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South Carolina 412-LV Bioptic Low Vision Certificate

South Carolina law (SC Code 56-1-222) requires drivers with low visual acuity who use bioptic telescopic lenses to have this certificate completed by an optometrist or ophthalmologist before applying for a beginner's permit or license, and again at annual evaluations. The examiner documents the bioptic system, acuity through the carrier lens and telescope, visual fields, color vision and the motor and cognitive qualities needed to drive.

Who completes it

The patient fills in identity details and signs in the examiner's presence; a licensed optometrist or ophthalmologist answers all eleven questions, adds comments and signs the certification with a professional number.

Submitting and payment

How to submit it
The certificate must be completed before the patient applies to SCDMV and is valid for 12 months from the exam; the form names SCDMV's Driver Improvement Office as the mailing destination for medical information.

Good to know

  • Thresholds on the form: at least 20/120 through the carrier lens and 20/40 through the bioptic in the better eye, and a binocular field of 120 degrees horizontal and 80 vertical without field expanders.
  • For a monocular driver, the horizontal field must be at least 70 degrees temporally and 35 degrees nasally.
  • The examiner records the bioptic vendor, dispensing date, system type and strength in X-power, and whether the patient recognizes red, green and amber or passes the large-disc D-15 test.
  • For a progressive condition, choose whether the customer remains eligible, needs more rehabilitation driver training, or should have a road test re-examination by an SCDMV examiner.

Get the official form

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

Certificate of Low Vision Acuity Examination for Non-Commercial Beginner's Permits or Driver's Licenses

Official pagePDF

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

How long is South Carolina's 412-LV valid?

12 months from the date of the vision examination, and it must be completed before applying for a beginner's permit or driver's license. The examiner marks whether it is an initial or annual evaluation and, for an annual one, whether the customer still meets the low vision requirements.

What training does a South Carolina bioptic driver need besides the 412-LV?

Proof of a certified bioptic driver training program in two parts: an in-clinic pre-driver bioptic evaluation and training program, and a recognized behind-the-wheel bioptic driving program. The road test must be taken within 12 months of completing the behind-the-wheel program, and three failed attempts mean repeating training.

Does signing the 412-LV make the eye doctor responsible for the patient's driving?

The instructions state that the optometrist or ophthalmologist assumes no responsibility in completing the certificate other than truthfully representing the facts. The examiner must still answer every question and indicate whether vision has deteriorated below the low vision requirements.