Form 5 Form 5 Visual Acuity and Color Vision Tests

OMB Control No.: 2126-00XX

Expiration Date: MM/DD/YYYY

Public Burden Statement

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control number. The OMB Control number for this information collection is 2126-00XX. Public reporting for this collection of information is estimated to be approximately 3 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Samuel.White@dot.gov.

Vision Tests

• The participant can wear glasses or contact lenses to meet these criteria but not transitional lenses.

We will now perform an informal vision test. You should wear your corrective glasses or contact lenses for this test. First we will test your visual acuity.

• Direct participant to tape mark on the floor.

Please stand with your heels against the wall and face the eye chart ahead. Keeping both eyes open, read aloud the letters on line 5 of the chart.

If the line is read successfully, read:

Good. Let’s move on…..next are going to perform a quick color vision test.

If the participant does not have a visual acuity of 20/40 or better, explain that he/she is not eligible for this research project.

Unfortunately you are not eligible for this particular study because we were unable to confirm that your visual acuity meets the minimum level needed to ensure you can drive safely in low visibility conditions. Thank you for your time.

We will compensate you for your time. Would you like to be called for future studies? [END]

• Direct participant to have a seat in the chair facing the wall.

• Using the pseudoisochromatic plates, perform a red-green color discrimination test.

Please have a seat in this chair and face the wall. This test will take just a couple of minutes.

• I will show you a series of pictures. Each picture is a circle with a number inside. When I show you the picture, please tell me which number is inside as quickly as possible. Do you have any questions? Ensure participant is seated facing the wall. Use reference stick on color plates to place plates back the correct distance from participant eyes.

• Proceed to show plates 1-7. Participant will have 3 seconds to identify each plate. Judge each response based on the appropriate response key.

• If participant correctly identifies all 7, they have passed. If participant hesitates or takes longer than 3 seconds, participant likely has a color vision defect. Record the participant’s pass/fail status on the demographics survey form.

If the participant passed the visual acuity test you can then proceed to the vehicle orientation.