CAN PROFESSIONAL PILOTS HAVE LASIK DONE?

Nearly about 55% of the private pilots in the USA need to utilize
some kind of refractive correction to fulfil the vision requirements
for medical certification as pilots. While eyeglasses are one of the
most typical option for pilots, current studies reveal an expanding
number of pilots have actually opted for refractive surgical
procedures, which include laser refractive surgical treatment. This
article explains the benefits along with feasible challenges laser
refractive surgery provides to those considering these treatments.

any range as well as might occur in addition to near-sighted or
hyperopic conditions. Approximately 60% of the population has
some astigmatism.

What is Refractive Error?
Refractive error protects against light rays from being brought to a
single focus on the retina resulting in reduced visual acuity. To see
clearly, refractive errors are usually corrected with ocular lenses
(glasses, contact lenses). The 3 major types of refractive problems
are near-sightedness, hyperopia, and astigmatism. An additional
ocular condition that also results in blurred near vision is called
presbyopia. Presbyopia is a progressive loss of accommodation
(decreased ability to concentrate at near distance because of
physiological changes in the eye’s crystalline lens) that usually occurs
around 40 years of age. Bifocals or reading glasses are essential to
correct this problem. Near-sightedness, (far-off objects appear
blurry) is a condition in which light rays are focused in front of the
retina. Nearly 30% of Americans are short-sighted. Hyperopia
(farsightedness, near items appear fuzzy) is a problem in which light
rays are focused behind the retina. An approximated 40% of
Americans are hyperopic. However, this number might not be exact.
Young hyperopes (< 40 years), who can compensate for their
farsightedness with their ability to accommodate, are frequently not
counted in this number and also some researches inaccurately
include presbyopes, who additionally require plus power lenses to
see clearly. Astigmatism is a problem frequently triggered from an
uneven curvature of the cornea. Therefore, light is not focused to a
single image on the retina. Astigmatism can trigger blurred vision at

What is Laser Refractive Surgical Treatment?
In October 1995, the (FDA) authorized the use of the excimer laser to
perform a refractive treatment called Photorefractive Keratectomy
(PRK). PRK improves visual acuity by altering the curvature of the
cornea through a series of laser pulses. The laser photo-ablates
(vaporizes) the corneal tissue to an established depth and diameter.
PRK can be utilized to correct near-sightedness, hyperopia, and
astigmatism. Reported PRK issues such as postoperative pain,
extended recovery period, enhanced risk of infection, and also glare
(halos) at night, has caused Laser InSitu Keratomileusis (LASIK)
ending up being the favoured choice for refractive surgery by
patients and eyecare specialists. PRK has gradually lost ground to
LASIK as the preferred surgical refractive procedure. LASIK is
performed using two devices which have been approved by the FDA:
the microkeratome and excimer laser. Throughout the LASIK
procedure, the microkeratome cuts a thin flap from the top of the
cornea, leaving it attached by a small joint of tissue. The corneal flap
is folded aside and the excimer laser is used to improve the
underlying corneal stroma. The flap is after that returned to its initial
position.

Is LASIK an Option for Me?
An eye care expert must completely assess your current ocular
health as well as correction demands to establish whether you are an
ideal prospect for refractive surgical procedure. Medical tests have
actually developed the following choice criteria for LASIK.
Option Criteria:
 Age 18 years or older

 Stable refractive error (less than.50 diopters [D] change within
the in 2015 or in 2014) correctable to 20/40 or better
 Less than – 15.00 D of myopia and approximately 6 to 7 D of
astigmatism
 Less than + 6.00 D of hyperopia and less than 6 D of
astigmatism
 No gender constraint, with the exemption of pregnancy
 Pupil size less than or equivalent to 6 mm (in normal room
lighting)
 Realistic expectations of final results (with a complete
understanding of the benefits, as well as the feasible risks)
In addition to complying with adapting the above criteria, it is
essential that you have normal ocular health and be free of pre-
existing conditions that may contraindicate LASIK.

Contraindications are as follows:
 Collagen vascular disease (corneal ulcer or melting)
 Ocular diseases such as dry eye, keratoconus, glaucoma,
incipient cataracts, herpes simplex keratitis & corneal oedema
etc.
 Systemic disorders such as diabetes, rheumatoid arthritis, lupus
& HIV etc.
 History of adverse effects from steroids being used medicinally
or otherwise.
 Signs of keratoconus, an eye condition.
 Use of some acne medicine (e.g. Accutane and/or Cordarone
etc.)

Is LASIK Safe for Pilots?
Pilots considering LASIK ought to know that in initial FDA tests
reporting high success rates (> 90%) and reduced complication rates
(< 1%), the criteria for success varied. In many clinical studies,
success was defined as 20/40 or better distant uncorrected visual

acuity (UCVA) under normal room lighting with high contrast targets,
not 20/20 which is perfect vision, or better UCVA. While most of the
patients do experience significant improvement in vision after laser
refractive surgery, there is no assurance that perfect UCVA will be
the final outcome. Even successful procedures may leave several
patients with a small amount of residual refractive error that
requires an ophthalmic tool (spectacles or contact lenses) to obtain
20/20 visual acuity defeating the very purpose of LASIK. If
overcorrection results, patients might need reading glasses.
Compared to its predecessor (PRK), LASIK requires higher technical
ability by the surgeon due to the fact that a corneal flap needs to be
produced. Although unusual, loss of best corrected visual acuity
(BCVA) can take place when there are medical complications such as
those summed up and listed below.

Surgical Problems:
 De-centred corneal flap
 Decentred ablation zone
 Button-hole flap (flap reduced too thin resulting in an opening)
 Perforation of the eye
Operation of an aircraft is an aesthetically demanding task carried
out in an atmosphere that is not always user friendly. This becomes
particularly apparent if the option of vision correction is improper for
the task. While the threat of serious vision-threatening problems
after having LASIK is reduced (< 1%), some issues might have a
significant impact on visual efficiency in a cockpit environment.

Threat of Post-Surgical Complications:
 Extended recovery durations: 3 months or even more
 Night glare (halos, starbursts): 1 in 50
 Under/over-correction: less than 1 in 100
 Enhanced intraocular pressure: non-significant
 Corneal haze: 1 in 1,000

 Corneal scarring: non-significant
 Loss of BCVA: 1 in 100 Infection: 1 in 5,000
 Corneal flap issues (disjointed flap, epithelial ingrowth): less
than 1 in 100

Complying with LASIK
Patients are warned to stay clear of massaging their eyes and also to
avoid swimming pools, jacuzzis, or whirlpools for a minimum of one
week. Contact sporting activities ought to be stayed clear of for a
minimum of 2 weeks, as well as several eye surgeons advise putting
on safety and security eyeglasses while playing sporting activities.
Also, after the patient’s vision has actually stabilized as well as
recovery shows up fully, the corneal flap might not be entirely re-
attached. There have actually been records of corneal flap
displacement because of trauma as much as 38 months after the
treatment. After surgical treatment, patients are warned to not put
on eye make-up or use creams and also lotions around their eyes for
a minimum of 2 weeks as well as to throw out all formerly utilized
make-up to lower the threat of infection. In some circumstances,
LASIK might be a choice for patients with greater refractive error
than can be securely remedied with PRK or those with problems that
can postpone recovery (e.g., lupus, rheumatoid arthritis etc.).
Pilots who look for monovision correction ought to seek advice from
an eye care specialist to help them be in conformity with criteria
described in the “Overview for Aviation Medical Examiners“:
 “Airmen who opt for monovision LASIK have to initially put on
correction (i.e., glasses or contact lenses) for near vision eye
while operating an airplane.”
 “After a 6-month duration of adaptation, they might apply for a
Statement of Demonstrated Ability (SODA) with a medical flight
examination.”

 “If the airman succeeds, the lens requirement is removed from
their medical certificate.”

Advancements in Refractive Surgical Treatment
Wave front LASIK Eye care experts have actually traditionally utilized
conventional dimension methods that determine as well as fix lower-
order aberrations, such as near-sightedness, farsightedness, and
astigmatism. However, no two people share the exact same eye
abnormalities or have comparable refractive requirements. Vision is
one-of-a-kind and as individual fingerprints or DNA. Wave front
technology enables eye surgeons’ specialists to personalize the LASIK
procedure for each and every eye, offering the opportunity of even
far better vision. The FDA authorized the first system for basic use in
October 2002. A laser light beam is sent out through the eye to the
retina and is reflected back through the pupil, measuring the
abnormalities of the light wave (wave front) as it arises from the eye.
This procedure produces a three-dimensional map of the eye’s
optical system. Measuring the cornea’s flaws or aberrations this way
permits the refractive surgeon to create a customized therapy to
prepare for the patient’s unique vision requirements. Dealing with
the patient’s specific flaws can lead to sharper vision, far better
comparison level of sensitivity, as well as minimizes issues associated
with higher-order aberrations after surgical treatment, such as
haloes and blurred pictures. Research studies show that 90-94% of
patients obtaining technology permits eye surgeons to personalize
the LASIK through wave-front LASIK attained visual acuity of 20/20 or
much better. However, those with thin corneas, high levels of
aberrations, extreme dry eyes, or conditions influencing the lens as
well as glasslike fluid inside the eye might not be excellent prospects
for wave-front LASIK. The FAA requires that civil pilots with refractive
surgeries (e.g., PRK, LASIK) cease flying up until their eyecare
professional has actually figured out that their vision is stable and
also there are no significant unfavourable impacts or issues. The

pilots need to send either records to the FAA (a report from their
eyecare professional or “Record of Eye Assessment” [FAA-8500-7].
These records can be sent straight to the Aerospace Medical
Certification Division when released from treatment, or to their
Aviation Medical Examiner during their following flight physical. This
record ought to state: “… that the airman satisfies the visual skill
criteria and also the record of eye assessment shows recovery is full,
visual acuity continues to be stable, and also the candidate does not
experience sequela, such as glare intolerance, halos, rings, damaged
night vision, or any kind of various other issues …” (Guide for
Aviation Medical Examiners, July 2005)
If you are a pilot considering refractive surgical treatment, seek
advice from an eyecare professional to figure out if you are a great
prospect for laser refractive surgical treatment. Although the FAA as
well as most significant air carriers permit laser refractive surgical
treatment, professional pilots ought to think about exactly how it can
impact their work-related and also certification standing. Just like
any type of intrusive treatment, there are numerous variables that
can influence the final end result. You ought to recognize all risks in
addition to the benefits prior to choosing to have a treatment carried
out that might jeopardize your visual efficiency in the cockpit.