North Carolina makes it legal for older motorists, who have been linked to a rising number of traffic deaths, to go up to 10 years without submitting to vision exams that prove they can see well enough to drive.
Since 2015, state law has let drivers renew their licenses online every other time it's due. Online renewals help reduce crowds in busy licensing offices and save time for drivers.
Vision exams are a required part of in-person license renewals for drivers of all ages. But online renewals ask license holders to simply state, without proof, that their vision hasn't changed. A North Carolina driver may renew his license in person at 66, renew online at 71 and not appear before an examiner again until 76.
"North Carolina law does mainly look at driver licensing based on a drivers' ability and not a driver's age," said Marge Howell, a spokeswoman for the state Division of Motor Vehicles. "Unless and until the legislature changes certain requirements, that is North Carolina law."
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Advocates differ on the wisdom of online renewals for seniors.
"Corrected vision is crucial to safe driving," said AAA Carolinas spokeswoman Tiffany Wright. "We're just relying on people to say, oh, I don't think anything's changed. For many people, when they go to get their license renewed, that's the first time they find out something's wrong with their vision. I'm not sure avoiding long lines is worth putting lives in danger."
But AARP, the association of Americans 50 and older, stands against age-based testing standards. The group encourages members to refresh their knowledge of road signs and changes in driving laws but, N.C. spokesman Steve Hahn says, "diminished ability can happen at any age."
People 65 and older are a fast-growing share of licensed drivers, the transportation research group TRIP reported in March, and the number of fatal crashes involving older drivers is also increasing.
The number of North Carolina drivers 65 and older grew 22 percent between 2012 and 2016, to nearly 1.4 million, the group reported, while the number of fatal accidents involving older drivers rose 30 percent. In 2016, the state's share of older drivers was about the same as their share of fatal accidents.
North Carolina ranked fifth-highest in the U.S. in 2016 for both the number of traffic fatalities involving 65-plus drivers — 285 deaths — and the number of older drivers killed: 175.
The TRIP report recommended steps that states could take to make driving safer for older drivers.
"Deteriorated vision among older drivers may make small or complex road signage difficult to process," TRIP reported. "Signs may be misunderstood or not seen quickly enough to caution older drivers about upcoming exits, obstacles or changes in traffic patterns. The amount of light needed by drivers doubles every 13 years, starting at age 20. A 72-year-old needs 16 times the amount of light required by a 20-year-old to drive safely."
North Carolina requires drivers to have at least 20/40 vision in one or both eyes in order to drive without corrective lenses. State law requires first-time applicants to undergo tests on rules of the road, road signs and visual acuity, plus a road test. Drivers 66 and older are limited to five-year license terms while eight-year terms are allowed for younger ones.
Renewals also require road-sign and visual tests — unless they're done online. In that case, drivers simply certify that they have no vision problems that would hinder their driving.
Older people are often affected by three common vision problems, said Dr. Dianna Seldomridge, an ophthalmologist with the Duke Eye Center in Winston-Salem. Cataracts reduce visual acuity and contrast sensitivity, producing glare and halos that make it harder to drive at night. Glaucoma, which damages the optic nerve, normally starts with peripheral vision losses that sometimes aren't obvious to the patient. Macular degeneration of the retina results in a loss of visual acuity and field of view.
The American Academy of Ophthalmology, for which Seldomridge is a clinical spokesperson, recommends that adults get a baseline eye exam at 40 with periodic exams as recommended. While the academy doesn't judge the adequacy of state license renewal requirements, Seldomridge said it's uncommon for people who have vision problems to not seek treatment.
"There are not a lot of people out there who have vision problems who are not seeking care," she said.
North Carolina drivers of any age can be required to undergo evaluation under DMV's medical review program. Law enforcement officers, family members or physicians cam recommend that drivers who seem unsteady or have poor eyesight be evaluated. As a result, drivers might be restricted to within a certain distance of home or to daytime driving.
Most states require vision tests or evidence of one for license renewals, the Insurance Institute for Highway Safety says. Eighteen states, including North Carolina, require shorter renewal periods for older drivers. But unlike North Carolina, 16 states and the District of Columbia exclude older drivers from online license renewals.
Research shows that vision tests for older drivers have benefits, IIHS says.
Requiring in-person renewals, and vision tests even when in-person renewals aren't required, are associated with lower fatality rates among drivers 85 and older, spokesman Russ Rader said. Other requirements for drivers 55 and older, such as mandatory road tests or shorter renewal periods, have not been shown to reduce fatalities.
While older drivers are involved in fewer crashes per capita than other age groups, their involvement in fatal crashes begins to inch up at about age 70, the IIHS says. Those rates largely reflect older drivers' greater odds of not surviving a wreck.
"Several studies have shown that higher levels of physical, cognitive or visual impairment among older drivers are associated with increased risk of crash involvement," it says. An IIHS study of a Florida vision test, required for drivers 80 and older, found that 7 percent failed the vision test.
South Carolina legislators last year dropped requirements for eye exams, which the state motor vehicles director said didn't make roads any safer.
“All we’re doing is adding a bureaucratic function to an already stressed system to increase the lines and send more people to the optometrist’s office,” Kevin Shwedo told The State.
But lawmakers revisited the exams this month after a push by eye doctors and other advocates, and this month restored vision screenings beginning in 2020.