Laser and Refractive eye surgery

Guidance for medical examiners when assessing a patient for either a general topic or condition – Laser and Refractive eye surgery.

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

  • Type of surgery

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

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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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