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