UK Keratoconus Self-Help and Support Association

I didn't know these had changed recently.

"Optometry Today" has an excellent summary, very clear and concise and anyone with Keratoconus should read it:

http://www.optometry.co.uk/news-and-fea ... ticle=3473

The full Standard is available from the DVLA, in all its wonderful verbosity:

http://www.dft.gov.uk/dvla/medical/~/me ... lance.ashx

Chapter 6 is the most relevant to people with Keratoconus. All in all, the new Standard make a much better job at explaining things than the old one, which was in many areas very vague and ambiguous. I particularly liked the explicit references to how the Standard relates to insurance policies e.g.

Patients may be reminded that if they choose to ignore medical advice to cease driving, there could be consequences with respect to their insurance cover.

and

Drivers should check their insurance policy before returning to drive after surgery.

The new Standard places the obligation on the driver to specifically ask the DVLA about their fitness to drive:

It is the duty of the licence holder or licence applicant to notify DVLA of any medical condition, which may affect safe driving.

This is actually a good thing because insurance providers rely, typically, on the DVLA not revoking your licence to continue cover. But if the driver never took the initiative and asked the person in the clinic about continuing to drive, there was a loophole which let unfit drivers on the roads -- who might have been uninsured. Whether in fact they were indeed uninsured was only crystallised in a loss situation for the insurer. Also, the health professional has to tell the driver and the guidence is very explicit. If the driver refutes this, then the clinician must tell the DVLA:

If you do not manage to persuade the patient to stop driving, or you discover that they are continuing to drive against your advice, you should contact the DVLA immediately and disclose any relevant medical information, in confidence, to the medical adviser.

I'd also hazard an opinion that it makes things easier for optometrists /opthalmologists and patients; at least now there's a required Visual Acuity (VA) spelled out. The "Optometry Today" editorial differs in that view, but I don't really get their argument. A defined VA standard must (???) be better than no VA standard ? The retention of the "number plate" element allows the lay person to check their own vision approximately on a day-to-day basis without a calibrated Snellen chart. But there might be issues there that I don't properly understand so I'll say no more !

The only big downside is that for professional drivers ("Class 2's") -- especially those who are new to that class and don't inherit "grandfather rights" -- the VA demands seem very, very high to me. I couldn't meet them I don't think (I might scrape by with my right eye alone and an RGP -- I got a decent 6/9 at the opticians yesterday, could maybe have just about managed the needed 6/7.5 but it would be a struggle). While normally I'm definitely one to say that Keratoconus shouldn't be a barrier to anyone doing anything they wanted to do by way of a career, I'd really caution against being a professional driver. But that's just my two pen'neth worth and I'd be interested in what someone in that position thinks.

Cheers

Chris

longhoc wrote:The "Optometry Today" editorial differs in that view, but I don't really get their argument. A defined VA standard must (???) be better than no VA standard ? The retention of the "number plate" element allows the lay person to check their own vision approximately on a day-to-day basis without a calibrated Snellen chart. But there might be issues there that I don't properly understand so I'll say no more !

I think perhaps where the article could be coming from is that under sterile conditions the driving standard can be achieved on the Snellen chart, but in a real world situation with changes in light casting shadows or if you are having a bad eye day. When I was wearing RGP's I could read the eye chart and have perfect 6/6 but get out in to the day light and glare and other aberations from the sun and reflections from the surroundings and sometimes I could find it hard to read a number plate but according to the hispital tests I was fine to drive. It is ambiguous still and unclear, and what I would recomend to anyone is to have their own eye chart that is a close approximation to the Snellen chart and be honest with yourself and test your vision before you drive, especially if prone to vision fluctuations thoughout the day. If I recall correctly a member of the KC group passed the VA requirements for driving on the Snellen chart but had to break out a tape measure for reading a number plate and was right on the limit.

In 1987 when I was at the early stages of KC I shoudl never have passed my driving test because I couldn't read a number plate at the required distance. My response to the examiner was which car, the blue Ford Fiesta and a Blue Vauxhall Cavalier? He said if you can tell the difference you can easily read the registration and off we went and I passed my test with flying colours! Without lenses I can see movement better than stationary object and although I would be unable to judge the distance of a stationary object I can catch a tennis ball that I see moving in my periheral vision!

On the subject of insurance, I have always declared the fact that I have a medical need for contact lenses and the insurers have always said that as long as I wear my vision correction when driving I am insured, they pointed out that it is in the small print of the policy that even if you need tow ear glasses to drive they must be worn at all times, otherwise the insurance will be void.

In 2006 when I was having RGP problems I was unsure how seeing with one eye periodically would affect my driving. The insurance said as long as I had a valid driving licence and was medically fit to drive they would cover me so although declared to the DVLA and sending forms to them, I heard absolutly nothing so I opted to retake my Institute of Advanced Driving Test where much to my surprise I had the same examiner (who is one of the police driving instructors) as I had in 1999. Well with just vision in my left eye I passed the test and he was completly unaware of the fact until he asked for my IAM membership and expressed surprise that I already had full membership because I had passed the test before. It was then that I told him that he had spent the past hour with someone that was legally bling in their right eye. He said I had passed and there was nothing in my drivinmg to suggest I was visually impaired. On the piece of paper that shows I passed he kindly wrote on that I was visually impaired in one eye and there was no evidence that my driving was affected in anyway.

One point here...

Also, the health professional has to tell the driver and the guidence is very explicit. If the driver refutes this, then the clinician must tell the DVLA:

If you do not manage to persuade the patient to stop driving, or you discover that they are continuing to drive against your advice, you should contact the DVLA immediately and disclose any relevant medical information, in confidence, to the medical adviser.

This guidance is issued by the GMC for medical clinicians. It is not an optometrist's repsonsibility to report to DVLA if someone ignores advice, as they are not covered by this guidance from the the GMC. It is that of the ophthalmologist. Since most people with KC spend the majority of their time with optometrists and not ophthalmologists, it is an important distinction.

It is interesting that despite these changes, there is stil a complete lack of understanding of the issues that keratoconics face. There is a complete section on "blepharospsm" - which is when eth eyes close relfexly in response to light and other factors and another on diplopia (double vision). Both these conditions affect keratoconics from time to time and I would say that the ghosting and double vision suffered by KCers is actually worse than double vision due to the fact your eyes dont work together. At least in the latter case you can wear a patch and it goes!

The problem is, that until eyesight issues for keratoconics are properly and legally recognised, one cannot be legally barred from driving - Gareth's case shows that perfectly. It therefore does rest a lot on you, the people with KC, to be very strong in deciding when you can and can't drive. As Gareth says, you should always play safe and inform DVLA.

Lynn

Lynn White wrote:
This guidance is issued by the GMC for medical clinicians. It is not an optometrist's repsonsibility to report to DVLA if someone ignores advice, as they are not covered by this guidance from the the GMC. It is that of the ophthalmologist. Since most people with KC spend the majority of their time with optometrists and not ophthalmologists, it is an important distinction.

Another thing that I didn't realise ! Thanks Lynn.

Those DVLA notes are still maddening vague in places -- I read the whole thing but didn't spot the switch from a general talk of "healthcare professionals" to actual physicians licenced by the GMC. Even more worrying is that I went through a 20 year Keratoconus "career" and on precisely 2 (yes, T-W-O) occasions saw an ophthalmologist until the point in time when matters moved to "... have you thought any more about a graft ?" when the optometrist was concerned about lens fitting being out of options.

It was the optometrist who coaxed some disclosure out of me about driving, lens wear and what happens if I had any issues with my right (better) eye lens. When I replied that I'd manage with my left eye alone, they pointed out that the best that could be achieved with the left eye alone was below the legal standard. To which I retorted that I'd use my glasses -- again, they suggested that it might be the case that I didn't always have them with me. And in that they were entirely correct. Throw in pretty much non existent usable night vision (especially with oncoming headlights) and I could understand that they were right to be concerned. The optometrist suggested I speak to the DVLA, and I did have a very useful conversation with their medical team. They were prepared to let me continue to drive but with restrictions that I must always be wearing my right lens and no night driving. They asked could I reasonably confirm that I would always be able to meet these conditions, the answer was no, in all honesty I couldn't. So we decided it was better if I didn't drive. I'm sure if I'd argued, I might have wrangled a continuation. But the going through the process showed me that it wouldn't be the right thing to do.

If only an opthalmologist has the authority to actually advise the DVLA if they are concered about someone driving when they ought not to be, I'm really shocked. I'm sure that it means for most people with Keratoconus is that the whole system is more-or-less down to self assessment and self disclosure becuase the optometrist can only suggest, not enforce. In fact, what's the point for the optometrist to even bring up the subject ? The patient, if they want to, can apparently simply ignore it ! Unfortnately while I reckon the majority of people will "do the right thing" if it comes to it, driving for many people comes with such a sense of entitlement -- and the loss of it means a great deal -- then it is all too easy to lose objectivity and maybe make bad decisions.

Best wishes

Chris (who is really hoping that everyone acts responsibly because it does seem like it is down to that and nothing more)