Over 12 million people over 40 in the U.S. have vision impairment, so it’s not uncommon for vision issues to come up during a DOT physical.
The DOT physical includes an eye exam to help medical examiners assess whether drivers meet the FMCSA vision standards for operating a commercial motor vehicle. FMCSA’s vision standards are outlined in 49 CFR § 391.41(b)(10) and supported by guidance in the 2024 Medical Examiner’s Handbook.
If you’ve noticed your vision changing, or if you’re preparing for your first DOT physical, understanding how the DOT vision standards are applied may help drivers feel more prepared for their exam.
If you’re not sure what to expect from the full exam, you may also find Foley’s overview of the DOT physical helpful, but if you specifically want to know what the DOT physical eye exam involves, read on.
The DOT physical eye chart is usually the familiar Snellen eye chart – the one with the big “E” at the top that you’ll find in most doctor’s and optometrist offices. You’ll stand or sit a set distance away (often 10 or 20 feet, depending on the setup) and be asked to read letters on progressively smaller lines.
Some medical examiners may use a Titmus Vision Tester, a small tabletop device that measures visual acuity, depth perception, and sometimes peripheral vision. This is less common but still acceptable.
Both tools measure visual functions that medical examiners reference when applying FMCSA’s vision standards.
FMCSA’s vision standards, as outlined in 49 CFR § 391.41(b)(10), generally include the following elements, which medical examiners reference during certification decisions:
Distant visual acuity of at least 20/40 (Snellen) in each eye, with or without corrective lenses.
Binocular visual acuity of at least 20/40 in both eyes together, with or without corrective lenses.
A field of vision of at least 70 degrees in the horizontal meridian in each eye.
The ability to recognize the colors of traffic signals and devices showing standard red, green, and amber.
If a driver meets these parameters, a medical examiner may determine that the vision standard has been met. The medical examiner will simply note that you are:
“Qualified only if wearing corrective lenses” on your medical examiner’s certificate (med card), which means you must wear those lenses any time you’re driving a CMV.
IMPORTANT: FMCSA’s current regulations do not include telescopic (bioptic) lenses as part of the standard vision qualification criteria.
Learn more about NRII and the transition to digital med cards
DOT vision evaluations reference two primary sources:
49 CFR Part 391.41(b)(10) – The regulation that sets the minimum visual acuity, field of vision, and color-recognition standards for CMV drivers.
FMCSA Medical Examiner’s Handbook 2024 Edition – The current reference for certified medical examiners, published January 2024, which replaces all prior handbook editions and provides guidance on how to apply these standards in practice.
Together, they guide how DOT physicals—and specifically, the vision portions—are carried out in 2025 and beyond.
The DOT vision exam helps medical examiners assess whether a driver meets FMCSA’s vision standards related to distance vision, peripheral vision, and color recognition. It focuses on three main areas:
Distance vision – Can you clearly read signs, see hazards, and react in time at highway speeds?
Peripheral (side) vision – Can you detect vehicles, pedestrians, and obstacles approaching from the sides?
Color recognition – Can you correctly distinguish red, green, and amber traffic signals and devices?
The examiner’s job is to match what’s on the eye chart (or vision testing machine) with these DOT requirements.
In most cases, drivers who normally use corrective lenses choose to wear them during the vision portion of the DOT physical.
If you usually wear glasses or contact lenses to see clearly, you should:
Wear them to the exam just like you do when driving.
Tell the medical examiner that you use corrective lenses regularly.
Most examiners will test your vision with your glasses or contacts on. As long as you meet the 20/40 and field-of-vision requirements with correction, you can still be certified—as long as there are no other disqualifying medical conditions.
To pass the DOT eye portion of your physical, the regulations state you must meet all of the following, with or without corrective lenses:
At least 20/40 in each eye individually (right and left).
At least 20/40 binocular vision (both eyes together).
A horizontal field of vision of at least 70 degrees in each eye.
Ability to correctly identify red, green, and amber traffic signal colors.
Drivers whose vision meets the FMCSA standard with corrective lenses may be certified at the medical examiner’s discretion, and the examiner typically notes when corrective lenses are to be used during CMV operation.
FMCSA adopted an alternative vision standard in 2022. Under this process, drivers who do not meet the vision standard in one eye may be evaluated through a vision specialist’s report and the certified medical examiner’s review. Medical examiners use this information to determine qualification in accordance with FMCSA’s guidance.
What Changed?
On March 22, 2022, FMCSA’s final rule on the Qualifications of Drivers; Vision Standard took effect. Key points:
The Federal Vision Exemption program was phased out; FMCSA no longer processes new requests under the old exemption system.
A new Alternative Vision Standard (§ 391.44) allows individuals who don’t meet the standard in one eye (the “worse eye”) to be physically qualified, under specific conditions and medical review.
Under the alternative vision standard, a driver with monocular vision may be certified if they:
Have at least 20/40 vision in the better eye, with or without corrective lenses.
Have a field of vision of at least 70 degrees in the horizontal meridian in the better eye.
Can recognize standard red, green, and amber traffic signal colors.
Have a stable vision deficiency and sufficient time to adapt.
Complete a Vision Evaluation Report (Form MCSA-5871) from an ophthalmologist or optometrist, which is then reviewed by the certified medical examiner.
FMCSA guidance explains that the Vision Evaluation Report must be completed and signed by the eye specialist, and the DOT physical must begin within 45 days of that signature. This process must be repeated at least annually for drivers qualified under the alternative vision standard.
Many drivers undergo vision procedures such as LASIK or PRK. Medical examiners typically review post-procedure stability and current visual acuity when making a qualification decision.
As long as:
Your vision stabilizes at 20/40 or better in each eye (with or without additional correction), and
You meet the field-of-vision and color-recognition requirements,
you can typically pass the DOT vision test after procedures like LASIK or PRK. Most examiners will want to know:
When the surgery occurred.
Whether you’ve had any complications (halos, glare, double vision, etc.).
Bring any paperwork from your eye doctor if your surgery was recent or if you’ve had any lingering issues.
If a driver does not meet the vision standard, the medical examiner may request additional documentation, updated corrective lenses, or follow-up evaluation. The examiner makes a determination based on FMCSA regulations and the Medical Examiner’s Handbook:
Mildly reduced vision that’s correctable – The examiner may advise you to see an eye doctor for updated glasses or contact lenses. Once your corrected vision meets the standard, you can return for another exam.
Significant or progressive eye disease – The examiner may request additional documentation from your eye specialist or delay certification until your condition is better understood or treated.
Doesn’t meet the standard in one eye – Instead of a Federal Vision Exemption (which is no longer issued), you may be evaluated under the alternative vision standard, using the Vision Evaluation Report (MCSA-5871) and annual follow-up.
In all cases, the medical examiner is required to make a safety-focused determination based on FMCSA regulations and the 2024 Medical Examiner’s Handbook.
During the vision portion of the DOT physical, you can generally expect:
Medical history questions:
The examiner will ask about:
Recent changes in vision
Difficulty seeing at night
Eye pain, double vision, or frequent headaches
History of eye disease (glaucoma, macular degeneration, retinal problems, etc.)
External eye exam
The examiner checks for obvious abnormalities—such as drooping eyelids, visible inflammation, or other signs of disease that could impact vision over time.
Distance visual acuity test
Using a Snellen chart or similar tool, they’ll:
Test each eye separately and together.
Confirm whether your distant vision is at least 20/40.
Peripheral (side) vision test
Typically done via:
A simple confrontation test (you look at the examiner’s nose while they hold up fingers in your peripheral vision), or
A device like a Titmus or other visual-field tester.
FMCSA’s vision standard includes a horizontal field of at least 70 degrees in each eye.
Color vision test
The examiner confirms that you can distinguish red, green, and amber—often via small cards, charts, or lighted devices that mimic traffic signals.
Some drivers choose to have an eye exam before their DOT physical, especially if they’ve noticed recent vision changes.
Consider scheduling with an optometrist or ophthalmologist beforehand if:
You’re squinting more to read signs.
You have frequent headaches after driving.
Your last eye exam was more than 1–2 years ago.
Benefits of a pre-exam eye appointment:
You can update your glasses or contact prescription ahead of time.
You’ll know whether you are likely to meet the 20/40 and 70-degree field requirements.
You reduce the chance of failing the DOT physical just because you need new lenses.
The DOT physical eye exam doesn’t need to be stressful. For most drivers who maintain their eye health and use appropriate corrective eyewear, passing the test is very achievable.
Many drivers bring their corrective eyewear, avoid excessive screen time beforehand, or bring documentation from their eye specialist if they have an existing condition.
Foley’s DOT physical management tools help carriers organize upcoming medical certificate renewals, maintain digital records, and stay aware of approaching deadlines. Automated scheduling workflows, centralized documentation, and optional reminders can support a more streamlined approach to managing DOT physicals across a fleet.
That’s where Foley’s DOT physical software comes in.
With Foley, you can:
Automate DOT physical scheduling – Foley can automatically trigger a DOT physical order up to 60 days before a driver’s medical certificate expires, including exams where vision needs closer monitoring.
Maintain a single digital archive of every driver’s medical certificate and exam history—no more digging through paper files during an audit.
Use alerts and notifications to flag drivers whose health conditions (including vision issues evaluated under the alternative vision standard) may require more frequent review or documentation.
Tap into a nationwide referral network of FMCSA-certified medical examiners so your drivers can complete their physicals, wherever they’re based.
The result? A streamlined, audit-ready process for DOT physical management that helps reduce missed appointments, expired med cards, and DOT audit risk.
Click here to schedule a free demo of Foley’s DOT compliance platform, and see how our solution supports your hiring, safety, and DOT compliance programs from end to end.
Learn more about Foley's DOT Exam Software for DOT Physical Automation.
