I Would Be Grateful If You Would Assess This Person

Medical in confidence

OPTICIANS REPORT To be completed by a qualified optician I would be grateful if you would assess this person. Please note that any charge for completion of this report is to be borne by the applicant/person to be assessed. PLEASE SEE OVER FOR HOME OFFICE STANDARDS. Please complete the Certificate of Vision below: Name

Address

Date of birth Date of examination Is there a history of eye surgery, retinal detachment or glaucoma? Yes/no Details:______Visual acuity assessment Distance visual acuity given in Near visual acuity at 40cm, given in N Snellen e.g. 6/6) ( e.g. N5) R L Bin R L Bin

Unaided vision

Unaided Vision under low illuminance if past eye surgery (if possible) Aided Vision ______Aided Vision under low illuminance if past eye surgery (if possible) Muscle balances within Yes / No Yes / No normal limits Name of Visual Field Visual field assessment result R L Binocular assessment Normal Yes/No Yes/No Yes/No technique used: ______Esterman preferable 120 degrees horizontally Yes/No Yes/No Yes/No 100 degrees vertically Yes/No Yes/No Yes/No ______160 degrees horizontally which extends at least 70 degrees left Yes/No Yes/No Yes/No and right from midline ______30 degrees up and down from the horizontal eye level. Yes/No Yes/No Yes/No ______Defects present within a radius of the central 30 degrees? Yes/No Yes/No Yes/No ______Impairment of visual function, including no glare sensitivity, Yes/No Yes/No Yes/No contrast sensitivity or impairment in twilight vision. Colour Vision Defect on City Yes/no University Test Score of 7/10 or above? Yes/no Declaration I am a qualified Optician and certify that I have today examined the above named person. Signed Date Name and Qualifications ADDRESS/Practice Stamp

ANNEX A Regulation 10

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OPTICIANS REPORT To be completed by a qualified optician EYESIGHT STANDARDS: POLICE RECRUITMENT The standard of eyesight which must be met by a candidate for appointment to a police force in respect of each of the matters specified in the first column of the following table is that specified in the second column of the table. Eyesight Mandatory requirement Static Visual Acuity Corrected distance visual acuity must be 6/12 in either eye and 6/6 or better, binocularly. Corrected near static visual acuity must be 6/9 or better, binocularly. [Applicants who do not reach the standard should not be rejected but should be invited for a further test after obtaining a stronger prescription]. Uncorrected visual acuity must be 6/36 or better, binocularly. Corrected low contrast distance visual acuity must be 6/12 or better for a 10% contrast target, binocularly. Visual Field A field-of-view of at least 120 degrees horizontally by 100 degrees vertically is required. The field-of-view should be free of any large defective areas, particularly in the fovea. Single defects smaller than the physiological blind spot, and multiple defects that add to an area smaller than the physiological blind spot, should be acceptable. Colour Vision Monochromats should be rejected. Mild anomalous trichromats are acceptable and should be treated as normal. Severe anomalous trichromats and dichromats are also acceptable and should be instructed in coping strategies. [Applicants who show a lowered discrimination for blue colours should be referred to an ophthalmologist for further assessment. This should include a measure of their dark adaptation performance]. Spectacles and contact lenses Correction should be worn where necessary to achieve 6/6 binocularly. Corrective spectacles and contact lenses are acceptable for the tasks of an Operational Police Constable. Eye surgery PRK, LASIK, LASEK, ICRS, cataract surgery: There is no significant weakening of the cornea and applicants should not be rejected. A period of at least 6 weeks after surgery should be allowed before applications are accepted. There may be a reduction in low light level visual performance: Test visual performance under low illuminance conditions.

Radial Keratotomy (RK), Arcuate Keratotomy (AK), corneal grafts. Any other surgical procedures that result in a significant weakening of the cornea. There is a measurable risk of corneal rupture if the eye is struck. Applicants should be rejected.

1. Colour vision should be tested using the Farnsworth D-15 test. Applicants should not wear ‘colour correcting’ lenses during the colour vision tests.

Police Reponses drivers within Surrey & Sussex are expected to meet Group 2 DVLA Standards for driving (DVLA March 2016). The minimum standard for the field of vision is defined by the legislation for Group 2 bus and lorry licensing as: ■ A measurement of at least 160° on the horizontal plane ■ Extensions of at least 70° left and at least 70° right ■ Extensions of at least 30° above and at least 30° below the horizontal plane ■ No significant defect within 70° left and 70° right between 30° up and 30° down (it would be acceptable to have a total of up to 3 missed points, which may or may not be contiguous*) ■ No defect is present within a radius of the central 30° ■ No other impairment of visual function, including no glare sensitivity, contrast sensitivity or impairment of twilight vision. (*Points tested in the ‘letterbox’ outside the central radius of 30° from fixation.)

086041c471a83d8afacf6a4377cbb35b.doc – V3 J Holland