Visual field testing and fitness to drive in Europe: A cross-country comparison against a potential reference standard.
Blaser Frank, Sudmann Thea Melsen, Bro Tomas, Barthelmes Daniel, Said Sadiq, Todorova Margarita G, Rowe Fiona J, Jørstad Øystein Kalsnes
AI Summary
This study found European countries apply driving visual field standards inconsistently, especially for central vision. A uniform test is needed for consistent fitness-to-drive assessments.
Abstract
Purpose
The purpose of this study was to assess the agreement between the European Driving Test (EDT)-a new perimetry test designed to comply with the visual field requirements for Group 1 drivers outlined in the European Commission Directive 2009/113/EC-and the manner in which these standards are applied across European countries.
Methods
This was a cross-sectional study of patients with visual field loss who underwent fitness-to-drive visual field assessments at the University Hospital Zürich between 2023 and 2025. Patients completed monocular static and kinetic perimetry, as well as binocular perimetry with the Esterman test and the EDT, all performed using an Octopus 900 perimeter. We determined pass/fail outcomes according to Swiss, Swedish, Norwegian and British criteria. We analysed inter-country agreement and diagnostic accuracy of national criteria relative to the EDT using Fleiss' kappa, sensitivity and specificity.
Results
The study enrolled 243 patients. Pass rates were 65% (Switzerland), 76% (Sweden), 74% (Norway) and 86% (UK). Inter-country agreement was moderate (Fleiss' κ = 0.56), with lower agreement in central (κ = 0.57) than peripheral (κ = 0.69) visual fields. Compared to EDT results, national standards demonstrated high specificity (0.87-1.00) but variable and low sensitivity (0.39-0.76), particularly for the central visual field.
Conclusion
The application of common visual field standards for driver licensing varies across European countries, especially concerning central visual field criteria. Our findings support adopting a uniform perimetry algorithm to ensure consistent visual field evaluation in fitness-to-drive assessments.
Shields Classification
Key Concepts5
Pass rates for fitness-to-drive visual field assessments in 243 patients with visual field loss were 65% in Switzerland, 76% in Sweden, 74% in Norway, and 86% in the UK.
Inter-country agreement on fitness-to-drive visual field assessments among Switzerland, Sweden, Norway, and the UK was moderate (Fleiss' = 0.56), with lower agreement in central (Fleiss' = 0.57) than peripheral (Fleiss' = 0.69) visual fields in a cross-sectional study of 243 patients with visual field loss.
Compared to the European Driving Test (EDT) results, national standards for fitness-to-drive visual field assessments demonstrated high specificity (0.87-1.00) but variable and low sensitivity (0.39-0.76), particularly for the central visual field, in 243 patients with visual field loss.
The application of common visual field standards for driver licensing varies across European countries, especially concerning central visual field criteria, supporting the adoption of a uniform perimetry algorithm to ensure consistent visual field evaluation in fitness-to-drive assessments.
The European Driving Test (EDT), a new perimetry test designed to comply with visual field requirements for Group 1 drivers outlined in the European Commission Directive 2009/113/EC, was assessed for agreement with how these standards are applied across European countries.
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