Glaucoma / Ocular Hypertension

Guidance for medical examiners when assessing a patient for either a general topic or condition – Glaucoma / Ocular Hypertension.

Definition

This guidance should be used for applicants with:

  • confirmed glaucoma
  • confirmed ocular hypertension with or without retinal changes.

Aeromedical implications

Effect of condition on aviation

  • Visual field restricted limiting awareness of internal and external visual cues
  • Acute glaucoma causing pain and visual loss

Effect of treatment on aviation

  • Blurring of vision
  • Loss of contrast sensitivity and night vision (Gtt. pilocarpine)

Approach to medical certification

Based on the condition

  • Adequate visual fields
    • 50+ degree monocular visual field testing. (Esterman binocular field not acceptable) Medmont binocular field test with fixation is acceptable
    • no overlapping field defect
    • no defect within 20 degrees of the visual axis
    • total field loss less than one quadrant.

Based on treatment

  • Absence of side-effects from eyedrops
  • Contrast sensitivity normal with pilocarpine drops

Demonstrated stability

  • Intraocular pressures well-controlled
  • Visual fields stable

Risk assessment protocol - information required

New cases

  • Confirmed diagnosis
  • Clinical status
    • intra-ocular pressures
  • Investigations conducted
    • results of computerised visual field plot (request 50+ deg. Binocular with fixation if available)
  • Management
    • treatment
    • side-effects
  • Follow-up plan.

Renewal

  • Confirmed diagnosis
  • Clinical status
    • intra-ocular pressures
  • Investigations conducted
    • results of computerized visual field plot (request 50+ deg. Binocular with fixation if available)
  • Management
    • treatment
    • side-effects
  • Follow-up plan.

Indicative outcomes

Favourable

  • Normal visual fields
  • Absence of side-effects from treatment 

Unfavourable

  • Overlapping field defect
  • A defect within 20 degrees of the visual axis
  • Total field loss greater than one quadrant
  • Profound generalised peripheral field loss

Pilot information

  • Main aviation risks are acute glaucoma and insidious onset visual field loss
  • Glaucoma is an insidious and progressive cause of vision loss and blindness
  • Early detection and treatment can preserve normal vision
  • The National Health and Medical Research Council Glaucoma guidelines recommends regular eye examination after age 50 and earlier for those with a family history
  • Following diagnosis may require regular review for up to 6 months until condition controlled

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Disclaimer

The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.

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