One of the hardest questions eye care professionals routinely have to deal with is when to tell people with visual difficulaties that they need to stop driving. Giving up your driving privilege is difficult to come to terms with if you have a problem that leads to permanent visual decline. The legal requirements for visual acuity vary from state to state. For example, in New Jersey the legal requirement to drive, based on vision, has been 20/50 vision or better with best correction in one eye for a “pleasure” driving license. For a commercial driving license, the requirement is 20/40 vision or better in both eyes. In some states there is also a requirement for a certain degree of visual field (the ability to see off to the sides). According to the Insurance Institute for Highway Safety, the highest rate of motor vehicle deaths per mile driven is in the age group of 75 and older (yes, even higher than teenagers). Much of this increased rate could be attributable to declining vision. There are also other contributing factors, such as slower reaction times and increased fragility, but the fact remains that the fatality rate is higher. , And so, when vision problems begin to occur with aging it is extremely important to do what is necessary to try to keep your vision as good as possible. That means getting regular eye exams, keeping your glasses up-to-date, dealing with cataracts when appropriate, and staying on top of other vision-threatening conditions such as macular degeneration, glaucoma, and diabetes. It is our responsibility to inform you when you are no longer passing the legal requirement to drive. Although not all states have mandatory reporting laws, your eye doctor will record in your medical record that you were informed that your vision did not pass the state requirements to maintain your privilege. And, yes, it is a privilege -- not a right -- to drive. If you have a significant visual problem and your vision is beginning to decline, you need to have a frank discussion with your eye doctor about your driving capability. If you are getting close to failing the requirement, you need to start preparing with family and loved ones about how you are going to deal with not being able to drive. Many of us eye doctors have had the unfortunate occurrence of having instructed a patient to stop driving because of failing vision, only to have him ignore that advice and get in an accident. Don’t be that person. Be prepared, have a plan. Article contributed by Dr. Brian Wnorowski, M.D.