The Esterman driving visual field test is often used in driver’s licensing evaluations, but it offers much more. As a binocular visual field test device assessment, it evaluates functional vision in patients with glaucoma, retinitis pigmentosa, stroke, and more. Monitoring the visual field for fitness to drive helps ensure safety and supports long-term care planning.
With this test, you can assess the functional vision of patients with glaucoma (up to 8% of people who walk into your practice) or retinitis pigmentosa, stroke, TBI, injury, AMD, diabetic retinopathy, and more. While monitoring peripheral vision can help assess driving fitness, you can also help support overall quality of life.
You may already offer the Esterman test, but are you using it to its full potential? Learn when this exam is recommended, its uses, and the many diagnoses it can help monitor.
What Is the Esterman Driving Visual Field Test?
Benjamin Esterman developed the test used for driving assessments worldwide in 1967. It provided a quantifiable way to measure patients’ visual field function — the Esterman Disability Score (EDS), which has since been updated with the Visual Field Score (VFS).
There are 120 points in the Esterman visual field exam. The monocular version ranges 70 degrees nasally, 50 degrees temporally, 30 degrees superiorly, and 50 degrees inferiorly. When combined, the binocular Esterman visual field test spans a 136-degree field of vision. This extensive range offers insight into peripheral vision as well as central.
It’s a comprehensive, relevant, straightforward exam perfect for a broad screening. Modern platforms now allow the portable Esterman test to be administered using virtual reality, simplifying access to visual field testing for driving fitness.
Conducting the Esterman test with Virtual Field takes this longstanding test into the modern age so you can easily collect data and track disease progression. It’s more comfortable, accessible, and patient-friendly than traditional methods so that you can create positive, scalable patient experiences.
Academic references and clinical validation
A study of 104 patients found the Esterman test to be generally reliable. However, results were less consistent in the peripheral and upper visual field areas, which should be considered when interpreting outcomes.
This study explored the relationship between the Esterman visual field test and the outcomes of on-road driving tests in individuals with visual field defects. Missing more points on the Esterman test was associated with higher odds of failing the driving test.
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Why Use a Binocular Visual Field Test Device for Driving Assessments?
Patients need sufficient binocular vision for everyday tasks like driving, socializing, and monitoring one’s surroundings. The Esterman test evaluates the combined visual field of both eyes and effectively simulates a driving environment. Optometrists appreciate that this test is easy to administer, provides a clear picture of a patient’s functional vision, and offers insight into conditions like glaucoma and retinitis pigmentosa. However, patients with severe visual field loss can find it challenging or uncomfortable, and it lacks the precision you can achieve with other visual field tests like the 24-2. It’s not especially sensitive to central vision, so patients with defects may need additional testing.
Pros and Cons of the Portable Esterman Test for Driving Fitness
The pros and cons that follow can help guide you toward the ideal scenarios to incorporate this test into your patients' diagnostic assessments.
Pros
A real-world, binocular visual field test aligned with visual field for fitness to drive requirements.
Commonly accepted for driver’s licenses, especially for people who have known visual conditions.
Particularly useful for detecting and monitoring peripheral vision loss and glaucoma.
Relatively simple and patients may find it more comfortable.
Can be conducted with a portable Esterman test device, reducing the need for tabletop perimetry systems.
Cons
Not the most precise or sensitive visual field exam, so it may not detect subtle vision loss.
Usually limited to binocular testing and can miss vision issues that impact only one eye.
Patients may find the Esterman test long, and after time, can become distracted, anxious, or fatigued — especially when using traditional tabletop devices.
Prioritizes peripheral vision and is less effective for detecting central vision defects.
Conditions Identified by the Esterman Visual Field Test
The Esterman driving visual field is best known for its role in evaluating driving eligibility, but it also helps monitor the functional impact of vision conditions.
Glaucoma
The Esterman test is highly effective in detecting peripheral vision loss, which is one of the earliest signs of glaucoma. Monitor glaucoma progression by assessing the patient’s binocular visual field and understand the functional impact of their vision.
Stroke
After a stroke, patients may experience hemianopia or other types of visual field loss. The Esterman test is helpful for identifying these defects in both eyes, allowing clinicians to monitor how stroke-induced vision loss affects functional vision.
Macular Degeneration
Although macular degeneration primarily affects central vision, some patients may experience associated peripheral vision changes. The Esterman test is instrumental in detecting peripheral vision deficits that can accompany macular degeneration, helping to provide a more comprehensive view of how the disease impacts overall vision.
~800K
Nearly 800,000 people in the U.S. experience a stroke each year
2 in 3
Up to 2 in 3 stroke survivors in Canada have some form of vision problem.
Retinitis Pigmentosa
Patients with retinitis pigmentosa experience progressive peripheral vision loss and tunnel vision. The Esterman test is well-suited to detect this condition early because it focuses explicitly on peripheral vision and can track the narrowing of the visual field as the disease progresses.
Diabetic Retinopathy
Diabetic retinopathy can lead to visual field loss due to damage to the retina's blood vessels, often affecting peripheral vision. The Esterman test helps identify areas of the visual field that may be compromised, which is vital for managing the disease and assessing the impact on activities that require full field vision.
Trauma and Injury
Trauma to the head or eyes can lead to various visual field defects, including loss of peripheral vision. The Esterman test is well-suited for detecting such defects in both eyes, offering a functional understanding of how the injury has affected the patient’s daily activities and driving capability.
Other Conditions
The Esterman test can also be used to monitor or diagnose:
- Retinal vein/artery occlusion
- Optic neuropathy
- Autoimmune and inflammatory disorders
- Ocular hypertension
- Brain tumors
Example Esterman Visual Field Test Reports
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CPT Code, Billing, and Use of the Esterman Test for Driver Licensing
The Esterman visual field test is typically billed using CPT 92083 and is often associated with visual field testing for driver licensing or long-term disease monitoring. The Medicare Physician Fee Schedule (MPFS) reimburses this exam between $40 and $90 per test. Your location, setting, and practice type will impact the actual fees for the Esterman test.
As more practices shift to portable Esterman test setups, coding accuracy becomes critical for maximizing reimbursement.
When is the Esterman visual field test required?
The Esterman test assesses a patient’s functional vision in real-world tasks — especially driving. People with known visual impairments who need an updated driver’s license may need an Esterman test. Pilots and safety-critical professionals may also need this specific exam.
The Esterman visual field test is also often used to screen people for glaucoma, retinitis pigmentosa, stroke-related visual field effects, and other conditions that impact peripheral vision. For these patients, annual or biannual testing is usually recommended.
Is the Esterman test required for driver’s licenses?
By name, no. In the United States, each state has its own driver’s licensing vision requirements, and only a few explicitly call for an Esterman visual field test score for driving.
Ultimately, the Esterman driving visual field is one of the most common tools used to measure visual field for fitness to drive, though not legally required in every state. It’s highly relevant to real-world driving experiences — but it’s not the only accepted method to assess drivers’ visual fields.
Virtual Field for Driver Licensing: A Portable Esterman Test Alternative
The Esterman test is a key visual field for driving fitness and functional vision exam. For patients with peripheral field loss, it can help assess fitness for tasks like driving or operating machinery.
With Virtual Field for driver licensing, you can offer the Esterman driving visual field in a portable, headset-based format. This binocular visual field test device makes screening easier for both patients and providers. You don’t need bulky tabletop perimetry equipment or long office visits. Patients can complete this test — whether required or recommended — faster, more comfortably, and with exceptional accuracy.
FAQs
1. Why do licensing authorities prefer the Esterman binocular visual field test?
2. How many missed points fail an Esterman for driving?
3. How long does a binocular Esterman take on Virtual Field?
4. Which CPT code applies to a binocular Esterman?
5. Can Esterman data be used for low-vision rehab planning?
6. Does the device store DMV-ready PDFs?
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