privacy) are in direct conflict in the issue of public safety. There is no public safety defence and in my opinion, the GOC standards are unacceptably silent on this issue,’ said Rumney.
‘The GOC won’t unequivocally say that we can breach confidentiality in the interests of public safety. If we did so and a complaint came in it would be dealt with on its merits – it may fall at case examiner stage or it may get referred to a fitness to practise committee with all the stress and time that takes.
‘This is directly contrary to the General Medical Council and other regulators who are unambiguous and who place public safety above confidentiality.’
‘In 99.9% of all of the cases I have seen I have found a way to stop someone driving in this situation. Usually by ensuring a family member comes in or I go and measure in the street. But I have to jump through hoops. I think the College has done its best but it isn’t the College that holds the sword of Damocles: a professional’s right to practice that the GOC does.’
College of Optometrists guidance: if you think a patient is unfit to drive
- A215: The DVLA and the DVA have legal responsibility for deciding if a person is medically unfit to drive.
- A216: The patient is legally responsible for informing the DVLA or DVA if they do not meet the vision standard for driving. However, if you think the patient may pose a very real risk of danger to the public or themselves, but you are not sure whether you should act, ask yourself: A: What might the outcome be in the short or longer term if I do not raise my concern? B: How could I justify why I did not raise the concern?
- A217: If you decide that the patient is unfit to drive, you should: A: First advise the patient that they are unfit to drive and give the reasons. B: Try to persuade the patient to stop driving. You may wish to discuss your concerns with a relative or carer. C: Tell the patient that they have a legal duty to inform the DVLA or DVA about their condition. D: Put your advice in writing to the patient, if appropriate. E: Keep a copy of any correspondence to the patient on the patient record. F: Notify the patient’s GP, if appropriate, with the patient’s consent.
- A218: Sometimes the actions in A217 above might not achieve their aim, or would take too long to do so. If you conclude the public interest outweighs the duty of confidentiality, for example, a patient who has told you that they intend to continue to drive after being told not to, you should: A: Notify the appropriate authority in writing, and, if appropriate, provide evidence of clinical findings. B: Notify the patient’s GP of the action being taken. C: Notify the patient, if appropriate.
- A219: If you are considering informing the DVLA or DVA that the patient may not be fit to drive, you may wish to contact your professional or representative body for advice.