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Laser and Refractive eye surgery
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Aeromedical Implications
Effect of aviation on treatment
- Aircraft air conditioning / low humidity causing worsening of dry eye complication
Effect of treatment on aviation
- Loss of best corrected visual acuity
- Fluctuation in vision at different times of the day
- Glare, ‘halo’, or ‘starburst’ effects due to corneal haze
- Loss of contrast sensitivity
- Under or over correction
Approach to medical certification
Based on the condition
- Pre-operative refractive error
Based on Treatment
Demonstrated Stability
- Stable and acceptable acuity
- Absence of complications
Risk assessment protocol - Information required
New cases
Specialist report no sooner than 2 weeks after the surgery should detail:
- Refraction before surgery
- Date of surgery
- Operative details (technique eg Femtosecond laser)
- Size of ablation zone
- Refraction after surgery
- Stability of refraction over three paired serial measurements
- Any sequelae including halo, haze, change in contrast sensitivity
- Visual acuity in each eye at 30 - 50cm, 100cm and distance
- Recent test of contrast sensitivity function (satisfactory contrast sensitivity is required, otherwise the certificate will be restricted as valid for day flying only).
- Planned follow-up.
Renewal
PRK, LASIK, LASEK
- A CASA Eye Report is required at 12 months post-operatively
- Subsequent screening by DAME at the aviation medical for myopic deterioration
- Ongoing ophthalmological review may be required for complex cases.
Radial Keratotomy
- Applicants whose eyes have stabilised following radial keratotomy must thereafter have an ophthalmological assessment every two years for Class 1 and 3 and every five years for Class 2 Medical Certificates.
Indicative outcomes
- Minimum grounding after LASIK with a laser keratome is 2 weeks.
- Other procedures may require a longer grounding period than 4-6 weeks
Favourable:
- Evidence of stability requires:
- A variation not exceeding 0.25 dioptres in refraction
- A visual acuity changing by not more than one Snellen line
- Visual acuity, which at least satisfies the minimum standard for the class of licence, at three paired serial measurements.
Unfavourable
- Significant diurnal fluctuation in visual acuity (i.e. loss of more than one Snellen line for Class 1 and 3 applicants and more than two Snellen lines for Class 2 applicants)
- Glare sensitivity, halo or starbust effects due to corneal haze
- Significant impairment of contrast sensitivity (will require restriction to day VFR)
Pilot and Controller Information
- Pilots and controllers should Inform their DAME prior to undertaking refractive eye surgery
- Pilots and controllers should ground themselves at the time of the surgery
- Pilots and controllers should should not exercise the privileges of their medical certificate until cleared by CASA
- This is an area of rapid technological innovation and not all procedures may be acceptable for certification
- Pilots and controllers should consult with their treating specialists and review CASA (guidance) before undergoing procedures
- There is a small risk of complications that may result in loss of certification
- Pilots and controllers with mono-vision correction need to meet the CASR standards and therefore may require prescription lenses
- Pilots and controllers should be aware that refraction can change with aging and prescription lenses may be required despite previous refractive surgery
Disclaimer
The Clinical Practice Guideline is provided by way of guidance only and subject to the Clinical practice guidelines disclaimer
