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Laser and Refractive eye surgery
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
- Stable and acceptable acuity
- Absence of complications
Risk assessment protocol - Information required
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.
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.
- 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.
- Minimum grounding after LASIK with a laser keratome is 2 weeks.
- Other procedures may require a longer grounding period than 4-6 weeks
- 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.
- 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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The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.