Aviation Medicals: Winning the Vision Game

Aviation Medicals: Winning the Vision Game

Aviation Medicals: Winning the Vision Game

What I’ve learned in nearly 50 years of examinations

Over the years, I’ve equated my yearly visit to an Aviation Medical Examiner (AME) to a sporting contest. In this game, you don’t have a traditional opponent; the referee is your opponent. A win means the referee (the AME) signs you off, after going down the checklist of bad things. Either you didn’t have any or he missed it – sort of like a referee missing a flagrant foul.
On the other hand, a “decline to issue” by the AME is a penalty flag and imposes a requirement for specialized tests that may or may not be covered by your insurance. There’s no more flying as PIC until you convince the FAA’s Civil Aerospace Medical Institute (CAMI) that you are unlikely to become incapacitated while exercising the privileges of your pilot’s certificate. To continue the sports analogy, an eventual certification by CAMI means you still win, but in overtime.
Finally, in a small amount of these cases, you are told your flying days are over. In essence, the FAA has determined that the risk of you conking out in the cockpit is too great. It’s the ultimate “Upon Further Review”.
In this article, I’ll share with you the steps I take to minimize the chances of a “decline to issue” situation when it comes to taking the vision test. First, we’ll take a look at what you can do to minimize busting your exam due to vision problems and also delve into a potential vision trap that awaits you as you age. Next time, we’ll look at coronary and cardiovascular issues and what you can do to avoid potential problems there.
Vision Issues
The FAA says that as long as near vision (16 inches distant) can be corrected to 20/40 or better, you’re good to go. This is true for all three classes of medical certificate. To qualify for a 1st or 2nd class certificate, you also have to be able to see with acuity of 20/40 or better at 32 inches – a portion of the examination known as intermediate vision acuity. These requirements are not difficult to meet with a little help from your optometrist.
Distance vision is a horse of a different color. Maybe.
If you are going for a 3rd class certificate, distance vision uncorrected or corrected to 20/40 is good enough. 1st and 2nd class applicants, however, have to be able to see at a 20/20 acuity, uncorrected or corrected.
It’s absurd, but it is what it is. The FAA’s reasoning is that people who pay for your pilot services are entitled to a higher standard of safety than those who willingly climb in an airplane with you and aviate for free.
800px-Cataract_in_human_eyePassing the Visual Acuity Tests
To better the odds, resolve to not use contact lenses during your examination; they will not allow you to see as well as standard eyeglasses. Also, don’t use multi-focus eyeglasses; use glasses relevant for each portion of the exam. It’s too difficult to find the sweet spot on the typical machine used by the AME when wearing multi-focus eyeglasses, plus you often end up with your head tilted at an impossible angle and light transmission suffers. Finally, don’t use glasses that darken when exposed to light. Again, you want maximum light transmission.
Next, visit your optometrist the week before your AME examination and request a complete eye examination including a color vision test. Tell him or her you need a printed report of the examina-tion results.
Pilots like to be in charge – it’s in our nature – and having the full optometrist’s report in your back pocket helps keep control of the situation in your hands. If you fail the AME’s acuity examination or color blindness tests, you can produce the optometrist’s examination results and challenge the failure. Most AME’s do not submit their equipment for calibration on a regular basis and know that their systems are not as accurate as those used by a Doctor of Optometry. Nine times out of ten, the report will trump the AME’s exam and he will accept it. Worse case, he will require the optometrist to fill out an FAA 8500-7 report instead of accepting their standard examination documentation. It’s the same information but in a format that CAMI is used to seeing and a CYA for the AME.
What else?
The human eye has a property called Dynamic Range. When you step out of a dark location into bright sunlight, the eye’s iris immediately closes down and the brain ratchets down the sensitivity of the optic nerve to protect it from overload.
When you walk back into a darkened area, the iris quickly opens up but it takes time for the signal from the optic nerve to reach maximum again. Since most AME’s do the vision tests first, this is significant. It means that you won’t be getting maximum signal to your brain from your eyes (and therefore maximum clarity).
There is a countermeasure. Before you leave your house, don not one but two pairs of standard sunglasses. (Like the scene in the movie Airplane, where Captain Rex Kramer whips off one pair of aviator glasses only to reveal another pair.) Don‘t use sunglasses made from cast-off welders hoods; plain old $15-dollar plastic drug-store “blue blockers” will suffice. Place them in front of your regular sunglasses and accept the fact that you will look strange to people you may meet along the way.
Keep both pairs of sunglasses on until you are inside the AME’s building and then wear the remaining pair until you are in the room where the vision test is given.
When the person administering the test is ready to proceed, remove the second pair of sunglasses and press your face against the machine’s visor. The result is, you’ll have the maximum signal possible from the optic nerve to the brain and – assuming you are wearing the best eyeglasses possible – have done all you can to improve your vision score.
Cataracts
Finally, here’s a heads up on a problem you will likely encounter towards the end of your flying career: Cataracts. A cataract is a cloudiness of the lens that is positioned between the eye’s cornea and retina. As we age, cloudiness often appears and then becomes greater and greater. Eventually, it becomes impossible to correct the problem using eyeglasses or contact lenses, rendering you unable to pass the FAA vision examination – even a 3rd class medical certificate requiring only 20/40 distance vision.
To fix the situation, the cloudy lens is removed surgically and a new lens is inserted into the eye. The problem is, many private insurance plans will not cover cataract surgery until your distance vision degrades to 20/50. Fortunately, it’s sometimes possible for a surgeon to receive a waiver by showing that significant lifestyle challenges or unemployment will occur without surgery. Pilots flying with 1st or 2nd class certificates and private insurance should investigate this option.
It’s also possible for the surgeon to document that glare is degrading the person’s night vision to 20/50 or worse, even though basic vision is still better than 20/50. In that case, most private insurers will also grant a waiver.
Medicare and Cataracts
For those having Medicare coverage (which, unfortunately, is what the great majority of pilots with cataracts are going to have), there is a greater challenge.
With Medicare, the 20/50 distant-vision rule applies in most regional Medicare fiefdoms and there is no procedure for requesting a waiver. In essence, a surgeon is taking a chance if he or she performs cataract surgery on someone who has distant vision better than 20/50, since an audit by the Medicare bureaucrats could bring a very substantial fine and sanctions.
On the other hand, if glare degrades a person’s night distant vision to 20/50 or worse, and the doctor properly documents that the requisite tests for glare were done, chances are he may feel comfortable performing the operation. Discuss this aspect with a potential surgeon if he or she seems leery of repairing your daytime distant vision when it isn’t 20/50 or worse.
Also, go over the FAA documen-tation requirements beforehand and make certain that the surgeon is willing to jump through those hoops, or it will all have been in vain as far as keeping you in the air is concerned. Your AME can advise you what the surgeon needs to provide before you go for your pre-surgery evaluation and supply an FAA 8500-7 form to give to the surgeon as well. If you have the proper paperwork after the surgery, the AME can issue you a new medical certificate at the time of your examination without CAMI intervention.

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