Guidance

People with diabetes who drive to appointments and the use of eye drops

Updated 27 September 2024

Applies to England

1. Driving and inadequate visual acuity (VA)

1.1 An individual has driven and VA appears to be below the legal limit

A person with diabetes cannot be prevented from driving, even where their vision is known to be inadequate. The screener can only strongly advise that the person with diabetes considers this issue. If appropriate the screener can suggest a visit to the optometrist to review their prescription. A note of this advice should be recorded in the episode notes.

An ophthalmologist can only stop someone from driving if the DVLA has asked them for an opinion, not if the person with diabetes presents routinely.

The guidance below regarding driving and mydriasis should still be followed.

2. Driving and mydriasis

2.1 Information to an individual regarding mydriasis and driving

Each invitation or appointment letter should always include advice in writing not to drive after mydriasis. This advice should be reiterated by the administration team taking telephone bookings and by the screener at the appointment prior to dilation.

2.2 If an individual has driven to the appointment

In the event the individual has driven, best practice is to offer another appointment.

2.3 Other options

Alternatives are to encourage the person with diabetes to leave their vehicle behind and collect later, or wait until they have fully recovered and their vision is clear before driving. This usually takes around four hours, The individual should be able to read a number plate from the distance required by the DVLA (https://www.gov.uk/driving-eyesight-rules).)

2.4 If an individual is not prepared to consider other options

If the individual is not prepared to consider either of the alternatives and plans on driving following mydriasis, it would be considered unsafe to continue to administer the drops and the person with diabetes should be offered another appointment.

2.5 If an individual refuses to attend a further appointment with drops

The screener should explain that screening requires mydriasis to enable the best possible view of the retina. Encourage the individual to discuss their concerns with their GP or diabetic eye screening programme (DESP) clinical lead. Book a further appointment no more than 2 months from the initial appointment. This allows time for a discussion with their GP or the DESP clinical lead.

If the individual still does not consent to dilation they should be informed about:

• their choice to opt out of screening
• the risks associated with opting out
• their ability to opt back in at any time

If the programme does not receive an opt out form it should continue to invite the individual for routine digital screening. By giving the advice outlined above, the programme has provided reasonable opportunity for the individual to make an informed decision about declining drops and eye screening.

2.6 Imaging without mydriasis

Guidance on screening without mydriasis can be found here: Use of mydriatic eye drops in the NHS diabetic eye screening programme - GOV.UK (www.gov.uk)

3. Rationale for not driving following mydriasis

When mydriasis takes place:

• the pupil enlarges which reduces the sharpness of vision; the degree of change varies with the person with diabetes and the level of their ‘normal’ vision
• the pupil is paralysed in the open position and a person who can still see sharply enough in overcast conditions may be dazzled if they turn into the sun and the pupil does not react
• the time the effect takes to wear off varies and relates to iris colour and the different strength and numbers of drops used

3.1 Legal position

A person with diabetes who is taking eye drops eg Tropicamide cannot be prevented from driving and the screener can only strongly advise that they do not drive for the stated time. This is because it is an offence to drive a motorised or non-motorised vehicle whilst unfit to drive under the influence of drink or drugs.

Tropicamide is a drug which can affect eyesight. The main test is whether eyesight is affected to reduce it below the legal limit for driving and impair ability. Insurance companies often have policy clauses to the same effect, so there is a possibility that a person’s insurance can be affected, for example by limiting it to 3rd party cover only.

People attending screening can also seek further information regarding Tropicamide and driving implications from their insurance policy provider.’

Appendix the legal statement:

Legal statement: We note that pursuant to section 148 of the Road Traffic Act 1988 where a policy purports to restrict the insurance by reasons including the age or physical or mental condition of the person driving the vehicle, such clause is to be treated as void for the purposes of third-party liability.