Driving is a visually demanding task, and in South Africa, gaps in driver licensing policies, particularly the limited integration of optometrists, Driver Licensing Testing Centres, and systematic visual assessments, persist despite clear evidence linking vision and road safety.
Aim
This study aimed to develop an evidence-based framework to strengthen South Africa’s vision screening standards for driving, integrating clinical, regulatory, and public health perspectives through empirical research and policy analysis.
Method
A mixed-methods approach was used, comprising a systematic review and meta-analysis, stakeholder interviews with policy analysis, a quantitative study on visual function and road traffic accidents, and an online survey of optometrists’ practices. Findings were synthesised through thematic analysis and methodological triangulation to identify gaps and develop an integrated framework for strengthening vision screening in South Africa’s driver licensing system.
Results
The resulting framework comprises five strategic pillars: (1) expanded screening criteria, (2) policy alignment, (3) stakeholder engagement, (4) infrastructure and technology enhancement, and (5) public awareness, underpinned by continuous monitoring and evaluation to ensure national scalability. It supports standardised, evidence-based vision screening, advancing early detection of visual impairments and contributing to South Africa’s road safety goals.
Conclusion
The proposed framework enhances the relevance and consistency of vision screening for drivers by standardising protocols, addressing systemic and clinical gaps, and introducing evidence-based assessments aligned with licensing regulations to better capture visual functions critical to driving performance.
Contribution
This study provides a strategic foundation for national policy and legislative reform, enabling scalable adoption of standardised, evidence-based vision screening programmes, strengthening driver fitness assessment, and enhancing road safety in South Africa.
vision screeningdriving standardsroad safetySouth Africaoptometryvisual functionpolicy frameworkFunding information This work was supported by the National Research Foundation of South Africa (Grant No.: 139103), the National Research Fund of South Africa awarded to Gloria T. Tamenti.Introduction
Road traffic safety is a significant public health concern that is frequently under-prioritised despite its substantial health, economic, and social impact, including injury-related morbidity and mortality, healthcare costs, and productivity losses.1 Global estimates from the World Health Organization (WHO) indicate that road traffic accidents (RTAs) result in approximately 1.19 million deaths each year. Notably, low- and middle-income countries bear a disproportionate burden, accounting for 92% of all road fatalities worldwide.1 South Africa reports the highest rate of road traffic deaths on the African continent, with a fatality rate of 25.9 deaths per 100 000 population.1 These fatalities result in significant economic costs and social consequences for both the nation and the individuals directly affected.1,2
Historically, numerous interventions have been implemented to enhance road safety.3 While these initiatives remain vital, it is imperative to acknowledge the significant contribution of drivers’ visual function within the broader context of road safety. Driving is a visually demanding activity, with vision estimated to provide up to 90% of the sensory input required for effective decision-making.4 Empirical evidence indicates that individuals with visual impairments are approximately twice as likely to be involved in serious RTAs compared to those with normal visual function.5
Several countries, including South Africa, have implemented minimum vision standards for driving to assess drivers’ visual capabilities, determine their fitness to hold a learner’s or driver’s licence, and promote road safety.6 In South Africa, the mandatory visual requirements for both the issuance and renewal of driving licences are stipulated in Regulation 102 of the National Road Traffic Act (Act 93 of 1996). These regulations, unchanged since 1996, are primarily based on conventional parameters such as visual acuity (VA) and visual field (VF) thresholds. However, emerging evidence indicates that these measures exhibit a weak correlation with road traffic safety outcomes, suggesting they inadequately capture the full spectrum of visual demands necessary for safe driving practices.7
The escalating incidence of RTAs in South Africa highlights an urgent public health concern and the critical need for effective road safety.7 Road traffic accidents are multifactorial in nature and may be influenced by several interacting factors, including driver behaviour and compliance with road safety regulations, road safety culture, vehicle conditions, environmental factors, and road infrastructure quality. However, visual function remains a critical component of safe driving performance as it directly influences hazard detection, spatial awareness, reaction time, and decision-making while driving. Poor vision, particularly deficits in VA, VF, and contrast sensitivity, has been associated with an increased risk of RTAs.8 Although substantial evidence supports the association between compromised visual function and increased accident risk, South Africa has established minimum visual requirements for driver licensing, primarily based on VA and VF criteria. This gap may contribute to variability in practitioners’ interpretation and application of vision screening practices, potentially affecting the consistency in driver fitness assessments and road safety outcomes.
This study is contextualised within South Africa’s broader road safety challenges, with a specific focus on the role of visual function in driving competence. It explores the current approach to driver vision screening in South Africa and the absence of a systematic, standardised clinical reference framework to support vision screening practices. This gap may contribute to variability in the interpretation and application of vision screening standards and highlights the need for further investigation. Drawing on empirical evidence, stakeholder perspectives regarding policy implementation, and an analysis of optometric practices within Gauteng province, the study develops a strategic framework for national driver vision screening standards. The framework proposes evidence-informed recommendations for regulatory guidance, professional capacity development, and public awareness initiatives to strengthen driver vision screening practices and informing road safety efforts.
Methods
The strategic framework for driver vision screening standards in South Africa was developed through the systematic integration and synthesis of evidence generated from four interrelated research components undertaken as part of the broader programme of work. These components addressed: (1) evidence on the association between visual function and RTAs, (2) stakeholder perspectives on driver vision screening and policy implementation, (3) visual functions associated with RTAs among drivers, and (4) optometrists’ knowledge and practices regarding driver vision screening.
A mixed-methods integrative approach was employed to facilitate the development of the framework. The framework development process involved five sequential stages: (1) evidence generation, (2) thematic synthesis of qualitative findings, (3) triangulation and cross-component integration, (4) identification of evidence domains, and (5) framework formulation (Figure 1).
Framework development process.
Stage 1: Evidence generation
In the first stage, findings from the four research components were reviewed and extracted according to their contributions to: (1) driver vision screening standards, (2) visual risk factors, (3) policy implementation, and (4) clinical practice. Quantitative findings were summarised to identify patterns and areas of convergence, while qualitative findings were retained for subsequent thematic synthesis.
Stage 2: Thematic synthesis of qualitative findings
The second stage involved thematic synthesis of qualitative findings using an iterative process of coding, categorisation, and refinement through constant comparison. Initial codes were grouped into descriptive categories, which were subsequently consolidated into higher-order themes representing key issues related to driver vision screening standards and implementation.
Stage 3: Triangulation and cross-component integration
The third stage involved triangulation and integration of findings across the quantitative and qualitative research components. Findings were compared to identify areas of convergence, complementarity, and divergence. Cross-component consistency checks were conducted to ensure coherence among empirical findings, stakeholder perspectives, and evidence from optometric practice.
Stage 4: Identification of evidence domains
In the fourth stage, the integrated findings were grouped into broader evidence domains representing key areas for driver vision screening and framework development.
Stage 5: Framework formulation
In the final stage, the identified evidence domains and synthesised findings were translated into strategic framework components. The evidence domains informed the development and refinement of framework themes relating to expanded vision screening criteria, regulatory alignment and policy integration, stakeholder and professional engagement, infrastructure and digital systems, public awareness and community engagement, and monitoring and evaluation. The resulting framework was therefore evidence-informed and grounded in empirical findings across the integrated research components.9
Research components informing framework development:
Systematic review and meta-analysis: Examined the association between visual functions and RTAs using pooled evidence from 10 empirical studies.9
Stakeholder perspectives component: Explored views of driver licensing stakeholders regarding vision screening standards and policy implementation through qualitative interviews.10
Driver visual functions component: Investigated associations between visual impairments and RTAs among motor vehicle drivers in Gauteng province using a cross-sectional design.11
Optometric practice component: Assessed knowledge and practices relating to driver vision screening among registered optometrists using a descriptive cross-sectional approach.12
Ethical considerations
Ethical approval was obtained from the University of KwaZulu-Natal (UKZN) Biomedical Research Ethics Committee (BREC/00000664/2019) and the Ministry of Transport in Gauteng province, South Africa.
Review findings
The integrated analysis generated five overarching themes and one cross-cutting theme that informed the strategic framework for driver vision screening standards in South Africa. The synthesis process combined findings across the four research components through triangulation and thematic integration to identify areas of convergence, complementarity, and policy relevance.9,10,11,12 Rather than linking findings directly to individual research components, evidence was synthesised across components to generate integrated framework themes. Findings that converged across multiple sources were prioritised to inform framework development, while complementary findings provided contextual and implementation insights.
Table 1 presents the synthesis of evidence across research components and illustrates how integrated findings informed the framework themes and pillars.
Synthesis of integrated findings informing the strategic framework.
Theme
Integrated evidence sources
Synthesised findings
Framework component
1. Expanded vision screening criteria
Systematic review and meta-analysis; Drivers’ visual function and road traffic accidents component
Evidence supported the inclusion of visual functions beyond visual acuity, particularly colour vision and contrast sensitivity, within driver vision screening
Expanded vision screening criteria
2. Regulatory alignment and policy integration
Stakeholder perspectives; Optometrists’ knowledge and practices; Drivers’ visual function component
Evidence identified implementation gaps, limited coordination, and the need for structured monitoring of visual fitness
Regulatory alignment and governance
3. Stakeholder and professional engagement
Stakeholder perspectives; Optometrists’ knowledge and practices
Findings highlighted variability in practice, training needs, and stakeholder coordination challenges
Clinical practice and professional training
4. Infrastructure, technology, and access
Stakeholder perspectives; Optometrists’ knowledge and practices
Findings supported strengthening technology, infrastructure, and integrated data systems
Infrastructure and access
5. Public awareness campaigns
Multiple research components
Findings highlighted the need for awareness initiatives to improve vision-related road safety practices
Public awareness
6. Cross-cutting theme
All research components
Evidence highlighted the need for monitoring, evaluation, and quality assurance mechanisms
Monitoring and evaluation
The integrated findings presented in <xref ref-type="table" rid="T0001">Table 1</xref> formed the basis for the thematic areas and cross-cutting components of the proposed strategic frameworkTheme 1: Expanded vision screening criteria
Integrated findings from the systematic review and meta-analysis, along with the driver visual function component, highlighted the importance of visual functions beyond VA in driver fitness assessments.9,11 Evidence demonstrated associations between impaired visual function and RTAs and identified significant relationships between RTAs and poor VA, uncorrected refractive errors, colour vision deficiency, and abnormal contrast sensitivity.
The convergence of findings provided supportive evidence for including colour vision and contrast sensitivity assessments within the proposed expanded vision screening protocol, extending beyond the current VA and VF requirements (Table 1 and Table 2).
The proposed expanded vision screening protocol for driving.
Visual functions
Current standard
Proposed standard
Proposed tests and remarks
Visual acuity (VA)
LMV:
6/12 (20/40), each eye with or without refractive correction
HVM:
Minimum VA of 6/9 (20/30) for each eye, with or without refractive correction
Maintain the current standards
Snellen rating
Monocularity
LMV:
Where the visual acuity of one eye is less than 6/12 (20/40) or where one eye of the person concerned is blind, a minimum visual acuity for the other eye of 6/9 (20/30)
HMV:
No monocular vision requirements
Maintain the current standards
Snellen rating
Visual fields (VF)
LMV:
Minimum VF of 70 degrees temporal, with or without refractive correction, in each eye
Where the VF of one eye is less than 70 degrees temporal, or where one eye is blind, a minimum total horizontal visual field of at least 115 degrees with or without refractive correction
HMV:
A minimum visual field of 70 degrees temporal in respect of each eye, with or without refractive correction
To assess significant defects within the central 20 degrees of fixation
Manual VF tests that measure the extent of the visual field to eliminate subjectivityVisual Fields tests:
Arc perimetry
Vision Disc
Novissphere
Colour vision (CV)
No requirements
Include colour vision screening test
Colour Vision tests:
Ishihara
Hardy-Rand-Rittler (HRR)
Contrast sensitivity (CS)
No requirements
Include contrast sensitivity vision screening for licensing
Contrast Sensitivity tests:
Pelli-Robson contrast sensitivity test chart
Mars chart
Mixed Contrast chart
LMV, Light motor vehicle; HMV, heavy motor vehicle.
These findings further highlighted the potential value of incorporating broader visual function assessments within driver fitness evaluations. In addition, alcohol consumption was identified as an important contextual factor associated with RTAs. Although outside the scope of vision screening, this finding highlights the multifactorial nature of road safety and reinforces the need for integrated and multisectoral road safety interventions.
Table 2 presents the proposed expanded vision screening protocol within the current South African regulatory framework, including additional visual functions beyond VA and VFs. While multiple factors were associated with RTAs, the proposed protocol focuses specifically on visual functions that can be assessed within clinical and licensing contexts.
Theme 2: Regulatory alignment and policy integration
Integrated findings from stakeholders’ perspectives, optometrists’ practices, and components of driver visual function highlighted the need for strengthened regulatory alignment and policy integration for driver vision screening. Evidence identified inconsistencies in the implementation of vision screening protocols, limited coordination between clinical and regulatory stakeholders, gaps in ongoing monitoring of visual fitness, and the absence of structured oversight mechanisms within the current system.
The integrated findings informed recommendations to review and strengthen existing vision-related policies and practices governing driver licensing in South Africa. In particular, the evidence supported the establishment of structured oversight mechanisms, such as a Medical Advisory Board, to coordinate and guide the implementation of standardised vision screening practices.
Furthermore, integrated evidence from stakeholders, optometric practice, and driver components supported maintaining vision screening at the initial issuance of a driver’s licence, while strengthening ongoing monitoring of visual fitness. Within this context, biennial vision assessments were identified as vision-focused fitness-to-drive clearances positioned within the existing 5-year driver’s licence renewal cycle. This recommendation aligns with guidance from professional bodies in ophthalmology and optometry.13
The findings further suggest that this approach may be feasible within the South African socioeconomic and health system context when supported by accredited eye care practitioners, public health services, and digital reporting systems, with potential benefits for accessibility, continuity of care, and road safety monitoring.
Theme 3: Stakeholder and professional engagement
Integrated findings from stakeholder perspectives and the components of optometrists’ knowledge and practices highlighted variability in the implementation of driver vision screening and identified gaps in standardisation, coordination, workforce integration, and professional training within the current system. The evidence indicated inconsistencies in the application of driver vision screening practices, variability in practitioner knowledge, and limited collaboration between transport authorities and eye care professionals. These findings informed recommendations to develop standardised vision screening guidelines and protocols to ensure consistency in practice and implementation.
Furthermore, the integrated findings supported strengthening continuing professional development initiatives related to vision and driving, enhancing collaboration between transport and eye care stakeholders, and increasing the involvement of eye care professionals within training, advisory, and implementation structures. The findings also highlighted the importance of strengthening workforce participation by including eye care professionals in driver vision screening services and training Driver Licensing Testing Centre (DLTC) examiners through programmes to support standardised implementation and capacity development.
Theme 4: Infrastructure, technology, and access
Integrated findings highlighted the importance of strengthening infrastructure, technology, and digital systems to support the implementation and sustainability of driver vision screening programmes. The evidence identified the need to standardise vision screening equipment and VF testing approaches, and to integrate advanced technologies to improve consistency and efficiency in vision screening. Findings further supported the implementation of electronic reporting and data management systems, including integration with the electronic National Administration Traffic Information System (eNatis), to facilitate accurate capture, monitoring, and reporting of vision screening outcomes.
Furthermore, the integrated findings highlighted the importance of digitised certification, real-time verification mechanisms, and technology-enabled continuity systems, including cloud-based platforms with offline functionality, to support uninterrupted service delivery and strengthen system resilience. The findings also emphasised the need for infrastructure support, including proactive equipment maintenance, routine calibration schedules, quality assurance measures, and access to technical support to ensure the reliability and performance of vision screening systems. In addition, strengthening access to eye care services within driver licensing environments was identified as an important consideration for improving accessibility and implementation capacity.
Collectively, these findings informed recommendations to enhance accessibility, reliability, efficiency, and sustainability in driver vision screening systems.
Theme 5: Public awareness campaigns
Integrated findings across the research components highlighted the importance of public awareness and community engagement initiatives in promoting ocular health and road safety.
The evidence supported the implementation of awareness campaigns to strengthen public understanding of the relationship between vision and safe driving, and emphasised the importance of integrating vision-related education into driver training programmes and educational materials. Furthermore, the findings highlighted the value of multimedia communication approaches, including television, radio, social media, and other public outreach platforms, in improving accessibility and dissemination of road safety and ocular health messages across diverse populations. Integration of awareness activities with national road safety campaigns, health promotion initiatives, and licensing programmes was also identified as an opportunity to enhance visibility and public engagement.
In addition, the findings emphasised the importance of community feedback and engagement mechanisms, including digital and conventional data collection approaches, to support service improvement, public participation, and continuous quality enhancement.
Collectively, these findings informed recommendations to strengthen public awareness, enhance community engagement, and promote vision-related road safety practices.
Theme 6: Monitoring and evaluation
Integrated findings across all research components identified monitoring and evaluation as a cross-cutting requirement supporting all framework areas and the long-term implementation of driver vision screening programmes. The evidence highlighted the importance of systematic monitoring and evaluation processes in assessing programme implementation, identifying barriers, tracking outcomes, and supporting continuous quality improvement. Findings further supported the need for national vision screening audits, periodic policy review, and data-driven analyses to facilitate evidence-informed refinement of driver vision screening practices and implementation strategies.
In addition, the findings underscored the value of structured data collection and reporting systems in strengthening monitoring capacity and supporting ongoing evaluation of programme effectiveness and impact. These recommendations align with the monitoring and evaluation principles outlined in the Global Plan for the Decade of Action for Road Safety 2021–2030.14
Collectively, the integrated findings identified monitoring and evaluation as essential for ensuring the sustainability, effectiveness, and continuous improvement of the proposed strategic framework and its contribution to road safety outcomes.
Implications and recommendations
This study presents an evidence-informed, integrative framework (Figure 2) for driver vision screening standards in South Africa. The framework was developed through the synthesis and integration of findings across four interrelated research components and incorporates clinical, regulatory, stakeholder, and public health perspectives relevant to driver vision screening. The framework further integrates insights from eye care practitioners and DLTCs to enhance contextual relevance, feasibility, and alignment with national road safety priorities.
Framework for vision screening standards for driving.
The integrated findings identified five thematic areas and a cross-cutting monitoring and evaluation component that collectively informed the proposed framework. These include expanded vision screening criteria; regulatory alignment and policy integration; stakeholder and professional engagement; infrastructure, technology, and access; public awareness and community engagement; and monitoring and evaluation. Collectively, these themes provide a structured approach for strengthening driver vision screening practices within the South African context.
Integrated findings from the systematic review and the driver visual function component supported the inclusion of visual functions beyond VA, particularly colour vision and contrast sensitivity, within the proposed vision screening protocol. These findings align with international evidence emphasising the importance of broader visual function assessment in driver fitness evaluations and the evolving approaches to driver vision screening.5,15 The findings further highlighted the need for strengthened regulatory alignment and policy integration to support standardised implementation of driver vision screening practices. Recommendations regarding policy review, structured oversight mechanisms, professional training, and monitoring approaches were informed by evidence from stakeholders, optometric practice, and driver components, and are consistent with internationally accepted integrated road safety approaches.1,3,14
In relation to stakeholder and professional engagement, the framework supports strengthened collaboration between transport authorities and eye care professionals, enhanced professional development initiatives, and broader workforce participation in driver vision screening services. The inclusion of dispensing opticians within vision screening services is consistent with task-sharing approaches adopted in health systems to improve service accessibility and workforce capacity.16
The findings also highlighted the importance of strengthening infrastructure, digital systems, and data management processes to support the implementation and sustainability of driver vision screening programmes. Recommendations on digital reporting systems, technology integration, and data-driven monitoring align with broader developments in digital health and road-safety management systems.17
Public awareness and community engagement were identified as important components for promoting ocular health and road safety. The findings support awareness initiatives, vision-related driver education, and broader public engagement approaches to strengthen understanding of the relationship between vision and safe driving, consistent with international road safety strategies.18
Monitoring and evaluation emerged as a cross-cutting component supporting all framework areas. The integrated findings emphasised the importance of systematic monitoring, national audits, outcome tracking, and periodic policy review to support continuous quality improvement and evidence-informed refinement of driver vision screening practices, consistent with global road safety frameworks.19
Although the framework focuses on vision-related factors, findings from the driver visual function component identified alcohol consumption as an additional factor associated with RTAs. While outside the scope of vision screening, this finding reinforces the multifactorial nature of road safety and highlights the importance of integrated, multisectoral approaches.
The proposed framework aligns with international approaches emphasising evidence-based visual assessment, periodic fitness-to-drive monitoring, and intersectoral collaboration between health and transport systems.1,20,21 However, implementation in the South African context may be influenced by system-level challenges, including limitations in vision-screening infrastructure, digital connectivity constraints, and variability in implementation practices. Addressing these challenges will require sustained institutional commitment, stakeholder collaboration, and continued professional engagement.
Further research is required to evaluate the implementation, feasibility, and long-term impact of the proposed framework on driver vision screening practices and road safety outcomes in South Africa.
Conclusion
This study highlights the need for an evidence-informed, standardised framework for driver vision screening in South Africa to strengthen screening practices and support road safety initiatives. The proposed framework provides a contextually relevant approach informed by integrated evidence across clinical, regulatory, stakeholder, and public health domains.
The framework incorporates expanded vision screening criteria, regulatory alignment and policy integration, stakeholder and professional engagement, infrastructure and digital systems, public awareness and community engagement, and a cross-cutting monitoring and evaluation component. Collectively, these elements provide a structured approach for strengthening driver vision screening implementation within the South African context. Successful implementation of the framework will require sustained governmental commitment, intersectoral collaboration between health and transport sectors, stakeholder engagement, and ongoing evaluation to support implementation and continuous improvement.
Acknowledgements
The authors owe a debt of gratitude to the National Research Foundation Scholarship and the staff of the School of Health Sciences, University of KwaZulu-Natal, South Africa, for their support.
Competing interests
The authors, Gloria T. Tamenti; Tuwani A. Rasengane and Khathutshelo P. Mashige, reported that they received funding from the National Research Foundation of South Africa, which may be affected by the research reported in the enclosed publication. The authors have fully disclosed those interests and implemented an approved plan to manage any potential conflicts arising from their involvement. The terms of these funding arrangements have been reviewed and approved by the affiliated university in accordance with its policy on objectivity in research.
CRediT authorship contribution
Gloria T. Tamenti: Conceptualisation, Data curation, Investigation, Methodology, Resources, Writing – original draft, Writing – review & editing. Tuwani A. Rasengane: Conceptualisation, Investigation, Methodology, Resources, Supervision, Writing – original draft, Writing – review & editing. Khathutshelo P. Mashige: Conceptualisation, Investigation, Methodology, Resources, Supervision, Writing – original draft, Writing – review & editing. All authors reviewed the article, contributed to the discussion of results, approved the final version for submission and publication, and take responsibility for the integrity of its findings.
Data availability
The data that support the findings of this study are available from the corresponding author, Gloria T. Tamenti, upon reasonable request.
Disclaimer
The views and opinions expressed in this article are those of the authors and are the product of professional research. They do not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or the publisher. The authors are responsible for the article’s results, findings, and content.
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How to cite this article: Tamenti GT, Rasengane TA, Mashige KP. Strategic framework for vision screening standards for driving in South Africa. Afr Vision Eye Health. 2026;85(1), a1124. https://doi.org/10.4102/aveh.v85i1.1124