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1. For the purpose of this Annex, drivers are classified in two groups: 1.1. Group 1: drivers of vehicles of categories A, A1, A2, AM, B, B1 and BE.

1.2. Group 2: drivers of vehicles of categories C, CE, C1, C1E, D, DE, D1 and D1E.

1.3. National legislation may provide for the provisions set out in this Annex for Group 2 drivers to apply to drivers of Category B vehicles using their driving licence for professional purposes (taxis, ambulances, etc.).

2. Similarly, applicants for a first driving licence or for the renewal of a driving licence are classified in the group to which they will belong once the licence has been issued or renewed. MEDICAL EXAMINATIONS 3. Group 1: Applicants shall be required to undergo a medical examination if it becomes apparent, when the necessary formalities are being completed or during the tests which they have to undergo prior to obtaining a driving licence, that they have one or more of the medical disabilities mentioned in this Annex.

4. Group 2:

Applicants shall undergo medical examinations before a driving licence is first issued to them and thereafter drivers shall be checked in accordance with the national system in place in the Member State of normal residence whenever their driving licence is renewed 5. The standards set by Member States for the issue or any subsequent renewal of driving licences may be stricter than those set out in this Annex. EYESIGHT 6. All applicants for a driving licence shall undergo an appropriate investigation to ensure that they have adequate visual acuity for driving power-driven vehicles. Where there is reason to doubt that the applicant’s vision is adequate, he/she shall be examined by a competent medical authority. At this examination attention shall be paid, in particular, to the following: visual acuity, field of vision, twilight vision, glare and contrast sensitivity, diplopia and other visual functions that can compromise safe driving.

For group 1 drivers, licensing may be considered in ‘exceptional cases’ where the visual field standard or visual acuity standard cannot be met; in such cases the driver should undergo examination by a competent medical authority to demonstrate that there is no other impairment of visual function, including glare, contrast sensitivity and twilight vision. The driver or applicant should also be subject to a positive practical test conducted by a competent authority. Group 1: 6.1. Applicants for a driving licence or for the renewal of such a licence shall have a binocular visual acuity, with corrective lenses if necessary, of at least 0,5 when using both eyes together. Moreover, the horizontal visual field should be at least 120 degrees, the extension should be at least 50 degrees left and right and 20 degrees up and down. No defects should be present within a radius of the central 20 degrees. When a progressive eye disease is detected or declared, driving licences may be issued or renewed subject to the applicant undergoing regular examination by a competent medical authority.

6.2. Applicants for a driving licence, or for the renewal of such a licence, who have total functional loss of vision in one eye or who use only one eye (e.g. in the case of diplopia) must have a visual acuity of at least 0,5, with corrective lenses if necessary. The competent medical authority must certify that this condition of monocular vision has existed for a sufficiently long time to allow adaptation and that the field of vision in this eye meets the requirement laid down in paragraph 6.1.

6.3. After any recently developed diplopia or after the loss of vision in one eye, there should be an appropriate adaptation period (for example, six months), during which driving is not allowed. After this period, driving is only allowed following a favourable opinion from vision and driving experts. Group 2:

6.4. Applicants for a driving licence or for the renewal of such a licence shall have a visual acuity, with corrective lenses if necessary, of at least 0,8 in the better eye and at least 0,1 in the worse eye. If corrective lenses are used to attain the values of 0,8 and 0,1, the minimum acuity (0,8 and 0,1) must be achieved either by correction by means of glasses with a power not exceeding plus eight dioptres, or with the aid of contact lenses. The correction must be well tolerated. Moreover, the horizontal visual field with both eyes should be at least 160 degrees, the extension should be at least 70 degrees left and right and 30 degrees up and down. No defects should be present within a radius of the central 30 degrees. Driving licences shall not be issued to or renewed for applicants or drivers suffering from impaired contrast sensitivity or from diplopia. After a substantial loss of vision in one eye, there should be an appropriate adaptation period (for example six months) during which the subject is not allowed to drive. After this period, driving is only allowed after a favourable opinion from vision and driving experts. HEARING

7. Driving licences may be issued to or renewed for applicants or drivers in Group 2 subject to the opinion of the competent medical authorities; particular account will be taken in medical examinations of the scope for compensation. PERSONS WITH A LOCOMOTOR DISABILITY 8. Driving licences shall not be issued to or renewed for applicants or drivers suffering from complaints or abnormalities of the locomotor system which make it dangerous to drive a power-driven vehicle. Group 1: 8.1. Driving licences subject to certain restrictions, if necessary, may be issued to physically disabled applicants or drivers following the issuing of an opinion by a competent medical authority. This opinion must be based on a medical assessment of the complaint or abnormality in question and, where necessary, on a practical test. It must also indicate what type of modification to the vehicle is required and whether the driver needs to be fitted with an orthopaedic device, insofar as the test of skills and behaviour demonstrates that with such a device driving would not to be dangerous.

8.2. Driving licences may be issued to or renewed for any applicant suffering from a progressive complaint on condition that the disabled person is regularly examined to check that the person is still capable of driving the vehicle completely safely. Where the disability is static, driving licences may be issued or renewed without the applicant being subject to regular medical examination. Group 2: 8.3. The competent medical authority shall give due consideration to the additional risks and dangers involved in the driving of vehicles covered by the definition of this group. CARDIOVASCULAR DISEASES 9. Cardiovascular conditions or diseases can lead to a sudden impairment of the cerebral functions that constitutes a danger to road safety. These conditions represent grounds for establishing temporary or permanent restrictions to driving.

9.1. For the following cardiovascular conditions, driving licences may be issued or renewed for applicants or drivers in the indicated groups, only after the condition has been effectively treated and subject to competent medical authorisation and if appropriate, regular medical assessment:

(a) brady-arrhythmias (sinus node disease and conduction disturbances) and tachy-arrhythmias (supraventricular and ventricular arrhythmias) with history of syncope or syncopal episodes due to arrhythmic conditions (applies to group 1 and 2);

(b) brady-arrhythmias: sinus node disease and conduction disturbances with second degree atrioventricular (AV) block Mobitz II, third degree AV block or alternating bundle branch block (applies to group 2 only);

(c) tachy-arrhythmias (supraventricular and ventricular arrhythmias) with — structural heart disease and sustained ventricular tachycardia (VT) (applies to group 1 and 2), or — polymorphic nonsustained VT, sustained ventricular tachycardia or with an indication for a defibrillator (applies to group 2 only);

(d) symptomatic of angina (applies to group 1 and 2);

(e) permanent pacemaker implantation or replacement (applies to group 2 only);

(f) defibrillator implantation or replacement or appropriate or inappropriate defibrillator shock (applies to group 1 only);

(g) syncope (a transient loss of consciousness and postural tone, characterised by rapid onset, short duration, and spontaneous recovery, due to global cerebral hypoperfusion, of presumed reflex origin, of unknown cause, with no evidence of underlying heart disease)(applies to group 1 and 2);

(h) acute coronary syndrome (applies to group 1 and 2);

(i) stable angina if symptoms do not occur with mild exercise (applies to group 1 and 2);

(j) percutaneous coronary intervention (PCI) (applies to group 1 and 2);

(k) coronary artery bypass graft surgery (CABG) (applies to group 1 and 2);

(l) stroke/transient ischemic attack (TIA) (applies to group 1 and 2);

(m) significant carotid artery stenosis (applies to group 2 only);

(n) maximum aortic diameter exceeding 5,5 cm (applies to group 2 only);

(o) heart failure:

— New York Heart Association (NYHA) I, II, III (applies to group 1 only),

— NYHA I and II provided that the left ventricular ejection fraction is at least 35 % (applies to group 2 only);

(p) heart transplantation (applies to group 1 and 2);

(q) cardiac assist device (applies to group 1 only);

(r) valvular heart surgery (applies to group 1 and 2);

(s) malignant hypertension (elevation in systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mmHg associated with impending or progressive organ damage) (applies to group 1 and 2);

(t) grade III blood pressure (diastolic blood pressure ≥ 110 mmHg and/or systolic blood pressure ≥ 180 mmHg) (applies to group 2 only);

(u) congenital heart disease (applies to group 1 and 2);

(v) hypertrophic cardiomyopathy if without syncope (applies to group 1 only);

(w) long QT syndrome with syncope, Torsade des Pointes or QTc > 500 ms (applies to group 1 only).

9.2. For the following cardiovascular conditions, driving licences shall not be issued or renewed for applicants or drivers in the indicated groups:

(a) implant of a defibrillator (applies to group 2 only);

(b) peripheral vascular disease — thoracic and abdominal aortic aneurysm when maximum aortic diameter is such that it predisposes to a significant risk of sudden rupture and hence a sudden disabling event (applies to group 1 and 2);

(c) heart failure:

— NYHA IV (applies to group 1 only),

— NYHA III and IV (applies to group 2 only);

(d) cardiac assist devices (applies to group 2 only);