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Background: Driving is a primary mode of travel in many countries. It relies primarily on the function of vision to navigate roads and traffic safely. Ensuring good vision for motor vehicle drivers is important to promote safety for all road users. Lesotho is a developing country, with road transportation central to the movement of people and goods within, and across the borders of the country. The absence of clear visual function requirements for driving in Lesotho motivated this study. Aim: To assess the visual function of motor vehicle drivers in Lesotho. Setting: The study was conducted at the Traffic Department in Maseru, the main licensing centre where all drivers in the country must apply for issuance or renewal of driving licenses. Methods: This cross-sectional study recruited 460 active licensed drivers using systematic random sampling. Data were collected through a structured questionnaire, and comprehensive vision examination and was analysed using Strata version 14. Results: The mean age of participants was 42.9 ± 10.35 years. One fifth of participants had not had an eye examination before obtaining their licenses. About 70% had normal vision (6/9 or better) in the better-seeing eye. Among those with sub-normal vision, 29% had visual acuity between 6/18 and 6/48 in the better-seeing eye. About 40% had refractive error, with myopia showing the highest distribution (46.46%), followed by astigmatism (32.96%) and hyperopia (24.59%). Most participants passed colour vision (CV) (97.61%), contrast sensitivity (53.70%) testing, as well as visual field (99.6%). About 44% of participants reported having been involved in road traffic accidents. Conclusion: Some vehicle drivers in Lesotho have compromised vision, with many not undergoing eye examination before obtaining driving licenses. Absence of screening methods for drivers in Lesotho could lead to road traffic accidents and have negative socio-economic impacts. Implementing standardised screening protocols would improve safety for road users. Contribution: A significant number of motor vehicle drivers in Lesotho have some form of visual impairment, with many not undergoing an eye examination before obtaining a driver's licenses. If drivers are encouraged to have their eyes examined regularly, many visual function anomalies could be detected early and their vision would be corrected accordingly. The absence of effective screening methods for drivers in Lesotho could possibly be a contributor to the incidence of RTAs in the country, with the resultant negative socio-economic impacts. Therefore, it is recommended that visual screening of motor vehicle drivers should be included in the traffic laws in Lesotho. [ABSTRACT FROM AUTHOR]