Texas DPS refers driver license applicants who fail its simple vision test, or who need more accurate measurement, to an eye specialist with this two-page form. The specialist records acuity without glasses, with present glasses and with best correction, color perception, field of vision and eye conditions, and the applicant returns the signed report to the driver license office.
An eye specialist (optometrist or ophthalmologist) completes the checklist on page 1 and the Report of Vision Specialist and Certification of Specialist on page 2, signing with a medical license number. The DPS examiner fills in the Report of Examiner, and the applicant signs in the specialist's presence.
Page 1 explains why the applicant was referred: DPS gives every applicant a simple vision test and refers anyone who fails the printed acuity scores, which differ for best eye, poorest eye and one-eyed applicants, with and without glasses. DPS asks the specialist to sign the report, list a medical license number, have the applicant sign in their presence, and add comments for unusual cases on a separate sheet if needed.
Check every condition found: hyperopia, myopia, astigmatism, presbyopia, cataract, traumatic condition, suppression, poor night vision, strabismus, or poor color perception with the affected color marked (red, green or yellow), or other. The form tells the specialist to check all applicable items, so mark every condition present rather than only the main one.
Mark whichever statements apply: corrective lenses are being fitted for distant vision; corrective lenses will not improve distant vision; the applicant would not accept corrective lenses; corrective lenses should not be worn for distant vision, with the reason; or, regardless of a qualifying acuity score, corrective lenses should be worn for distant vision, with the reason.
Item 7 recommends that the applicant drive in daylight only. Item 8 states that other treatment to improve vision is recommended. Item 9 states that, because of a permanent eye condition, the applicant need not be referred for visual reexamination at the next renewal. Item 10 is space for any other recommendation.
This page 2 block belongs to the DPS examiner, not the specialist. It records the examinee's full name and address, the acuity DPS measured for the right eye, left eye and both eyes without glasses and with present glasses, color results (normal, red, green or amber), and the examiner's signature. If your readings differ widely from these, the form says the examining officer would welcome a discussion with you.
Record acuity as 20/ values for the right eye, left eye and both eyes in three rows: without glasses, with present glasses and with best correction. Mark color perception as normal or deficient for red, green or amber. Then record the field of vision in degrees to the right and to the left of the point of fixation, and the total angle.
Write your name in the certification that you personally examined the applicant's eyes, that the report is a true record of the examination, and that the applicant signed in your presence. Then sign, and add your business address, telephone number, medical license number, the date of examination and the examinee's driver license number. The applicant signs on the line for the examinee.
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Explanation for Eye Specialist (Report of Vision Specialist)
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An eye specialist, meaning an optometrist or ophthalmologist, examines the applicant and completes the report. DPS asks the specialist to sign it and list a medical license number, and to have the person examined sign the report in the specialist's presence so the identification is certain. The DPS examiner completes a separate Report of Examiner block.
All Texas driver license applicants take a simple vision test. Applicants who fail to meet the acuity scores printed on page 1, or who may need a more accurate measurement, are referred to an eye specialist with the DL-63. The applicant instructions explain that the exam is to determine whether the applicant's sight can be improved by glasses or treatment.
The form addresses this directly: the specialist assumes no responsibility in making the report other than truthfully representing the facts. DPS adds that the examining officer welcomes a discussion with the specialist when acuity scores vary widely between the DPS test and the specialist's exam, to improve the accuracy of DPS vision testing.