Guidance following a diagnosis of RVO
Pilots with RVO should be declared unfit. The subsequent aeromedical fitness assessment needs to take into account both the effect on visual function and the cardiovascular incapacitation risk.
RVO reduces visual acuity and field of vision in the affected eye, sometimes permanently.
RVO is usually associated with an increased cardiovascular mortality. High blood pressure is a cardinal risk factor for RVO and satisfactory blood pressure control is therefore essential before re-certification.
Assessment of visual function
A report must be obtained from the treating ophthalmologist, to include:
• visual acuity in each eye separately
• visual field results in each eye separately and together in a binocular Esterman test.
• evidence that intraocular pressure is stable
If the pilot develops substandard vision in one eye following a vascular event then they should be assessed:
a) For Class 1, in conjunction with the AMS. Review with a specialist advisor in aviation ophthalmology is likely to be required.
b) For Class 2, in accordance with the substandard vision in one eye guidance.
Assessment of cardiovascular risk
All pilots must undergo a cardiovascular review with a cardiologist to include:
• confirmation that blood pressure is stable (assessed by 24-hour ambulatory blood pressure recording)
• assessment and appropriate management of other cardiovascular risk factors.
• Exercise ECG, symptom limited and performed to the Bruce protocol.
• thrombophilia 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 fit assessment can be made. Where there are visual 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.