Comparison of the automated First 3D^TM vision screener to a manual driver vision screening method in Gauteng (South Africa)

Background: The automated (First 3DTM) vision screener developed for the South African licensing department was designed to address the limitations in the current driver vision screening tests. Aim: To compare distance visual acuities (VAs) and visual fields (VFs) using the First 3D^TM vision screener with the manual method, both with and without the use of spectacles. Setting: Optometry clinic at the University of Johannesburg. Methods: Visual acuities and temporal VFs of 98 participants (18–68 years) were measured using both the automated First 3D^TM and manual methods (Snellen Tumbling E’s and Novice^TM sphere). T-test and correlation coefficients assessed associations and the direction of linear relationships between the two screeners. Results: A moderate, positive and statistically significant correlation was found between the manual and automated VA assessments for the right oculus dexter (OD) and left eyes oculus sinister (OS), with r = 0.44, P < 0.001 and r = 0.54, P < 0.001, respectively. A significant positive correlation was observed for OD VF measurements (r = 0.365, P < 0.001) but not for the OS (r = 0.028, P = 0.788). Conclusion: Although both methods showed similar VA trends, agreement between them was weak, indicating that the two methods should not be used interchangeably for individual VA assessments. No significant differences were found between manual and automated VF testing methods; however, factors such as test sensitivity, examiner judgement, eye dominance, calibration and procedural variation warrant cautious interpretation. Contribution: Findings support improvements in driver vision screening and policy development for standardised vision testing in licensing systems.