Why does the CBR ask for an ophthalmologist examination?

To drive you must see well enough: sharp enough to read road signs in time and wide enough to notice traffic from the side. The CBR tests this against the Dutch fitness regulations. If you report an eye condition on the Health Declaration, or the examining doctor doubts your vision, the CBR asks for an ophthalmologist’s report.

An ophthalmologist examination does not mean you lose your licence. Often you simply meet the requirements, sometimes with glasses or for a shorter period.

The most common reasons:

• Renewing your licence from age 75
• Glaucoma
• Cataract
• Macular degeneration
• Diabetes
• Seeing with one eye
• Visual field loss after a stroke or brain injury
• Insufficient visual acuity
• Double vision
• Large licence (C, D and E)

Renewing your licence from age 75

From age 75 you fill in a Health Declaration at every renewal and are examined by a doctor, who measures your visual acuity and checks your visual field. If your vision is insufficient, even with glasses, or the field shows defects, the CBR asks for an ophthalmologist examination. Cataract or macular degeneration often plays a role; sometimes outdated glasses are the cause.

Glaucoma and your licence

Glaucoma damages the optic nerve and slowly affects the visual field, usually at the sides first. You often do not notice, because the other eye and the brain fill in the gap. That is why the CBR wants to know how large your visual field is with both eyes. Glaucoma therefore usually comes with an Esterman visual field test.

Cataract and your licence

With cataract the lens becomes cloudy: blurrier vision, more glare from oncoming traffic and less contrast at dusk. The CBR mainly looks at visual acuity. If cataract surgery is planned, it may be wise to have the examination afterwards, when vision is usually good again.

Macular degeneration and your licence

Macular degeneration affects the macula, the part of the retina for sharp vision. Side vision usually stays good, but acuity decreases. The ophthalmologist assesses whether you still reach the required acuity. Because the condition can change, the CBR may issue the licence for a shorter period.

Diabetes and your eyes

Diabetes can damage the small retinal vessels (diabetic retinopathy). The CBR therefore often asks for an ophthalmologist’s report, sometimes periodically. If your retina has been treated with laser, an Esterman visual field test may also be needed, as laser can reduce the visual field.

Seeing with one eye

Do you see with one eye, or is there a large difference between your eyes? For licence B, driving with one eye is allowed if that eye meets the acuity and field requirements. After sudden loss of vision in one eye, an adjustment period of at least three months applies. For trucks and buses (group 2) the weaker eye must reach at least 0.1.

Visual field loss after a stroke or brain injury

A stroke, brain haemorrhage or brain tumour can cause visual field loss, for example of the left or right half of the image (hemianopia). You do not always notice this yourself. In these situations the CBR asks for an eye examination with an Esterman visual field test.

Insufficient visual acuity

For licence B you must see at least 0.5 (50%) with both eyes together, with glasses or lenses if needed. If you do not reach this at the examining doctor, an ophthalmologist examination follows. If acuity is lower due to an eye condition, the CBR can limit the licence to 1, 3 or 5 years. If you need glasses or lenses, your licence shows code 01.

Double vision

Disturbing double vision, for example due to eye muscle paralysis, is not allowed for licence B. For group 2 double vision is not allowed at all. The ophthalmologist assesses whether and how much it hinders you.

Large licence: C, D and E (group 2)

Stricter requirements apply for truck and bus drivers:

• the better eye at least 0.8 and the other at least 0.1, corrected if needed;
• a horizontal visual field of at least 160 degrees, without defects within 30 degrees of the centre;
• glasses up to plus or minus 8 dioptres;
• no double vision.

The Esterman visual field test

The Esterman test is the standard test to determine whether your visual field is large enough to drive safely. The CBR prefers this method for driving examinations.

Where does the Esterman test come from?

It is named after the American ophthalmologist Dr Benjamin Esterman (1906–1994), who in 1982 published a scoring grid for both eyes together. Not every part of the visual field matters equally in daily life: the centre and the sides at eye level count more than the upper part. Since 1984 it has been a standard used in many countries, including the UK and the Netherlands, to assess fitness to drive.

When do you get an Esterman test?

• with glaucoma;
• after a stroke, brain haemorrhage or brain tumour;
• after laser treatment of the retina, for example with diabetes;
• with other retinal or optic nerve conditions that can affect the visual field;
• if the examination finds visual field defects.

How does the test work?

1. With both eyes open and your own glasses, you look at a fixed point in the middle of the device.
2. The device shows a light at 120 spots spread over more than 130 degrees of your visual field.
3. When you see a light, you press a button. A missed spot is shown again; only if you miss it twice does it count as a defect.
4. The result goes to the ophthalmologist, who includes it in the report for the CBR.

What is the standard?

For licence B the horizontal field with both eyes must be at least 120 degrees, with at least 50 degrees to the left and right, and no defects within 20 degrees of the centre. For group 2: at least 160 degrees, without defects within 30 degrees of the centre.

At Novio Oogzorg we carry out the Esterman test in Nijmegen, in addition to the CBR eye test (€ 80 extra). Read more about the Esterman visual field test.

How the ophthalmologist examination works at Novio Oogzorg

The optometrist carries out the examination. An ophthalmologist from Okulus, with whom we work, assesses the results and signs the report, as the CBR requires. The examination costs € 134. Allow about half an hour; longer with an Esterman test. Read everything about the CBR eye test.

What should you bring?

• Always your glasses and/or contact lenses, even if you only wear them sometimes.
• Your ID.
• The letter or code you received from the CBR.
• A current medication list.
• Sunglasses.

Please note: you may be given eye drops. If needed we dilate your pupils with eye drops. Your vision is then blurred for a few hours and you are sensitive to light. You may not drive yourself: arrange transport or come with someone who drives.