Cataract

Guidance for medical examiners when assessing a patient for either a general topic or condition – Cataract.

Cataract is an opacity of the lens of the eye that may cause blurred or distorted vision, or glare.

Aeromedical Implications

Effect of aviation on condition

• High levels of ultraviolet light
• High reflectivity

Effect of condition on aviation

• Glare - both veiling and disabling
• Degraded visual acuity
• Degraded contrast sensitivity
• Degraded stereopsis or binocular vision capacity
• Degraded colour vision

Effect of treatment on aviation

Positive effects of uncomplicated cataract surgery are noted leading to improvement in visual acuity and contrast, reduction of glare, reduced dependence on refractive correction,

Complications of cataract surgery can include:

• residual refractive error or unexpected refractive outcome
• monocular vision or binocular rivalry
• reduced visual acuity
• intraocular lens (IOL) location instability
• capsular opacification
• anterior or posterior segment infection, oedema
• choroidal haemorrhage, retinal detachment, cystoid macular oedema and opacification of posterior lens capsule.

Note: Multifocal or extended depth of focus IOLs, instead of monofocal IOL, may be acceptable on a case-by-case basis

Approach to medical certification

Based on condition 

• Visual function meets standards
  • Acuity
  • Contrast sensitivity
  • Colour sensitivity
  • Absence of halo/glare

Based on Treatment

• Uncomplicated surgery

Demonstrated stability

• Absence of symptoms after a reasonable period of neuroadaptation

Risk assessment protocol - Information required

New cases

• Ophthalmologist’s report
  • Confirmed diagnosis
  • Aetiology (History of eye trauma etc)
  • Completed ophthalmologist’s report
  • Details of surgery, including IOL parameters
  • Follow-up plan
• CASA Eye Report
  • Including test for contrast sensitivity function
  • Test for glare, if indicated
• Clearance from DAME or CASA

Renewal

• CASA Eye report after 12 months

Indicative outcomes

• Review for return to aviation activities after surgery at least 2 weeks after monofocal IOL and 12 weeks after multifocal or EDOF IOL in case of recovery after uncomplicated surgery
• Clearance by DAME or CASA to recommence flying or controlling requires a post-operative report from the Ophthalmologist and satisfactory CASA Eye Report
• Post-Nd:YAG laser capsulotomy is at risk of raised intraocular pressure and necessitates grounding for 30 days

Favourable

• Evidence of adequate recovery post-cataract surgery without any sequelae or complication and meets applicable visual requirements

Unfavourable

• Failure to meet visual requirements despite surgery and corrective lenses
• Complications impacting visual acuity or other visual function
• Functional impairment
• Monovision (where one eye is corrected for near and the other for distance vision. Spectacles are required to restore binocular vision)
• Extended Depth of Focus [EDOF] IOLs (variable optics within visual axis) will be considered on case-by-case basis due to the potential for:
  • compromised binocularity
  • flare and glare at night
  • reduced contrast sensitivity.

Pilot and Controller Information

• Any change in condition must be reported to the DAME
• The choice of IOL – multifocal or monofocal – is to be made between aviation medical certificate holder and their ophthalmic surgeon, based on the likely adverse effects of the type of the lens and its potential impact on their occupation
• A period of grounding will be required until post-surgical recovery is complete and a satisfactory review from the operating surgeon has been received, typically 4 to 6 weeks
• Treatment need not restore normal physiological vision and may not be risk-free