Elderly License Vision Requirements

The elderly don't drive that badly; they're just the only ones with time to do the speed limit. ~Jason Love

The issue concerning driving licensure for the elderly is a sensitive topic to many because driving gives the independence and overall improved quality of life that so many enjoy. It is an issue that needs careful examination and consideration especially since in the next 20 years the number of elderly drivers is predicted to triple in the United States1. When asked why should there be a change in which elderly drivers receive their license? There are two main themes for emplacing stricter requirements; the first is the overall improved safety for all drivers and pedestrians. The second is the prevention of costly accidents from occurring that involve functionally disabled elderly drivers.

Currently, the ways in which states manage elderly driver licenses vary from state to state. Only New Hampshire and Illinois currently require a road test for the elderly. A mere ten states actually require that an elderly driver have a vision test before renewing a license. The rest of the states vary in either having a license renewal or not as unpredictable ages. There is also little consistency in the age at which the vision tests should be performed. Of the ten states, two states begin vision testing at age 40, one at age 50, and the rest at anywhere from ages 64 to 80.

As a profession, the American Optometric Association (AOA) stands behind the concept that in order for elderly drivers to continue to drive, they must been seen by an eye doctor to verify that they have the vision required to accomplish such a task. According to the research stated by the AOA, in 1990, motor vehicle crashes were the leading cause of unintentional injury,3 and motor vehicle crashes accounted for roughly 2.5% of America’s gross national product—an estimated $135.5 billion.4

If we consider that we are close to 20 years in the future to that statistic, the amount of which the social expenditure is costing us is quite high. In addition to the benefit of lives saved through having a safer road and highway system, the advantage of saving billions of dollars must not be ignored. This is especially true in this time of recession. Some may ask if we implement such vision criteria for licensure, what will the costs be? The answer is hardly anything if we implement a vision test. If we consider that most elderly receive routine eye care, an extra test for a driver license seems to be cost effective and of little inconvenience.

The AOA also suggests that a comprehensive eye exam is necessary for the best screening of drivers. The AOA goes as far as recommending that drivers be seen solely by ophthalmologists and optometrists before renewing or acquiring a driver’s license5. Their logic is that it will promote the ocular health of the population.

On a personal note, I see the advantages to having an eye exam for the elderly. That is certainly a great start. Ultimately, having all drivers examined by an eye doctor would be optimal to make sure that the field of vision and acuity is acceptable.

One example is my own experience with the department of motor vehicle of New York. When I went for my vision screening, I could pass the 20/40 stipulation by accommodating because I am a +6.00 diopter hyperope in both eyes. However, it would clearly be a violation in my opinion if I could drive on the road without glasses because of my high refractive error and visual demands. The common lay individual would not easily be able to detect a driver like me accommodating on an eye chart.

Eventually, having all drivers be examined would be optimal, but for the time being, in concern to elderly drivers, requiring that the elderly been examined by an optometrist or ophthalmologist would be a great starting point.

If you account for elderly drivers (75+ years), they cause 5% of all people injured in traffic crashes, 13% of all traffic fatalities, 13% of all vehicle occupant fatalities and 18% of all pedestrian fatalities1. This was reported by a National Highway Traffic and Safety Administration (NHTSA) study of 1995 FARS (Fatal Accident Reporting System). It was also noted that in another NHTSA study, it was found that on the basis of estimated annual travel, the fatality rate for drivers 85 and over is nine times as high as the rate for drivers 25 through 69 years old1.

It has been said that the elderly may have the lowest rate of driving under the influence of alcohol and the highest rate of seat belt use. Which certainly may be true, however, many elderly drivers also are taking a number of medications which interfere with cognitive abilities such as benzodiazepines for pain and hypnotics for sleeping.

According to a 1993 German Study, there was a dramatic difference in performance between elderly drivers (60-80) to middle aged motorists (40-50)6. Differences were noted in tests such as visual acuity in daylight and dark, simultaneous perception, and reaction time tests like the tachistoscope. This tends to point toward stricter guidelines for elderly drivers.

These results were backed up in an Australian study which involved subjects from various age groups. The first ten were young visually normal drivers (mean age 22.6 years), then there were eighteen elderly drivers with no visual impairments (mean age 67.7 years), and finally there were eighteen elderly drivers with early cataracts (mean age 68.6 years). The results showed that both elderly subject groups had the poorer driving performance as assessed on a closed-circuit driving course compared with the young subjects7. Between the two elderly subject groups, the group with early cataracts had poorer driving performance than those who were visually normal7. This supports the idea that a vision screening would be very useful to diagnose cataracts.

In Florida, there was a reduced amount of elderly crashes that resulted in death after implementing a new system of driver license guidelines which included an eye exam in the period of 2004 through 2006 as compared to 2001 through 2003. The percentage in 2001 to 2003 were 14.91% as compared to 12.34% in 2004 to 20068. There was not decrease in the neighboring states of

Alabama and Georgia who did not implement such changes.
This means that requiring elderly motorists to take a vision test did indeed improve the motor vehicle collision figures. If we consider the amount of lives that can be saved and the prevention of monetary loss for many Americans, this system makes sense. Having a driver license process in which prevents death and financial loss is a win-win situation for everyone.

There is opposition to the eye examination requirement claim that implementing a vision exam is of little benefit. According an article in 2004 titled “Elderly Licensure Laws and Motor Vehicle Fatalities” in the Journal of the American Medical Association (JAMA) through stringent state licensure policies such as vision tests, road tests, and more frequent license renewal cycles, there were no independently associated benefits9. However, the flaw with this study as compared to the Florida study printed in the Archives of Ophthalmology is that the analysis of a vision exam was compared between different states that have vision screenings to those that do not. The reason why this is flawed is that each state may have different variables, such as New York having bad winters. Unless you can isolate a state like the Florida study did, there will always be multiple variables that are too complex and unaccounted for. The JAMA study did support the importance of in-person license renewal for older adults that lead to a decreasing the fatality crash rate among the elderly drivers9.

As previously mentioned, the current framework for each state is not consistent. To briefly go through each elderly driver license state requirement, we’ll start with the breakdown of states that require some type of elderly state driver’s license renewal or screening process.
Alaska only requires that you send in a registration form by mail if you are 69 years old or older. In Arizona, once you are 65 years old, you have to send in a renewal via the mail with a proof of a vision test within 3 years. Under 65, your license does not have to be renewed2. In California, it is very similar to Alaska in that once the driver reaches the age of 50, he/she will have to send in a registration form2.

In Colorado, the normal term for licensure is 10 years, but once the driver reaches 61, the registration on lasts for 5 years. The District of Columbia is distinctly different in that the first renewal is at least at age 70, vision tests are required plus a possible reaction test2. The drivers must also provide a doctor's statement that certifies the driver’s physical and mental competency to drive. There are road tests that may be implemented as well with the elderly. Of all the elderly state driver license laws, this seems to be stricter than most.
As stated in the study earlier by the Archives of Ophthalmology, Florida requires that all drivers eighty years old and older since 2004 renew their license by mail with an exam that is performed by a physician or optometrist2.

In Georgia, there is either a 5 year or 10 year option for drivers. But once a driver reaches age 65, there is only a 5 year license available. Once the driver reaches age 64, there is a mandatory vision test2.

In Hawaii and Idaho, there is a change in the time frame that the drivers license last. In Hawaii, at age 72, the drivers have to renew their license every 2 years. In Idaho, the drivers have to renew their license every 5 years once they reach the age of sixty three2.

Illinois has a much stricter policy in that elderly drivers have to renew their license at age 75 every 4 years until age 81, then every 2 years, and at age 87, every year. At every renewal, the elderly driver will have to take a road test2.

In Indiana, Iowa, Kansas and Missouri, each state has similar renewal processes. The licensure term varies from age 2 to 4 years2.

In Maine, the normal license term is 6 years. However, when a driver reaches age 65, the term changes to 4 years. A vision test is required every other renewal from age 40 to 62 and every renewal at age 62. In Maryland, the process is very similar in that there is a mandatory vision test for drivers 40+ years2.

Montana and New Mexico have similar renewal requirements of renewing elderly driver licenses at age 75 that lasts for 4 years. Rhode Island has a renewal process in place at age 70 that lasts only 2 years2.

New Hampshire is similar to Illinois in that elderly drivers are required to take a road test for drivers above age 75. However, there is only one road test administered, unlike to Illinois2.

In Oregon, the license requirement is every 8 years for drivers over the age of fifty2.
Lastly, vision tests are all required by the states of South Carolina, Virginia and Utah. For South Carolina, a vision test is required every 5 years with the renewal. In Utah, a vision test is required at age 80 and in Virginia, a vision test is required at age sixty five2.

As you can see, each state has their unique policies. For the ones not mentioned, there is no distinction in elderly driver license requirements. I foresee that as our nation’s age demographics change toward a larger elderly population, so will our driving licensure laws.
From observations made in the 20th century to the climate in which we find ourselves in today with the automobile industry, banking industry and health care industry, I foresee that our government will tend to shift more federally. Much like the seat belt laws and national drinking age laws from the past that have become universal among all states, it is only a matter of time before state elderly driver license requirements becomes universal.

With that said, that is why we as a profession need to continue to be proactive and complete as many studies as possible to analyze the correlation to stricter license guidelines that involve eye exams to improve safety.

The age above 60 years is critical in that most of the sight threatening conditions that may take away vision from drivers is highest in the age bracket of 64 to 75 at a percent of 85%5. That is why a screening process is essential not just for other people on the road but for patients themselves so that they can seek treatment if treatment is available for such conditions as glaucoma or cataracts.

In closing, according to the study completed by the NHTSA, the Florida study, the studies in Germany and Australia, having a vision exam for elderly drivers will have a positive effect in diagnosing many potential risks and reducing motor vehicle collisions which will also decrease the amount of fatalities. In the future, if we implement such regulations, the people of the United States will have maximum benefit.

Bibliography

1. Website: Smart Motorist; motorist news and driving guideline: http://www.smartmotorist.com/traffic-and-safety-guideline/older-drivers-elderly-driving-seniors-at-the-wheel.html

2. Website: (REQUIREMENTS IN OTHER STATES FOR ELDERLY DRIVERS RENEWING DRIVERS LICENSES By: James J. Fazzalaro, Principal Analyst): http://www.cga.ct.gov/2006/rpt/2006-R-0457.htm

3. Rice DP. Health status and national health priorities. In: Lee PR, Estes CL, Ramsay NB, eds. The Nation’s health, 4th ed. Boston: Jones and Bartlett, Inc., 1994.

4. Blincoe LJ, Faigin BM. The economic cost of motor vehicle crashes, 1990. Washington, D.C.: U.S. Department of Transportation, National Highway Traffic Safety Administration, 1992.

5. Motorist Vision Policy; The American Optometric Association Environmental and Ocupation Vision Committee. Comprised of Melvin V. Shipp OD, PHD, chairperson, Kent M. Daum. OD, PHD, Jeffrey L Weaver OD, MS, Van B. Nakagawara OD, Ian Baily OD MS, Gregory W Good OD, PHD, Michael B Maizel OD and Low vision specialization reprentative William L Park OD. Volumn 71, number 7, July 2000, pages 449-453

6. Elderly drivers in Germany--fitness and driving behavior. Schlag, BAccident Analysis & Prevention [ACCID. ANAL. PREV.]. Vol. 25, no. 1, pp. 47-55. 1993.

7. Visual impairment and driving
Wood, Joanne M., Troutbeck, Rodney J.; Queensland University of Technology 1996; conference paper Rail Transportation and Freight Services (150702), TRANSPORTATION AND FREIGHT SERVICES (150700), OPTOMETRY AND OPHTHALMOLOGY (111300), Vision Science (111303)

8. The Impact of a Vision Screening Law on Older Driver Fatality Rates
Gerald McGwin Jr, MS, PhD; Scott A. Sarrels, BS; Russell Griffin, MPH; Cynthia Owsley, PhD, MSPH; Loring W. Rue III, MD
Arch Ophthalmol.~2008;126(11):1544-1547.

9. Elderly Licensure Laws and Motor Vehicle Fatalities Vol. 291 No. 23, June 16, 2004
David C. Grabowski, PhD; Christine M. Campbell, AB; Michael A. Morrisey, PhD
JAMA. 2004;291:2840-2846.