AMC1 MED.B.070 Visual system

(a) Eye examination

(1) At each aero-medical examination, an assessment of the visual fitness should be undertaken and the eyes should be examined with regard to possible pathology.

(2) All abnormal and doubtful cases should be referred to an ophthalmologist. Conditions which indicate ophthalmological examination include but are not limited to a substantial decrease in the uncorrected visual acuity, any decrease in best corrected visual acuity and/or the occurrence of eye disease, eye injury, or eye surgery.

(3) Where specialist ophthalmological examinations are required for any significant reason, this should be imposed as a limitation on the medical certificate.

(4) The possible cumulative effect of more than one eye condition should be evaluated by an ophthalmologist.

(5) In their examination AMEs should give proper consideration to the degenerative effects of ageing on the visual system.

(b) Comprehensive eye examination

A comprehensive eye examination by an eye specialist is required at the initial examination. All abnormal and doubtful cases should be referred to an ophthalmologist. The examination should include:

(1) history;

(2) visual acuities ­ near, intermediate and distant vision (uncorrected and with best optical correction if needed). Where a degeneration of the visual acuity is observed, additional specialised examinations could be considered, subject to the suspected pathology;

(3) examination of the external eye, anatomy, media (slit lamp) and fundoscopy;

(4) ocular motility;

(5) binocular vision;

(6) visual fields;

(7) tonometry on clinical indication and for all cases where a comprehensive eye examination is required for applicants over the age of 45;

(8) objective refraction: hyperopic initial applicants with a hyperopia of more than +2 dioptres and under the age of 25 should undergo objective refraction in cycloplegia;

(9) assessment of mesopic contrast sensitivity; and

(10) colour vision.

(c) Routine eye examination

A routine eye examination may be performed by an AME and should include:

(1) history;

(2) visual acuities - near, intermediate and distant vision (uncorrected and with best optical correction if needed);

(3) examination of the external eye, anatomy, media and fundoscopy;

(4) contrast sensitivity assessment test for applicants above the age of 60; and

(5) further examination on clinical indication.

(d) Refractive error and anisometropia

(1) Applicants with the following conditions may be assessed as fit subject to satisfactory ophthalmic evaluation and provided that optimal correction has been considered and no significant pathology is demonstrated:

(i) hypermetropia not exceeding +5.0 dioptres;

(ii) myopia not exceeding –6.0 dioptres;

(iii) astigmatism not exceeding 2.0 dioptres;

(iv) anisometropia not exceeding 2.0 dioptres.

(2) Applicants should wear contact lenses if:

(i) hypermetropia exceeds +5.0 dioptres;

(ii) anisometropia exceeds 3.0 dioptres.

(3) An evaluation by an eye specialist should be undertaken 5-yearly if:

(i) the refractive error is between –3.0 and –6.0 dioptres or +3 and +5 dioptres;

(ii) astigmatism or anisometropia is between 2.0 and 3.0 dioptres.

(4) An evaluation by an eye specialist should be undertaken 2-yearly if:

(i) the refractive error is greater than –6.0 dioptres or +5.0 dioptres;

(ii) astigmatism or anisometropia exceeds 3.0 dioptres.

(e) Uncorrected visual acuity

No limits apply to uncorrected visual acuity.

(f) Visual acuity

(1) Reduced vision in one eye or monocularity: Applicants for revalidation or renewal with reduced central vision or acquired loss of vision in one eye may be assessed as fit with an OML if:

(i) the binocular visual field or, in the case of monocularity, the monocular visual field is acceptable;

(ii) in the case of monocularity, a period of adaptation time has passed from the known point of visual loss, during which the applicant should be assessed as unfit;

(iii) the unaffected eye achieves distant visual acuity of 6/6 (1,0) corrected or uncorrected;

(iv) the unaffected eye achieves intermediate visual acuity of N14 and N5 for near;

(v) the underlying pathology is acceptable according to ophthalmological assessment and there is no significant ocular pathology in the unaffected eye; and

(vi) a medical flight test is satisfactory.

(2) Visual fields

Applicants with a visual field defect, who do not have reduced central vision or acquired loss of vision in one eye, may be assessed as fit if the binocular visual field is normal.

(g) Keratoconus

Applicants with keratoconus may be assessed as fit if the visual requirements are met with the use of corrective lenses and periodic evaluation is undertaken by an ophthalmologist.

(h) Binocular function

Applicants with heterophoria (imbalance of the ocular muscles) exceeding:

(1) at 6 metres:

2.0 prism dioptres in hyperphoria,

10.0 prism dioptres in esophoria,

8.0 prism dioptres in exophoria

and

(2) at 33 centimetres:

1.0 prism dioptre in hyperphoria,

8.0 prism dioptres in esophoria,

12.0 prism dioptres in exophoria

should be assessed as unfit. A fit assessment may be considered if an orthoptic evaluation demonstrates that the fusional reserves are sufficient to prevent asthenopia and diplopia.

(i) Eye surgery

The assessment after eye surgery should include an ophthalmological examination.

(1) After refractive surgery, a fit assessment may be considered, provided that:

(i) stability of refraction of less than 0.75 dioptres variation diurnally has been achieved;

(ii) examination of the eye shows no post-operative complications;

(iii) glare sensitivity is within normal standards;

(iv) mesopic contrast sensitivity is not impaired;

(v) an evaluation is undertaken by an eye specialist.

(2) Following intraocular lens surgery, including cataract surgery, a fit assessment may be considered once recovery is complete and the visual requirements are met with or without correction. Intraocular lenses should be monofocal and should not impair colour vision and night vision.

(3) Retinal surgery entails unfitness. A fit assessment may be considered 6 months after surgery, or earlier if recovery is complete. A fit assessment may also be considered earlier after retinal laser therapy. Regular follow-up by an ophthalmologist should be carried out.

(4) Glaucoma surgery entails unfitness. A fit assessment may be considered 6 months after surgery or earlier if recovery is complete. Regular follow-up by an ophthalmologist should be carried out.

(j) Visual correction

Correcting lenses should permit the licence holder to meet the visual requirements at all distances.