Diabetic retinopathy and driving: the field, not just the laser

On diabetic retinopathy and driving, the DVLA's public list is short: a car or motorcycle driver must report diabetic retinopathy "with laser treatment" in both eyes, or in the only eye with sight. A 2025 re-analysis of two landmark trials, funded by the US National Eye Institute and published in Ophthalmology Retina, found that untreated eyes with severe retinopathy had lost about as much field by year 3 as lasered eyes.

That matters at the sight test. The list names laser, not injections, and severe retinopathy narrowed the field without either.

Diabetic retinopathy and driving: what the DVLA asks

The DVLA's guide for drivers has a bus or lorry driver report it in either eye, on form V1V. The DVLA may refer a driver to its contracted optician for a free eyesight test. A test from another optician must include an Esterman visual test and may still not be accepted.

Its guidance for clinicians, updated in September 2025, lists bilateral retinopathy among the disorders that produce a field defect: for car and motorcycle drivers, the DVLA must be notified and the field standard met, laser or not. That standard is at least 120° on the horizontal, 50° to each side, and no significant defect within 20° of fixation above or below the horizontal meridian, on a binocular Esterman with no more than 20% false positives. Four or more adjoining missed points within the central 20° are generally regarded as significant. A bus or lorry licence needs at least 160°, 70° to each side and 30° above and below, with no defect within the central 30°. Acuity, the number plate and 6/12, is a separate subject in this series.

What the field studies found

The re-analysis took 830 participants of the Diabetic Retinopathy Study (1972 to 1979), each with severe non-proliferative or proliferative retinopathy and one eye randomised to laser, the other to none. Goldmann fields were scored as the field's extent summed over 12 meridians: 900 at most, 729 on average at the start. Lasered eyes lost 54.6 of that score by 4 months, untreated eyes 21.5. The untreated eyes kept losing, and by year 3 the difference was no longer significant. At 5 years they were down 156.7, the lasered eyes 124.9.

In Protocol S, a US trial in proliferative retinopathy, an exploratory analysis of the 167 eyes with usable fields at the start found that eyes on ranibizumab lost little field for 2 years, then lost it through year 5. At 5 years the total point score had fallen by 330 dB with ranibizumab and 527 dB with laser, and by about 200 in ranibizumab eyes when tests after any later laser were left out.

In Sweden, 15 of 27 people who lost their licences over field loss after laser passed a driving simulator test, though as a group they drove less safely than controls, and none of the 13 relicensed had an injury accident in 3 to 6 years, which the authors call uncertain with so few licences (Eye, 2022).

Why it matters in practice

The DVLA decides who is fit to drive. The optometrist controls the record and the advice, and the College's guidance on records asks for whether the patient drives, any field test with screener, programme and correction, a printout of any abnormal result, and the oral and written advice. For a patient with diabetes:

• Ask whether they drive, on a car or a bus or lorry licence, since the rules differ, and which eye has had laser or injections. Write it down.
• Laser to both eyes, or to the only eye with sight, must be reported by a car driver, online or on form V1, and laser to either eye by a bus or lorry driver, on form V1V. Under the clinicians' guidance, so is bilateral retinopathy with a field defect. Tell them, and record that you did.
• Where retinopathy is severe or treated in both eyes, it would make sense to run a binocular Esterman, the DVLA's own test, if your screener has one. Keep any abnormal printout.
• If they do not meet the standard, tell them they have a legal duty to inform the DVLA (the DVA in Northern Ireland), advise them not to drive, put it in writing and record it, as the College's guidance on patients who drive sets out. If they keep driving and cannot be persuaded to stop, it says to contact the DVLA and tell the patient.

The caveats

• The Diabetic Retinopathy Study ran in the 1970s, with heavier burns, Goldmann fields and poorer control of glucose, blood pressure and cholesterol than now, its authors say.
• The catch-up was in severe retinopathy: in the milder ETDRS eyes, lasered eyes had still lost more at 7 years, 203.9 against 79.2.
• 320 of the 830 untreated eyes were lasered on progressing and left the analysis, which the authors think understates untreated loss, and cataract or glaucoma may explain some decline.
• Protocol S had 5-year fields for 79 of the 234 eyes in its field study.
• None of the three measured a pass or fail against the UK standard.

Sources

1. 1.Visual disorders: assessing fitness to drive · DVLA (GOV.UK), 26 September 2025
2. 2.Eye conditions and driving (the whole guide, car and bus or lorry licences) · DVLA (GOV.UK)
3. 3.Visual field changes in diabetic retinopathy: natural history and after pan-retinal photocoagulation in the Diabetic Retinopathy Study and the ETDRS · Ophthalmology Retina (author manuscript in PMC), 8 May 2025
4. 4.Visual field changes over 5 years in patients treated with panretinal photocoagulation or ranibizumab for proliferative diabetic retinopathy · JAMA Ophthalmology (author manuscript in PMC), 1 March 2020
5. 5.The effects of visual-field loss from panretinal photocoagulation of proliferative diabetic retinopathy on performance in a driving simulator · Eye (author manuscript in PMC), 13 January 2022
6. 6.Patient records: Guidance for Professional Practice · College of Optometrists
7. 7.Examining patients who drive: Guidance for Professional Practice · College of Optometrists