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.