Pilots with retinal vein occlusion (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
Class 1, 2 and 3 Certification
A report must be obtained from the treating ophthalmologist, to include:
- visual acuity in each eye separately
- visual field results (monocular and binocular Esterman in accordance with the visual field guidance)
- evidence that intraocular pressure is stable
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:
- 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 to the Bruce protocol
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 both 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 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.