ATTACHMENT C - Kentucky Slide Images.pdf
PDF 151 KB Posted
- Attached to
- DDL Vision Testing Equipment
- Solicitation number
- RFB 758 2400000341 1
- Issued by
- Kentucky
About this file
This file is a vision testing record form used by the Kentucky Department of Motor Vehicles (DMV) for the OPTEC Vision Tester, model 1000-75. The document serves as a standardized testing template for evaluating applicant visual acuity and eye health during driver's license examinations or renewals. The form includes five sequential tests: Test #1 measures binocular, right eye, and left eye visual acuity at the 20/40 level using colored slides (red, amber, and green) with number identification; Test #2 assesses road sign recognition and depth perception by presenting traffic signs (yield, school zone, do not enter, stop, railroad, and no passing zone signs) and requiring subjects to identify which signs appear closer; Test #3 evaluates visual acuity across multiple levels (20/100, 20/60, 20/50, 20/40, and 20/30) using colored numbered slides for each eye and both eyes simultaneously; Test #4 measures muscle balance and eye coordination; and Test #5 assesses peripheral vision for both left and right eyes. The form includes pass/fail criteria, such as marking two or more incorrect responses in any group as a failure for that particular acuity level and eye.
The testing apparatus uses standardized slide images with specific visual angles measured in seconds of arc (323 and 145 seconds of arc for road sign depth perception). The form provides spaces to record results for left eye, right eye, and both eyes visual acuity measurements, as well as documentation of muscle balance testing outcomes. This standardized form was effective as of July 2017 and represents Kentucky's uniform methodology for screening vision capabilities in prospective and renewing drivers to ensure public safety on roadways.
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Text version
1000-75 RECORD FORM FOR THE OPTEC® VISION TESTER
NAME: DATE:
20/40 1 RED 6 2 6 5 3 6 8 9 3 9 62653 68939 85923 6 8 9 3 9 8 5 9 2 3
20/40 2 AMBER 9 8 3 6 2 9 3 8 2 5 98362 93825 59862 9 3 8 2 5 5 9 8 6 2
20/40 3 GREEN 2 5 9 3 8 2 5 2 9 6 25938 25296 68238 2 5 2 9 6 6 8 2 3 8
20/40 4 RED 3 9 2 6 8 3 2 5 8 5 39268 32585 36598 3 2 5 8 5 3 6 5 9 8
5 INFORMATION SIGN
6 (323 Seconds of Arc)
7 REGULATORY SIGN
8 DO NOT ENTER SIGN
9 STOP SIGN
10 RAILROAD SIGN
11 (145 Seconds of Arc)
12 NO PASSING ZONE SIGN
Which of the Road Signs appear to be closer to you?
BOTH CORRECT IS ACCEPTABLE DEPTH PERCEPTION.
20/100 1 GREEN 3 9 5 8 5 2 395 852 628 8 5 2 6 2 8
20/60 2 AMBER 9 3 2 8 5 6 8 3 9328 5683 2965 5 6 8 3 2 9 6 5
20/50 3 RED 3 5 9 6 2 6 3 8 2 9 35962 63829 85293 6 3 8 2 9 8 5 2 9 3
20/40 4 GREEN 8 9 2 3 5 9 3 5 2 8 89235 93528 65939 9 3 5 2 8 6 5 9 3 9
20/30 5 AMBER 9 2 3 5 6 5 6 8 6 9 92356 56869 26953 5 6 8 6 9 2 6 9 5 3
LEFT EYE = 20/ ____ BOTH EYES = 20/ ____ RIGHT EYE = 20/ ____
Step 1 Occlude LEFT Eye Ball Box = PASS Step 2 Ask subject if they see the box? Ball of Box = FAIL Step 3 Illuminate LEFT Eye Step 4 Ask subject if the RED ball falls IN or OUT of the box?
RIGHT PERIPHERAL TEST
LEFT PERIPHERAL TEST
Use line # (both eyes column) numbers from test # as fixation point.
TEST #1:
Two or more incorrect in any group = FAIL for that particular acuity and eye.
TEST #2:
(#6 & #11)
TEST #3:
Two or more incorrect in any group = FAIL for that particular acuity and eye.
TEST #4:
TEST #5: ° ° ° °
1000-75
VISUAL ACUITY- BINOCULAR
ACUITY LINE COLOR BOTH EYES RIGHT EYE
ROAD SIGN AND DEPTH RECOGNITION
YIELD SIGN
SCHOOL ZONE SIGN
VISUAL ACUITY- BINOCULAR
ACUITY LINE BOTH EYES RIGHT EYE
MUSCLE BALANCE - Binocular
IN
OUT
85 70 55 NASAL 45
85 70 55 NASAL 45
6 8 9 3 9 1
LEFT EYE
LEFT EYE
PASS
PASS
Denotes Stereo Depth
OPTEC VISION TESTER SLIDE 1000-75
Test #1 Visual Acuity Number Right Eye, Left Eye Monocular and Both Eyes Simultaneously (20/40)
Test #2 Road Sign and Depth Recognition Traffic Sign Identification and Depth Perception of (323 and 145 Seconds of ARC)
Test #3 Visual Acuity Number Right Eye, Left Eye Monocular and Both Eyes Simultaneously (20/100,20/60,20/50,20/40,20/30) ri Li
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Test #4 Muscle Balance
| DMV 1000-75 record form 07.2017 |
| 1000-75 KY Test Slide Image |
File details come from the government source that posted it. Updated .