MCSA-5871: FMCSA Vision Evaluation Report

Since the January 2022 vision standard rule, an interstate commercial driver who cannot meet the acuity or field standard in the worse eye can still be certified, at least annually, if an ophthalmologist or optometrist first completes this three-page report. It records acuity, formal perimetry, color recognition, stability and adaptation; the medical examiner makes the qualification decision.

Who completes it

An ophthalmologist or optometrist completes all 14 items and signs the attestation with license number and state; the driver supplies name, license number and date of birth.

Submitting and payment

How to submit it
The report goes to the driver, and the medical examiner must receive it and begin the physical qualification exam no more than 45 days after the eye specialist signs and dates it.

Good to know

  • The better eye must have distant acuity of at least 20/40 and a horizontal field of at least 70 degrees, and the driver must recognize red, green and amber signals.
  • Item 4 requires formal perimetry testing at least 120 degrees horizontally, with results for each eye attached; "normal" or "full" is not accepted as a field result.
  • The specialist gives opinions on whether the deficiency is stable, whether enough time has passed to adapt, and whether evaluation is needed more often than annually.
  • Progressive conditions such as macular edema, cataracts, glaucoma or retinopathy are listed with diagnosis date, severity, current treatment and whether each is stable.

Get the official form

Download the current version from the source each time; forms change without notice.

Vision Evaluation Report

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who needs an MCSA-5871 Vision Evaluation Report?

A driver who has monocular vision as FMCSA defines it, or who did not meet the vision standard at a physical exam: the worse eye has corrected acuity below 20/40, a horizontal field under 70 degrees, or both. The report is required before each exam, at least annually.

How long is the MCSA-5871 valid?

The medical examiner must begin the physical qualification exam no more than 45 days after the ophthalmologist or optometrist signs and dates the report. A newly completed report is needed before each required exam.

Does the eye specialist decide if the driver can drive a commercial vehicle?

No. The ophthalmologist or optometrist reports findings and opinions on stability and adaptation. Whether the driver meets the vision standard and is physically qualified is decided by a medical examiner on FMCSA's National Registry of Certified Medical Examiners.