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‘Driving licenses renewal should cover health conditions that could affect driving’

25 Jul 2021

  • Forensic academic proposes issuance of restrictive/conditional licenses, frequent review in SL 
  • License renewal process can be used to screen for relevant health conditions
By Ruwan Laknath Jayakody The existing system of the mandatory renewal of all driving licenses should be expanded to include components of a system to mandatorily notify of health conditions that could affect driving, and the issuance of restrictive or conditional licenses, along with frequent review, where relevant. This has been proposed by a forensic academic as a means of reducing the incidence of road traffic accidents caused due to age and vision-related health conditions. It was also suggested that the time of the renewal of the driving license be used as an opportunity to screen for chronic age-related health conditions that affect driving, such as glaucoma, where the optic nerve, which connects the eye to the brain, becomes damaged due to fluid building up in the front part of the eye, which in turn increases the pressure inside the eye, and causes loss of vision in the absence of early diagnosis and treatment. The forensic academic made these observations and recommendations in a concept paper on “Safe driving – Assessment mechanism to reduce morbidity and mortality: A concept paper with reviewing a clinical case” authored by N.D.N.A. Mendis (attached to the Colombo University's Medical Faculty's Forensic Medicine and Toxicology Department) and published in the Medico-Legal Journal of Sri Lanka's Ninth Volume's First Issue on 30 June 2021. According to the data in the Health Ministry Epidemiology Unit’s 48th Volume Issue Number Eight’s “Part I of the Weekly Epidemiological Report on Road Traffic Accidents” published from 6-12 February 2021, during 2018, there were 3,590 road traffic accident-related deaths, amounting to 2.8% of total deaths for the said year. As Mendis notes, human factors are the main causes of such accidents. In the process of driving, as explained by N. Chakrabarty, A. Lakshman, K. Gupta, and A. Bhatnagar in “Visual challenges among drivers: A case study in Delhi, India”, drivers process information through visual (90%), auditory, and internal inputs. Various health conditions (congenital [present from birth] disabilities such as cerebral palsy [disorders that affect mobility and the maintenance of balance and posture caused due to abnormal brain development or damage to the brain that affects the ability to control muscles] and spina bifida [when the baby's spine and spinal cord does not develop properly in the womb, thereby causing a gap in the spine], trauma leading to neurological and orthopaedic [musculo-skeletal system] injuries, age-related changes, drug and alcohol addiction, human immunodeficiency virus, and diabetes) that impact multiple bodily systems, and specially visual impairment caused by cataract (a dense, cloudy area that forms in the eye lens), and diabetic retinopathy (a diabetes related complication that causes damage to blood vessels of the light sensitive tissue in the retina at the back of the eye), as noted by H. Behboudi, R.S. Moghadam, N. Tiefej, and M.F. Karkan in “Vision disorders in drivers involved in traffic accidents”, affect the ability to drive. As per the “Vision standards for driving license in Sri Lanka” of the College of Ophthalmologists of Sri Lanka, visual acuity (ability to discern shapes and details of things seen), visual fields (the area that can be seen when the eye is fixed straight at a point) and the presence of eye conditions such as nystagmus (where the eyes make repetitive, uncontrolled movements), squints, diplopia (double vision where one sees two images of the same thing), and progressive eye diseases are aspects that are considered.   Mendis adds that driving with monocular (one eye) vision is allowed in Sri Lanka. Further, the “Vision standards for driving license in Sri Lanka” of the College of Ophthalmologists of Sri Lanka notes no driving-related restrictions for colour-blindness. Moreover, the “Vision standards for driving license in Sri Lanka” of the College of Ophthalmologists of Sri Lanka notes that for certain medical conditions, a conditional license with appropriate vehicle modifications is also granted. Since 2012, the National Transport Medical Institute (NTMI) has been assessing medical fitness to drive using the relevant national guideline. According to the Transport Ministry's “Statistics – Medical examinations in 2018”, the most commonly identified medical condition (in 53,655 cases from 877,243 examinations during the said year) involved visual problems. Under the guidelines in the “Vision standards for driving license in Sri Lanka” of the College of Ophthalmologists of Sri Lanka and those of the NTMI, certain criteria are considered when issuing a license to an individual with monocular vision. These criteria include the following: visual acuity in the worse eye being less than 6/12 which is contraindicated for commercial passenger transport vehicles and all heavy vehicles; visual acuity in the worse eye being 6/60 or less than 6/60 being absolutely contraindicated for three-wheelers and motorcycles; and when the visual acuity in the worse eye is 6/60 or less than 6/60, a conditional license with appropriate vehicle modifications is granted for light vehicles for personal use only, and not for commercial passenger transport. Thus, Mendis noted the requirement of higher visual standards for driving heavy and commercial vehicles. An 81-year-old male motorcyclist was admitted to a tertiary care hospital following a road traffic accident. He had sustained only minor injuries. There was no significant past medical history. He had obtained a valid-for-life heavy and light vehicle driving license in 1958. Since 1960, he has had monocular vision, following accidental trauma to the right eye, and since then, there is a history of the patient meeting with repeated accidents. As observed by Mendis, this case highlights whether the driving ability should be reviewed regularly, or at least reviewed after meeting with an accident which results in injuries, and also whether the relevant authorities should be notified of the subsequent (subsequent to receiving the license) diagnosis of any medical condition that affects vision, and thereby driving ability. The International Council of Ophthalmology's “Visual standards: Vision requirements for driving safety with emphasis on individual assessment”, mentions that in certain countries, even after a driving license is granted, further monitoring of the license holder is done through real time testing, where the driver’s ability to drive in various life circumstances and stressors on the road is recorded and assessed over a period of time, while in Australia, if a patient’s condition is found to affect their ability to drive safely, the healthcare professional, through a standard notification form, may notify of the condition to the authority that issues the driving licenses. Therefore, Mendis noted that the process of proper documentation, record keeping, and reporting to the driving license-issuing authority, when appropriate, aids in monitoring license holders. In this regard, Mendis also pointed out that though there is a process of license renewal for heavy and light vehicle licenses, some drivers possess heavy and light vehicle licenses that are valid for life (as is the case in the aforementioned case report) and therefore does not require renewal or medical tests, which means that even if a license holder was physically fit at the time of obtaining the license originally, any subsequent medical condition, such as the loss of sight in one eye, will not be subjected for checking until an accident takes place or the condition is learnt of by a Police officer. This situation carries grave consequences in terms of the health safety of the driver-cum-patient and members of the public, including fellow drivers and road users. Hence, highlighting the absence of a proper referral system for the purpose, Mendis explained that both the proper evaluation of subsequent (subsequent to obtaining the license) illnesses, and having in place a proper referral mechanism is important, in order to reduce both morbidity (including the risk of injury) and mortality in the context of road traffic accidents. In conclusion, calling attention to this serious issue which requires the urgent attention of the society and the Parliament as the legislature, Mendis recommended the appropriate modification of the existing laws and their proper implementation thereafter, so as to minimise the incidence of road traffic accidents caused due to vision impairment, which are, for the most part (owing to there being a multitude of other factors that cause motor traffic accidents), avoidable.


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