My Flight Surgeon
Sr. Aviation Medical Examiner
This is one of a series of posts about medical issues potentially affecting a pilot’s ability to obtain a medical certificate. In this series, we will look at common problems seen by the AME, review the requirements the FAA has to consider allowing one to fly and discuss what you need to do to expedite consideration by the FAA to allow you to fly. We plan to go through all of the medical history items in Section 18 on the front of Form 8500-8 over the next several months.
Item 18d. Eye or vision trouble except glasses
Applicants with many visual conditions may be found qualified for FAA certification following the receipt and review of specialty evaluations and pertinent medical records. Examples include retinal detachment with surgical correction, open angle glaucoma under adequate control with medication, and narrow angle glaucoma following surgical correction.
In the case of cataract surgery, the AME may issue a certificate after cataract surgery for applicants who have undergone cataract surgery with or without lens(es) implant. If pertinent medical records and a current ophthalmologic evaluation (using FAA Form 8500-7 or FAA Form 8500-14) indicate that the applicant meets the standards, the FAA may delegate authority to the AME to issue subsequent certificates.
The following lists the most common conditions (it is not all inclusive) of aeromedical significance: tumors and ptosis (drooping of the eyelid)obscuring the pupil, acute inflammatory disease of the eyes and lids, cataracts, double vision, diabetic and hypertensive retinopathy, amblyopia ex anopsia ( the visual acuity of one eye is decreased without presence of organic eye disease, usually because of strabismus in childhood), macular degeneration, vascular occlusion, glaucoma, and retinal detachment. All of these conditions except glaucoma require a full report from the ophthalmologist in either letter form of as a FAA Form 8500-7 http://forms.faa.gov/forms/faa8500-7.pdf . Glaucoma requires either a full report from the ophthalmologist in either letter form of as a FAA Form 8500-14 http://forms.faa.gov/forms/faa8500-14.pdf .
Of these conditions, the more common ones we tend to see are glaucoma and cataracts, both of which develop as we age. Both of these conditions are treatable and with good medical or surgical management, the FAA allows pilots to fly with them.
Vision after the loss of an eye is termed monovision. Although it has been repeatedly demonstrated that binocular vision is not a prerequisite for flying, some aspects of depth perception, either by stereopsis or by monocular cues, are necessary. It takes time for the monocular airman to develop the techniques to interpret the monocular cues that substitute for stereopsis; such as, the interposition of objects, convergence, geometrical perspective, distribution of light and shade, size of known objects, aerial perspective, and motion parallax. In addition, it takes time for the monocular airman to compensate for his or her decrease in effective visual field. A monocular airman’s effective visual field is reduced by as much as 30% by monocularity. This is especially important because of speed smear; i.e., the effect of speed diminishes the effective visual field such that normal visual field is decreased from 180 degrees to as narrow as 42 degrees or less as speed increases. A monocular airman’s reduced effective visual field would be reduced even further than 42 degrees by speed smear. For the above reasons, a waiting period of 6 months is recommended to permit an adequate adjustment period for learning techniques to interpret monocular cues and accommodation to the reduction in the effective visual field.
The important take home points regarding vision problems include: 1) with most of the common diseases of the eye, one is still able to fly with a Special Issuance, 2) one may fly with just one eye, 3) with most of the more uncommon diseases of the eye, the FAA still makes many favorable decisions regarding flying if the disease is controlled and stable, and 4) if you are having visual problems, don’t put off an eye evaluation – remember, if you go blind, you will not fly at all (nor look at chicks, etc.)
*Italicized sections are excerpts from FAA documents.
Item 18d. Eye or vision trouble except glasses
Eye or vision trouble except glasses
Visual problems are one of the more common issues that arise during a flight physical. Most of the visual difficulties we see are just pilots getting older and needing reading glasses. That topic will be addressed in another thread. Here we are going to discuss eye diseases that can permanently affect vision and even cause blindness. The majority of these can be treated and the pilot is allowed to continue flying if treatment is successful and the condition stable. Applicants with many visual conditions may be found qualified for FAA certification following the receipt and review of specialty evaluations and pertinent medical records. Examples include retinal detachment with surgical correction, open angle glaucoma under adequate control with medication, and narrow angle glaucoma following surgical correction.
In the case of cataract surgery, the AME may issue a certificate after cataract surgery for applicants who have undergone cataract surgery with or without lens(es) implant. If pertinent medical records and a current ophthalmologic evaluation (using FAA Form 8500-7 or FAA Form 8500-14) indicate that the applicant meets the standards, the FAA may delegate authority to the AME to issue subsequent certificates.
The following lists the most common conditions (it is not all inclusive) of aeromedical significance: tumors and ptosis (drooping of the eyelid)obscuring the pupil, acute inflammatory disease of the eyes and lids, cataracts, double vision, diabetic and hypertensive retinopathy, amblyopia ex anopsia ( the visual acuity of one eye is decreased without presence of organic eye disease, usually because of strabismus in childhood), macular degeneration, vascular occlusion, glaucoma, and retinal detachment. All of these conditions except glaucoma require a full report from the ophthalmologist in either letter form of as a FAA Form 8500-7 http://forms.faa.gov/forms/faa8500-7.pdf . Glaucoma requires either a full report from the ophthalmologist in either letter form of as a FAA Form 8500-14 http://forms.faa.gov/forms/faa8500-14.pdf .
Of these conditions, the more common ones we tend to see are glaucoma and cataracts, both of which develop as we age. Both of these conditions are treatable and with good medical or surgical management, the FAA allows pilots to fly with them.
Vision after the loss of an eye is termed monovision. Although it has been repeatedly demonstrated that binocular vision is not a prerequisite for flying, some aspects of depth perception, either by stereopsis or by monocular cues, are necessary. It takes time for the monocular airman to develop the techniques to interpret the monocular cues that substitute for stereopsis; such as, the interposition of objects, convergence, geometrical perspective, distribution of light and shade, size of known objects, aerial perspective, and motion parallax. In addition, it takes time for the monocular airman to compensate for his or her decrease in effective visual field. A monocular airman’s effective visual field is reduced by as much as 30% by monocularity. This is especially important because of speed smear; i.e., the effect of speed diminishes the effective visual field such that normal visual field is decreased from 180 degrees to as narrow as 42 degrees or less as speed increases. A monocular airman’s reduced effective visual field would be reduced even further than 42 degrees by speed smear. For the above reasons, a waiting period of 6 months is recommended to permit an adequate adjustment period for learning techniques to interpret monocular cues and accommodation to the reduction in the effective visual field.
The important take home points regarding vision problems include: 1) with most of the common diseases of the eye, one is still able to fly with a Special Issuance, 2) one may fly with just one eye, 3) with most of the more uncommon diseases of the eye, the FAA still makes many favorable decisions regarding flying if the disease is controlled and stable, and 4) if you are having visual problems, don’t put off an eye evaluation – remember, if you go blind, you will not fly at all (nor look at chicks, etc.)
*Italicized sections are excerpts from FAA documents.
