American Osteopathic College of Occupational and Preventive Medicine DOT FMCSA Certified Medical Examiners Course FMCSA Clinical Areas Vision Bret H. Holland, D.O., FAOCOPM Original slides from Lance Walker DO Learning Objectives Standards • Discuss medical standards for vision • 20/40 or better in each eye uncorrected or corrected • Discuss how to perform the visual exam • 20/40 or better in both eyes- (fused)(binocular) uncorrected or corrected • Discuss recording of results • Peripheral vision 70 degrees horizontal each eye • Able to distinguish traffic lights Key Concepts Color- Depth -Peripheral vision • Vision is sort of important to driving Color Vision is also important Normal Depth Perception is important Peripheral Vision is important to driving B-1 American Osteopathic College of Occupational and Preventive Medicine DOT FMCSA Certified Medical Examiners Course Medical Standard Acuity • Distant vision of at least 20/40 – In each eye without corrective lenses – Or corrected to 20/40 – Binocular vision of 20/40 or better – No requirement for near vision Depth Perception Medical Standard Peripheral and Color • No specific test for depth perception • Horizontal field of vision – At least 70 degrees in each eye • But Monocular vision is disqualifying 70 Color Vision • Color vision – Must be able to distinguish red, amber and green traffic lights – Not required to pass color plates only be able to see difference in traffic lights B-2 American Osteopathic College of Occupational and Preventive Medicine DOT FMCSA Certified Medical Examiners Course Chemicals that can affect color Long cones Medium cones Short cones vision • styrene, • carbon disulphide, • perchloroethylene, • fertilizers, • n-hexane, • solvent mixtures, • organic and inorganic mercury L cones reds S cones blue Mmm cones greens Health History Questions Physical Exam • Examine for: • History of Eye Disorders – Pupillary equality • History of impaired vision – Reaction and accomodation • Symptoms related to or caused by eye – Ocular Motility disorders – Ocular muscle imbalance • Use of ophthalmic preparations that could – Extra-Ocular movements impair safe driving – Exopthalmos • Yes answers require clarification and documentation Physical Exam Retinopathy • Ask about MG car – Macular Degeneration – Glaucoma – Cataracts – Aphakia – Retinopathy B-3 American Osteopathic College of Occupational and Preventive Medicine DOT FMCSA Certified Medical Examiners Course Cataracts Cataracts Aphakia Required Tests • Central Visual Acuity – May be performed with Snellen Chart or Titmus must be recorded in Snellen Values • Peripheral Vision – Confrontation, fingers or Titmus, if inconclusive refer • Color vision – Distinguish Red, Amber, Green, Titmus or Color Plates VA tattoo B-4 American Osteopathic College of Occupational and Preventive Medicine DOT FMCSA Certified Medical Examiners Course Specific Diseases Certification • Cataracts • Driver may be certified if: • Glaucoma – Distant acuity of at least 20/40 in each eye • Macular Degeneration – Binocular Acuity of at least 20/40 • Retinopathy – Horizontal Fields of at least 70 degrees – Distinguish between red, amber and green • FMCSA Reports Available on FMCSA Website Documentation Remember • If driver must wear corrective lenses to meet standard this must be notated in the “wearing corrective lenses” checkbox • Monocular Vision is Disqualifying • Advise drivers to carry a spare set of glasses – However they may apply for a Federal Vision Exemption • If driver has Federal Vision Exemption they should present you with specialist eye exam before you certify, one year certification only • Exemption Program at FMCSA website THE END Diabetic Impaired Thinking B-5 American Osteopathic College of Occupational and Preventive Medicine DOT FMCSA Certified Medical Examiners Course Hearing Testing for FMCSA B-6 American Osteopathic College of Occupational and Preventive Medicine DOT FMCSA Certified Medical Examiners Course 2 Types of Hearing Tests 5 Foot Forced Whisper Test • 5 foot forced whisper test • Audiogram B-7 American Osteopathic College of Occupational and Preventive Medicine DOT FMCSA Certified Medical Examiners Course Audiogram STANDARDS • 40 dB average in 500, 1000, 2000 hz in better ear (Different from sight, only one ear needs to qualify ) Sample 1 Sample 2 Sample 3 Hearing Aids • Use of hearing aids is allowed but only with the whisper test • Audiometric evaluation requires a booth with speakers because headphones won’t work with hearing aids • Check the appropriate boxes if hearing aids are required to pass test B-8 American Osteopathic College of Occupational and Preventive Medicine DOT FMCSA Certified Medical Examiners Course B-9 American Osteopathic College of Occupational and Preventive Medicine DOT FMCSA Certified Medical Examiners Course B-10 American Osteopathic College of Occupational and Preventive Medicine DOT FMCSA Certified Medical Examiners Course B-11 American Osteopathic College of Occupational and Preventive Medicine DOT FMCSA Certified Medical Examiners Course B-12.