Indiana drivers who fail the vision screening at a BMV branch receive this Certificate of Vision (Eye Referral) to take to an eye doctor. The ophthalmologist or optometrist certifies the driver's visual acuity, and visual fields when needed, and the BMV's Driver Ability Department can then ask for more information, order a driving evaluation, add restrictions, set follow-up, or revoke privileges.
An ophthalmologist or optometrist completes the vision certification.
Download the current version from the source each time; forms change without notice.
Certificate of Vision (Eye Referral)
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When the driver fails the vision screening at a BMV branch, they receive this Certificate of Vision (Eye Referral) to be completed by an ophthalmologist or optometrist. Drivers with an existing annual or biennial vision restriction must also submit one before their screening expiration date.
When the acuity reading is in category 6 or 7, the BMV requires visual fields for each eye. Accepted tests are the Humphrey 120 full field point screener, Esterman monocular, HVF kinetic, Goldmann III 4E, or an equivalent test covering 60 degrees or more temporally from fixation.