CASA Website > Avmed > Guidelines > Keratoconus
Keratoconus
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Definition
This guidance should be used for applicants diagnosed with keratoconus by an Ophthalmologist
Aeromedical Implications
Effect of aviation on condition
- High glare environment may worsen glare and halo formation
- Low contrast environment at night or in bad weather may significantly impair visual acuity
- Dry and cold air of aircraft environment may worsen contact lens intolerance
Effect of condition on aviation
- Impairment of visual function may be safety relevant
Effect of treatment on aviation
- Complications of chronic contact lens use may contribute to impairment of visual function
Approach to medical certification
Based on the condition
- Severity of keratoconus
- Risk of acute visual impairment from acute corneal hydrops
- Variability of visual function eg acuity instability
Based on Treatment
- Tolerance to treatment
- Effectiveness of treatment
Demonstrated Stability
- Stable disease during the period of certification
- Stable response to treatment during the period of certification
Risk assessment protocol - Information required
New cases
- A report from an Ophthalmologist with respect to:
- Diagnosis
- History
- Presenting symptoms
- Nature of condition
- Other relevant medical history (specifically comment on the presence of any of the following)
- Distracting distortions, glare/flare, monocular diplopia or ghost images
- Unstable refraction
- Uncorrectable refractive error
- Contact lens wear complicated by intolerance, allergic reactions (eg, giant papillary conjunctivitis), corneal abrasions,neovascularization
- Significant corneal scarring
- Advanced keratoconus with significant risk of acute corneal hydrops
- Impairment or loss of function
- Clinical findings
- CASA Eye Report, including also
- Retinal examination
- Slit lamp examination
- Corneal topographies (colour copy)
- Contrast sensitivity assessment
- Tolerance of refractive correction
- Treatment
- Recent past and ongoing treatment must be detailed
- Specify treatment (spectacles, contact lens supervision, cross linking, corneal transplant)
- comment whether correction can only be achieved with contact lenses
- Ocular and other current and recent past medications (name, dose, start and finish dates, frequency)
- Surgical reports
- Comment re prognosis and follow up plan
Renewal
A report from a Designated Aviation Ophthalmologist or Credentialled Optometrist with respect to:
- Clinical Progress
- Clinical findings (as applicable)
- CASA Eye Report also including
- Retinal examination
- Slit lamp examination
- Corneal topographies (colour copy)
- Contrast sensitivity assessment
- Tolerance of refractive correction
- Treatment
- Details of any interventions / surgery
- Comment re prognosis and follow up plan
Indicative outcomes
- Review at least annually will be required
- Return to flying following Collagen Cross Linking:
- Demonstrated stability of refraction is essential
- Full ophthalmological review no sooner than 3 months post-treatment, before consideration of return to flying or controlling.
- 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 star-bursting before a decision is made to re-certificate.
Favourable
- Applicants with a clinical diagnosis of keratoconus may be assessed as fit subject to a satisfactory examination by an eye examiner.
- Applicants with keratoconus may be considered for a fit assessment if the visual requirements are met with the use of corrective lenses and periodic review is undertaken by an eye examiner
Unfavourable
- Distracting distortions, glare/flare, monocular diplopia or ghost images
- Unstable refraction
- Uncorrectable refractive error
- Contact lens wear complicated by intolerance, allergic reactions (eg, giant papillary conjunctivitis), corneal abrasions,neovascularization
- Significant corneal scarring
- Advanced keratoconus with significant risk of acute corneal hydrops
Pilot & Controller Information
- Keratoconus is an aero-medically significant condition and should be reported to your DAME or CASA on diagnosis
- Certification is possible in cases where there is stable disease and a stable response to vision correction and treatment
- A shortened certification period may be required
- Regular specialist review will be required
- A condition may be applied in cases of keratoconus where the visual requirements can only be met with contact lenses, ie “ Correction by means of contact lenses only”
Disclaimer
The Clinical Practice Guideline is provided by way of guidance only and subject to the Clinical practice guidelines disclaimer
