CERTIFICATE OF VISION
(ORS 807.090)
The medical information in this report is confidential and will be used by the Driver and Motor Vehicle Services (DMV)
only to determine the qualifications of the person to operate motor vehicles.
INSTRUCTIONS TO APPLICANT:
1. Take this certificate to the licensed vision specialist of your choice and have a vision examination.
2. After the vision specialist conducts the examination, dispenses new prescription lenses if necessary, and completes
the certificate:
z
Return completed form to a local DMV office, or
FAX (503) 945-5329 or mail completed form to DMV Driver Safety Unit, 1905 Lana Ave NE, Salem, OR 97314.
z
z For Valid With Previous Photo License, return completed vision form along with your application in the enclosed
envelope.
NOTE X Failure to comply with this requirement may result in suspension of your driving privileges.
T
APPLICANT or DMV EXAMINER – COMPLETE THIS SECTION T
LAST NAME (PLEASE PRINT)
FIRST NAME
MIDDLE NAME
DATE OF BIRTH
ODL / CUSTOMER NUMBER
T
OFFICE USE ONLY
TSR ID
DATE STAMP
SEX
VISION SPECIALIST – COMPLETE THIS SECTION T
Submission of this form may result in an immediate suspension of driving privileges if the applicant does not meet vision standards.
REPORT OF EXAMINATION BY VISION SPECIALIST
(Refer to Vision Standards on Page 2)
Without
Corrective Lenses
Right Eye
Left Eye
Both Eyes
20 /
20 /
20 /
With Best Possible
Correction
20 /
20 /
20 /
Check all that apply:
Applicant's vision meets the eyesight standard stated in OAR 735-062-0050 (Refer to standards on Page 2):
with corrective lenses
without corrective lenses
Applicant's field of vision meets the eyesight standard stated in OAR 735-062-0050.
Driving should be restricted to daylight hours only.
Applicant has a progressive vision impairment and DMV should require the applicant to submit updated
vision information in:
6 months
1 year
Applicant's vision does not meet the eyesight standard stated in OAR 735-062-0050.
Does not meet standards for:
acuity
field of vision
Comments: Please include any vision-related diagnoses or any other recommendations.
VISION SPECIALIST’S NAME (PLEASE PRINT)
SPECIALTY
LICENSE or CERTIFICATE #
MAILING ADDRESS
TELEPHONE #
FAX #
CITY
STATE
ZIP CODE
SIGNATURE OF VISION SPECIALIST
DATE SIGNED
COUNTY
DATE OF EXAMINATION (MUST be within last 6 months)
X
735-24 (8-15)
Page 1
STK# 300007
STANDARD FOR VISION SPECIALISTS
(ophthalmologist or optometrist)
OAR 735-062-0050
Eyesight Check Content and Standards
(1) The Driver and Motor Vehicle Services Division of the Department of Transportation (DMV) will check
the following items when testing the eyesight of applicants for a driver permit or driver license:
(a) Acuity; and
(b) Field of vision.
(2) To qualify for driving privileges, a person must meet the following eyesight standards:
(a) Acuity: The person must have a visual acuity level of 20/70 or better when looking through both eyes
(or one eye if the person has usable vision in only one eye). A person with usable vision in both eyes will
meet the standard if the visual acuity level in one eye is worse than 20/70 so long as the visual acuity
level in the other eye is 20/70 or better;
(b) Field of vision: The person must have a field of vision of at least 110 degrees; and
(c) Daylight driving only: DMV will restrict the person's driving privileges to daylight driving only if the
person's best eye is worse than 20/40 and no worse than 20/70 unless, in the written opinion of a
licensed vision specialist (ophthalmologist or optometrist), the person's driving should not be restricted.
DMV will not restrict a person whose vision is 20/40 or better to daylight driving only unless, in the written
opinion of a licensed vision specialist, such restriction is warranted.
(3) A person may meet the eyesight standards with the use of a corrective lens or lenses. When a person
must use a corrective lens or corrective lenses to meet the eyesight standards, DMV will restrict the
person to driving only when wearing corrective lenses.
(4) DMV may authorize a person to use a bioptic telescopic lens on a corrective lens, as defined in OAR
735-062-0310(1) if, when looking through the carrier lens and not the telescopic device, the person
meets the eyesight standards set forth in section (2) of this rule.
---Please see "Persons with Limited Vision" section below for additional information.---
Persons with Limited Vision - ORS 807.355 - ORS 807.369
Oregon laws specify vision qualification and licensing steps pertaining to persons with a Limited Vision
Condition that are different than the standards under OAR 735-062-0050. Limited vision condition means
visual acuity in the better eye with best lens correction that is no better than 20/80 and no worse than
20/200. The visual requirement is 120 degrees horizontally and 80 degrees vertically. (DMV form
735-24A required.)
For Official Use Only – DMV
For additional information write to:
DMV DRIVER SAFETY UNIT
1905 LANA AVE NE
SALEM, OR 97314-4120
Ref#: ____________
Action: ____________
Date: ____________
MV#: _____________
– OR CALL –
(503) 945-5083
Telecommunication Device for the
Hearing Impaired - Statewide relay: 7-1-1
www.oregondmv.com
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