Table of Contents

Introduction

FAA Guidelines for Laser Refractive Surgery

FAA Guidelines for Conductive Keratoplasty

Article on LASIK from the Spring 2001 Federal Air Surgeon's Medical Bulletin

Additional Information...

Introduction

    The vast majority of individuals that have refractive surgery so they will see well without glasses or contact lenses experience successful outcomes. Many achieve a perfect 20/20 uncorrected visual acuity. Some may require a minimal eyeglass prescription for this level of sight.  After their refractive surgery a few patients have glare associated with bright lights, difficulty seeing well at night, or haziness in their vision. Over a period of months these symptoms usually regress. For many occupations if the outcome is slightly less than ideal the patient will not have any personal or occupational limitations. These individuals are usually quite satisfied with their new ability to see relatively well without having to rely on glasses or contact lenses. 

    However certain occupations require for all intents and purposes perfect vision, and the bar is raised for these individual when you consider what is a good surgical outcome. A Class I or II medical certificate requires a corrected or uncorrected visual acuity of 20/20 in each eye and no problems with haziness or glare. These individuals may have an unacceptable outcome for their profession despite a result that is compatible with the visual requirements for the majority of occupations and activities. If your profession or hobby does not allow for any visual compromises you need to carefully consider refractive surgical procedures.

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FAA Certification Guidelines for Pilots who have had Laser Refractive Surgery    
 

If these determinations are favorable and if otherwise qualified, the pilot may immediately resume piloting but must ensure that:

The airman may continue flight duties unless informed otherwise by the FAA or another disqualifying condition occurs.

    These requirements  were current as of 6/6/06, however they may be updated at any time. To check for updates visit the LASIK or Other Laser Eye Surgery to Correct Vision  page on the FAA website.  To return to this page please click you Browser Back  Button.

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FAA Certification Guidelines for Pilots who have had Conductive Keratoplasty

    These requirements  were current as of 6/6/06, however they may be updated at any time. To check for updates visit the Conductive Keratoplasty  page on the FAA website.  To return to this page please click you Browser Back  Button.

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Considering LASIK Eye Surgery? Think Again

By Mike Wayda.  
 

Note: The following article is downloaded  from the Spring 2001 Federal Air Surgeon's Medical Bulletin. The author sounds a cautionary note for pilots considering refractive surgery.

Pilots know that their vision is the most important sense they possess, and their safety depends on how well they see. The prospect of having refractive surgery done to improve their eyesight— without having to rely on glasses or contact lenses — is an attractive, appealing notion to many.

The advertisements that some practitioners use to attract potential patients make the procedures appear to be swift, painless, convenient, and effective. However, because of the notion that refractive surgery is a simple, fool-proof procedure, aviators might not appreciate what is at risk. When considering the advantages of refractive surgery to correct vision deficiencies, pilots should also consider the disadvantages before making a decision. They should consult an eyecare specialist to determine how a particular procedure would affect their vision, as well as their work and leisure activities.

One of the most popular and effective methods of vision correction designed to reduce dependency upon glasses or contact lenses is LASIK (laser-assisted in situ keratomileusis) surgery.

LASIK, as well as radial keratotomy and photorefractive keratectomy procedures, have potential adverse effects that could be incompatible with flying duties. These adverse effects include corneal scarring or opacities, worsening or variability of vision, night glare, and haziness of vision.

LASIK practitioners mention that between 95 and 99 percent of their patients are doing well and are pleased with the outcome of their refractive surgery. However, if that leaves a 1 to 5 percent group of patients whose outcome is unsatisfactory, then thousands of people, some of whom are pilots, are experiencing permanent vision impairment. For some, this could mean the end of flying as a career.

• Career impact — does your job prohibit refractive surgery?

• Eye conditions — do you have or have you ever had any problems with your eyes other than needing glasses or contacts?

• Medications — do you take steroids or other drugs that might prevent healing?

• Stable refraction — has your prescription changed in the last year?

• High or low refractive error — do you use glasses/contacts only some of the time? Do you need an unusually strong prescription?

• Pupil size — are your pupils extra large in dim conditions?

• Corneal thickness — do you have thin corneas? (not everyone has sufficient corneal thickness)

Some Risks and Procedure Limitations

• Overtreatment or undertreatment — are you willing and able to have more than one surgery to get the desired result?

• After treatment, you may still need reading glasses — do you have presbyopia?

• Results may not be lasting — do you think this is the last correction you will ever need? Do you realize that long-term results are not known?

• You may permanently lose vision —some patients may lose some or all vision, experience blindness.

• Development of visual symptoms — glare, halos, starbursts, etc.; night driving might be difficult.

• Contrast sensitivity — vision could be significantly reduced in dim light conditions.

• Bilateral treatment — there are additional risks of having both eyes treated at the same time.

• Patient information — read the patient information booklet about the laser being used for your procedure.

Finding the Right Doctor

• Medical doctor — is your doctor a refractive surgeon?

• Professional care — will you be seen by the surgeon at all visits before and after surgery?

• Experienced — how many eyes has your doctor performed LASIK surgery on with the same laser?

• Equipment — does your doctor use an FDA-approved laser for the procedure you need?

• Informative — is your doctor willing to spend the time to answer all your questions?

• Long-term care — does your doctor encourage follow-up and management of you as a patient?

• Be comfortable — do you feel you know your doctor and are comfortable with an equal exchange of information?

Preoperative, Operative, and Post-operative Expectations

• Do not wear contact lenses just prior to evaluation and surgery — can you go for an extended period of time without wearing contact lenses?

• Have a thorough exam — have you arranged not to drive or work after the exam?

• Read and understand the informed consent — has your doctor given you an informed consent form to take home, carefully read, and completely answer your questions?

• No makeup before surgery — can you go 24-36 hours without makeup prior to surgery?

• Arrange for transportation — can someone drive you home after surgery?

• Plan to take a few days to recover — can you take time off to recuperate for a couple of days if necessary?

• Expect not to see clearly for a few days — can you handle the problems associated with fuzzy vision?

• Know the sights, smells, sounds of surgery — has your doctor made you feel comfortable with the actual steps of the procedure?

• Be prepared to take drops/medications— are you willing and able to put drops in your eyes at regular intervals?

• Be prepared to wear an eye shield — you need to protect the eye for a period of time after surgery to avoid injury.

• Expect some pain/discomfort — do you know how much pain to expect?

• Know when to seek help — do you understand what problems could occur and when to seek medical intervention?

• Know when to expect your vision to stop changing — final results could take up to months.

• Make sure your refraction is stable before any further surgery — if you don't get the desired result, do you know not to have an enhancement until the prescription stops changing?

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For Additional Information...

1. The FDA Web site on LASIK: The FDA has the regulatory role of approving medical devices, and so has accumulated a considerable amount of data on the lasers used for refractive surgery. There is a section on describing what LASIK is, indications, risks, finding a doctor, what to expect, checklist, glossary, and other information

2. The Eye Surgery Education Council:  This site endeavors to present an objective evaluation of LASIK. There is information on considerations you need to go through prior to deciding to have surgery, issues on physician selection, treatment options, a bibliography and a glossary. On a page devoted to "expectations" the percentages of individuals achieving uncorrected 20/40 and 20/20 vision are given. For further information there are links such as ones to Department of Defense web sites, which delineate the military approach to refractive surgery.

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This page was last edited on 06/07/06