Includes– retinal artery occlusion, ischaemic optic neuropathy and amaurosis fugax
including – retinal artery occlusion, ischaemic optic neuropathy and amaurosis fugax
Pilots with arterial vascular disease affecting the eye should be made unfit. The subsequent aeromedical fitness assessment needs to take into account both the effect on visual function and the cardiovascular incapacitation risk.
Arterial vascular disease affecting the eye reduces visual acuity and field of vision in the affected eye, sometimes permanently.
It is important to identify disease due to emboli from the left side heart and carotids, as this carries a higher cardiovascular risk. Infective endocarditis and the systemic vasculitides, including giant cell (temporal) arteritis and thrombophilia must all be excluded, as these conditions have their own treatment protocols and aeromedical implications.
Arterial vascular disease affecting the eye is usually associated with an increased cardiovascular mortality. Cardiovascular risk factors must be identified and managed before re-certification.
Assessment of visual function
A report must be obtained from the treating consultant ophthalmologist, to include:
• visual acuity in each eye separately
• visual field results in each eye separately and together in a binocular Esterman test.
If the pilot develops substandard vision in one eye following a vascular event then they should be assessed in accordance with the ‘substandard vision in one eye’ guidance.
Assessment of cardiovascular risk
All pilots must undergo a cardiovascular review with a consultant cardiologist and submit a report to their AME (or if Class 1 to the AMS if referred by their AME) to include:
• FBC and ESR
• Results of temporal artery biopsy if performed
• Carotid Doppler scan and echocardiogram
• confirmation that blood pressure is stable (ideally with a 24-hour blood pressure recording)
• assessment and appropriate management of other cardiovascular risk factors
• Exercise ECG, symptom limited and performed in accordance with the Bruce protocol
• thrombophila screen
If both ophthalmic and cardiological assessments are satisfactory, the pilot can be assessed by the AMS as fit with an OML applied to the certificate. Abnormal findings may require further investigation/assessment.
If ophthalmic and cardiological assessments are satisfactory, an unrestricted assessment can be made. Where there are field defects and/or cardiovascular risks, an OSL may need to be applied to the certificate. This can be done by an AeMC or AME in consultation with the AMS.