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.
Class 1, 2 and 3 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 (monocular and binocular Esterman in accordance with the visual field guidance)
If the applicant develops substandard vision in one eye following a vascular event then they should be assessed:
- for Class 1 and 3, in conjunction with a Civil Aviation Authority (CAA) Medical Assessor (a review with an aviation ophthalmologist is likely to be required)
- for Class 2, in accordance with the substandard vision in one eye guidance
Assessment of cardiovascular risk
All applicants must undergo a cardiovascular review (for Class 1 and 3 with a consultant cardiologist) and submit a report to their AME to include:
- FBC and ESR
- results of temporal artery biopsy if performed
- Carotid Doppler scan and echocardiogram
- confirmation that blood pressure is within normal limits
- a 10-year cardiovascular risk assessment with appropriate management of other cardiovascular risk factors
- exercise ECG, symptom limited and performed in accordance with the Bruce protocol
- thrombophilia screen
If both ophthalmic and cardiological assessments are satisfactory, the pilot can be assessed by a CAA Medical Assessor as fit with an OML applied to the certificate. Abnormal findings may require further investigation or 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 and/or SSL (valid only with approved eye protection) may need to be applied to the certificate. This can be done by an AME in consultation with a CAA Medical Assessor.
If both ophthalmic and cardiological assessments are satisfactory, the air traffic controller can be assessed by a CAA Medical Assessor as fit although assessment should include functional testing in the work environment. Abnormal findings may require further investigation or assessment.