Guidance following eye surgery

Information regarding recertification following eye surgery

Eye Surgery

1) Refractive surgery

Prerequisites

i) For Radial Keratotomy (RK), stability of refraction must be demonstrated before recertification (less than 0.75 dioptres diurnal variation).

ii) Should have detailed refraction and slit lamp examination.  There should be no post-operative complications (eg, corneal scarring) that may impact on flight safety.

iii) Pre-operative refraction should not have been greater than +5.00 dioptres.  No refraction limits apply to myopia, astigmatism or anisometropia.

iv) Glare sensitivity and mesopic contrast sensitivity should be satisfactory.  Class 1 should be assessed at an AeMC and there should be no symptoms such as glare, halos (rings of light) or starbursts (streaking of point lights).  In cases of doubt referral to a consultant aviation ophthalmology adviser should be considered.  For Class 2 there should be no symptoms such as glare, halos or starbursts.

v) A report must be provided from the centre that carried out the surgery.  Details should include dates and type of surgery performed, pre-operative refraction and details of any complications.

Revalidation Periods

All pilots must be assessed as unfit following surgery.  Assessment for certification may be up to 12 months post-operatively depending on the type of surgery conducted and the presence of any complications.  All refractive surgery procedures may be considered for revalidation with the exception of multifocal intra-ocular lens implants.  Guidance on the most prevalent procedures is given below.  Further guidance on other procedures should be sought from the AMS.

Further reviews will be required if stability of refraction is in doubt or there are side-effects present.

Photo Refractive Keratectomy (PRK) for myopia

Class 1 
Full ophthalmological review by a consultant aviation ophthalmology adviser at an AeMC at 6 months, demonstrating satisfactory surgical result and freedom from adverse side-effects is required, before returning to flying.  Recertification before 6 months may sometimes be possible if only a low level of myopia has been treated and stability of refraction and freedom from side effects can be demonstrated.

Class 2  
As for Class 1, but review can be with a local ophthalmologist.

PRK for hypermetropia

Class 1 
Full ophthalmological review by a consultant aviation ophthalmology adviser at an AeMC at 6 months, then again at 12 months, demonstrating satisfactory surgical result and freedom from adverse side-effects is required, before returning to flying.  Recertification before 12 months may sometimes be possible if only a low level of hypermetropia has been treated and stability of refraction and freedom from side effects can be demonstrated.

Class 2  
As for Class 1, but review can be with a local ophthalmologist.

 

Laser Assisted in-Situ Epithelial Keratomileusis (LASEK)

The policy for Class 1 and 2 is the same as for PRK.

 

Laser Assisted In-situ Keratomileusis (LASIK)

Class 1
Refraction should be assessed at 2 months, and then a full ophthalmological review at an AeMC should be undertaken at 3 months, before returning to flying.

Class 2 - Refraction at 2 months, then again at 3 months before returning to flying.

 

Clear Lens Exchange

Policy as for cataract surgery, see below.

 

Conductive Keratoplasty

Class 1
Refraction should be assessed at 2 months, and then a full ophthalmological review should be undertaken at an AeMC at 3 months before returning to flying.

Class 2
Refraction at 2 months, then again at 3 months before returning to flying.

Due to refraction regression following this procedure, ongoing 3 monthly refractions will be required until stability can be assured.

 

2) Cataract Surgery

The assessment of individuals following cataract surgery should be done on a case by case basis.  This should take into account clinical evidence on recovery times and outcomes from modern day surgery. A pilot can be assessed as fit following cataract surgery from 6 weeks post-operatively.

A report shall be provided from the consultant ophthalmologist who performed the procedure and should include the date of surgery and type of implant used, details of distance and near visual acuities, any post-operative complications, confirmation that the pilot has fully recovered from surgery and that there is no significant photophobia, glare or diplopia.

Note: multifocal and bifocal implants are NOT compatible with certification.  Monovision is not recommended and pilot would require well-tolerated multifocal spectacles in order to meet the distance and near vision standards.  Accommodating lenses may be acceptable following a review with a consultant aviation ophthalmology adviser.

For Class 1 pilots, an operational multi-crew limitation (OML) may be appropriate if there is evidence of co-morbid disease or procedure or complication that may increase the risk of visual incapacitation.


3) Glaucoma Surgery

A report shall be provided from the consultant ophthalmologist who performed the procedure and should include full details of the treatment carried out, current management, visual acuities and up to date visual field results.

Following selective trabeculoplasty a pilot may be recertificated immediately.  For other procedures, a report from the consultant ophthalmologist who undertook the operation shall be made available and an individual assessment shall be made.  For Class 1 an assessment by a consultant aviation ophthalmology adviser is required before a decision is made to recertificate.

 

4) Retinal surgery

A report shall be provided from the consultant ophthalmologist who performed the procedure and should include full details of the treatment carried out, current management, visual acuities and up to date visual field results.

Selective retinal laser treatment may be recertificated following receipt of a satisfactory ophthalmology report.  For other procedures, an individual assessment will be made.  For Class 1, an assessment by a consultant aviation ophthalmology adviser may be required before a decision is made to recertificate.

 

5) Collagen Cross Linking

Class 1 - Refraction at 2 months and then full ophthalmological review at an AeMC at 3 months, before returning to flying.

Class 2 - Refraction at 2 months and then again at 3 months, before returning to flying.

Due to a risk of corneal haze following this procedure, an assessment is required of contrast sensitivity together with any history of symptoms such as glare, halos or starbursting before a decision is made to recertificate.