Guidance following eye surgery
cataract, glaucoma and retinal surgery, and collagen cross linking.
All pilots must
be assessed as unfit at the time of surgery. Assessment for restoration of
fitness status should be carried out one week after the satisfactory cessation
of post-operative medication when no longer necessary. Further reviews will be
required if stability of refraction is in doubt or there are adverse effects. Guidance on the most common
procedures is given below. Further guidance on other procedures should be sought
from the AME or CAA Medical Assessor before the applicant is listed for surgery.
applicants or holders should undergo formal testing as above at an AeMC at 6
months and have an ophthalmological review with a consultant ophthalmologist.
This should confirm a satisfactory surgical result and freedom from adverse
side-effects. Restoration of fitness status before 6 months (but not less than
three months) may sometimes be possible if only a low level of refractive error
has been treated and early stability of refraction is demonstrated.
applicants do not require formal testing for dysphotopsia but should confirm
absence of glare, halos and starburst. Review can be with a local consultant
As for PRK for
Laser Assisted In-situ Keratomileusis (LASIK)
refraction should be assessed at 4 and 6 weeks at an AeMC and an
ophthalmological review undertaken with a consultant ophthalmologist at the 6
week point before recertification can be considered.
Class 2 –
refraction should be assessed at 4 and 6 weeks with confirmation of absence of
dysphotopsia symptoms and local consultant ophthalmological review at the 6
week point before recertification can be considered.
Policy as for
cataract surgery; please see below.
As for LASIK, but
no return to fit status of any class until 3 months. Due to the higher
incidence of refraction regression following this procedure, ongoing 3 monthly
refractions will be required until stability is confirmed.
implants may be offered by the pilot's surgeon before cataract surgery as an
alternative to traditional monofocal lens implants. The CAA does not recommend
or approve a particular intraocular lens (IOL) for certification.
A review of
randomised controlled trials studying multifocal versus monofocal intraocular
lenses after cataract extraction was published by the Cochrane Collaboration in
2016. It reported that distance visual acuity was similar in the multifocal and
monofocal groups but people with multifocal lenses achieved better near vision
overall and were less dependent on spectacles. Adverse subjective visual
phenomena, particularly halos, were common and troublesome in people receiving multifocal
There was some
evidence that contrast sensitivity may be lower in people receiving multifocal
IOLs. There were no significant differences between IOLs with respect to
in this review indicates that monofocal IOLs are likely to be less problematic
than multi-focal IOLs for the issue of an aeromedical certificate. However, the
decision to proceed with a multifocal implant should be made by the applicant and
their surgeon, considering the potential impact on the applicant’s occupation.
Applicants should be aware of the possible adverse effects from any type of
lens as aeromedical certification may not be possible if they occur.
after both laser refractive surgery and intraocular lens implantation may be
permitted subject to freedom from adverse effects and glasses being available
which reverse the micromonovision* and restore both eyes in full focus at
distant, intermediate and near.
*In traditional monovision, one eye was set
for distant vision and the other for near using surgical strategies that
created a large difference (typically 2- 3.5 dioptres) between the eyes.
Micro-monovision aims to establish a reduced interocular
dioptric power difference, typically of the order of 0.75D and not greater than
2D, such that a large intermediate zone of binocularity is achieved.
surgery will generally result in an unfit assessment for at least 6 weeks.
Fitness can be reassessed following complete recovery from surgery. Assessment
should include a comprehensive eye examination to include assessment of
contrast and glare sensitivities and mesopic contrast sensitivity. For Class 1
and 3 applicants, this should be conducted with the vision specialist at an
Aeromedical Centre. Class 2 applicants may undertake this with their local
vision specialist. A report from this assessment should be provide to the
applicant’s AME along with a detailed report from the specialist who performed
the procedure following the template for Ophthalmic medical reports provided on
the CAA website. This report should include the date of surgery, the type of
implant used and confirmation that the pilot has fully recovered from surgery
and that there are no post-operative complications.
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,
postoperative distant and near visual acuities, and up to date visual field
results (please refer to separate guidance material on visual fields).
For Class 1 an
assessment by a consultant aviation ophthalmologist may be required.
** Glaucoma drainage devices create alternate
channels to drain the aqueous humour from the anterior chamber through a long
tube to a reservoir placed at the equator of the globe. Glaucoma drainage
devices are being used more frequently but usually indicate that the glaucoma
being treated is particularly severe and has not responded to medication, laser
or traditional trabeculectomy surgery OR that the patient has an atypical form
of glaucoma such as neovascular glaucoma, where it may be used as the primary procedure.
A report should
be obtained from the consultant ophthalmologist who performed the procedure
based on a review at 3 months. This should include full details of the
procedure, and in particular whether any medical gases were used;
post-operative recovery should be complete and current visual acuities and
Esterman visual field analysis should be provided. The report should either
confirm absence of post-operative ocular motility problems (except with
vitrectomy) or incorporate an orthoptic report and/ or strabismology report.
For Class 1, an
assessment by a consultant aviation ophthalmologist may be required before
recertification can be considered.
Due to the risk
of corneal haze following this procedure, assessment for dysphotopsia is
required (see refractive surgery guidance).
Class 1 -
Refraction at 2 months and then further refraction and full dysphotopsia
testing and consultant aviation ophthalmological review at 3 months.
Class 2 -
Refraction at 2 months and then review by a local consultant ophthalmologist at
3 months to include refraction and confirmation of absence of dysphotopsia
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