Virginia drivers who want to be licensed with a bioptic telescope need their eye doctor to report their vision on this form. It captures changes in vision over the past year, uncorrected acuity, acuity through the carrier lens and through the telescope, horizontal field in degrees, and the telescope's make, power and date received. DMV Medical Review Services reviews it with the MED 41 certification before allowing testing.
The applicant's identifying details go in Applicant Information. An ophthalmologist or optometrist completes the vision history, examination results, telescopic lens, diagnosis and prognosis fields and signs the certification.
Download the current version from the source each time; forms change without notice.
Bioptic Telescopic Lens Vision Report
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Virginia's MED 44 information sheet sets 20/200 or better in one or both eyes through the carrier lens and 20/70 or better through the bioptic telescope, which must be mounted to the carrier lens. Horizontal vision must be 70 degrees or better, or 40 degrees temporal and 30 degrees nasal if only one eye is used.
Bioptic licenses start with daylight-only driving, from half an hour after sunrise to half an hour before sunset. According to MED 44, the restriction may be lifted after one year if acuity is 20/40 or better in one or both eyes without field expanders and the licensee passes a night driving road skills examination.