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 (e.g. 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.
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.
The policy for Class 1 and 2 is the same as for PRK.
Policy as for cataract surgery, see below.
Due to refraction regression following this procedure, ongoing 3 monthly refractions will be required until stability can be assured.
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.
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 recertified 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.
Selective retinal laser treatment may be recertified 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.
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.
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