DOT Physical Vision Requirements for Truck Drivers

This article is general information about federal DOT physical rules for commercial motor vehicle drivers. It is not medical or legal advice. A certified medical examiner makes the certification decision for each driver. Regulation text is from the eCFR (Title 49, Part 391) as displayed in October 2026; guidance is from FMCSA's Medical Examiner's Handbook, 2024 Edition.

These are federal standards for drivers subject to FMCSA's interstate commercial motor vehicle rules. Drivers who operate only in intrastate commerce are regulated by their state. FMCSA's Handbook says nearly all states have adopted the federal standards for intrastate drivers, but some have additional, different or more stringent requirements.

What Are the DOT Physical Vision Requirements?

• 20/40 in each eye and both eyes, with or without corrective lenses.
• 70° field of vision in the horizontal meridian in each eye.
• Red, green and amber. You must be able to recognize standard traffic signal colors. Some color deficiency is allowed if you can.
• Glasses and contacts are fine, but if you need them to pass, you must wear them while driving.
• Vision in only one eye? The alternative vision standard may let you qualify, with an annual exam and an eye specialist's report.
• The old federal vision exemption program is gone. Certificates issued with a vision exemption became void on March 22, 2023.

The DOT Vision Standard

Vision is one of the 13 physical qualification standards in 49 CFR 391.41(b). The regulation says a person is physically qualified to drive a commercial motor vehicle if, among other things, that person meets this vision standard.

Here's the same standard broken into its four parts:

Source: 49 CFR 391.41(b)(10)(i)

FMCSA's Medical Examiner's Handbook says a driver doesn't meet the vision standard if they fail any part of the vision testing with one eye or both eyes, as applicable. The Handbook also notes there are no Medical Advisory Criteria for the vision standards; the requirements come from the regulation itself.

How the DOT Eye Test Works

The Handbook describes how examiners usually check each part:

• Distance vision. A Snellen chart or a Titmus Vision Tester. Results must be recorded in Snellen-comparable values, and if you meet the standard with your glasses or contacts on, your uncorrected vision doesn't need to be recorded.
• Peripheral vision. Often a confrontation test, where you look at the examiner's eye or nose and count fingers held out to the side with one eye closed at a time, or the Titmus Vision Tester.
• Color. A standard test such as Ishihara, pseudoisochromatic, yarn or Farnsworth, or a controlled test using standard red, green and amber, such as the colors on the Snellen chart.

The Handbook also says examiners should look at your eyes for abnormalities, such as abnormal pupils, nystagmus or exophthalmos, that may need to be considered under a different standard. An eye specialist (ophthalmologist or optometrist) can do the vision testing, but the medical examiner makes the qualification decision.

Glasses, Contacts and Other Lenses

The regulation allows corrective lenses for both the each-eye and both-eyes acuity standards. The Handbook adds these details:

• You must wear them to drive. If you need corrective lenses to meet the standard, the lenses must be used while driving, and the examiner checks the "Wearing corrective lenses" box on your Medical Examination Report and your Medical Examiner's Certificate.
• Contact lenses are permissible if there's sufficient evidence that you tolerate them well and are well adapted to them.
• One contact for distance and one for near vision is acceptable as long as you still meet the standard.
• Bioptic telescopic lenses aren't permissible for driving commercial motor vehicles.

Color Blindness and the DOT Physical

Being color blind doesn't automatically disqualify you. The Handbook interprets "ability to recognize the colors of" to mean that if you can recognize standard red, green and amber, you meet the minimum standard, even if you have some type of color perception deficiency.

Vision in One Eye: The Alternative Vision Standard

Since a 2022 FMCSA rule, drivers who don't meet the standard in one eye can qualify through the alternative vision standard in 49 CFR 391.44, without a federal exemption. It applies if you don't satisfy, with the worse eye, the distant acuity standard with corrective lenses, the field of vision standard, or both.

The alternative vision standard is not a way to avoid corrective lenses. If the only reason your worse eye fails the regular standard is distant vision that can be corrected to 20/40 or better, you must use corrective lenses and qualify under the regular standard. However, if the worse eye still fails the 70° field of vision requirement, 391.44 may apply even when its distant vision can be corrected to 20/40.

Source: 49 CFR 391.41(b)(10), 391.44 and 391.45; FMCSA Medical Examiner's Handbook, 2024 Edition

Under 391.44(c)(2), the examiner must consider the eye specialist's report and use independent medical judgment. To qualify, the better eye must have distant vision of at least 20/40, with or without corrective lenses, and a field of vision of at least 70° in the horizontal meridian. You must also be able to recognize standard red, green and amber; your vision deficiency must be stable; and enough time must have passed for you to adapt to and compensate for the change in vision.

Steps to Qualify Under the Alternative Standard

Road test exceptions

Section 391.44(d) waives the road test in three situations:

• Three years of experience. The motor carrier determines that you held a valid CDL or non-CDL license and drove a commercial motor vehicle with the vision deficiency in intrastate commerce, or in excepted interstate commerce, for the 3 years before qualifying. You certify in writing to the carrier the date the deficiency began, and the carrier prepares a written statement that you aren't required to complete a road test.
• Former exemption holders. You held a valid federal vision exemption on March 22, 2022.
• Former waiver study participants. You were medically certified on March 22, 2022, under the old 391.64(b) vision waiver study provision.

Determination pending

The Handbook says an examiner may place you in determination pending only if you already have a completed MCSA-5871. That status gives you up to 45 days to provide clarifications or more information from the eye specialist. It doesn't extend your current certificate; you can keep driving interstate only if your current certificate hasn't expired.

What Happened to Vision Exemptions

FMCSA published the vision standard final rule on January 21, 2022. According to the Handbook, the rule eliminated the need for the Federal Vision Exemption Program, which had let certain drivers with monocular vision get an exemption to drive interstate. FMCSA defines monocular vision as:

• In the better eye, distant vision of at least 20/40 (with or without lenses) and a field of vision of at least 70° in the horizontal meridian; and
• In the worse eye, distant vision of less than 20/40 with corrective lenses, or a field of vision of less than 70°, or both.

On March 22, 2023, all Medical Examiner's Certificates issued with a vision exemption became void. The rule also ended the old 391.64(b) grandfather provision for drivers in a previous vision waiver study program. The Handbook says qualification under 391.64 is no longer available and certificates issued under it are void, and the eCFR now shows 391.64 as reserved. Drivers in those groups now qualify under the standard vision rule or the alternative vision standard. FMCSA still has general authority to consider exemption requests from any physical qualification standard, but the established vision exemption program has ended.

Eye Conditions and Diabetic Retinopathy

Meeting the numbers isn't the whole picture. The Handbook says that while the standard can be met with objective test results, examiners should consider underlying medical conditions when deciding how long to certify you. Examiners should ask about:

• Changes in vision and night vision
• Eye disorders such as cataracts, glaucoma, retinopathy or macular degeneration
• Eye medications
• Any other visual condition that could keep you from driving a commercial motor vehicle safely

Some eye conditions may be considered under a different standard. The Handbook's example is a visual condition considered as a vascular disease under 391.41(b)(7).

Diabetic retinopathy

Drivers with insulin-treated diabetes fall under a separate rule, 49 CFR 391.46. It says a driver isn't physically qualified on a permanent basis if they have severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy. The Handbook notes this doesn't apply to non-insulin-treated diabetes or to retinopathy generally. See our guide to DOT physical diabetes requirements for the full insulin rules.

How Long Your Medical Card Lasts

Source: FMCSA Medical Examiner's Handbook, 2024 Edition, sections 1.3 and 3.1; 49 CFR 391.45(b) and (f)

These are maximums. The Handbook says examiners may certify you for less when they need to monitor you more often. Your certificate expires at midnight on the date written on it, and the Handbook says there's no grace period.

If You Fail the Vision Screening

The Handbook says that if you fail the vision screening, the examiner should tell you to see an ophthalmologist or optometrist for a vision evaluation, and must not place you in determination pending while you get it. If the examiner thinks you may qualify under the alternative vision standard, they should ask you to have the eye specialist complete Form MCSA-5871. After the evaluation, you can go through a new DOT exam.

If you disagree with the examiner's decision, the Handbook says the federal rules don't prohibit getting a second exam from another certified medical examiner, but you're expected to give both examiners the same medical information.

Frequently Asked Questions

Related Guides

• DOT physical hearing requirements
• DOT physical diabetes requirements
• DOT physical blood pressure requirements
• DOT physical medication rules

Sources

1. 49 CFR 391.41 — Physical qualifications for drivers (eCFR)
2. 49 CFR 391.44 — Physical qualification standards for an individual who does not satisfy, with the worse eye, the distant visual acuity or field of vision standard (eCFR)
3. 49 CFR 391.45 — Persons who must be medically examined and certified (eCFR)
4. 49 CFR 391.46 — Physical qualification standards for an individual with diabetes mellitus treated with insulin for control (eCFR)
5. 49 CFR 391.64 — reserved (eCFR)
6. FMCSA Medical Examiner's Handbook, 2024 Edition
7. FMCSA — Vision Evaluation Report, Form MCSA-5871