Pilots & Cataracts

by Dr. Bill Blank, M.D.
Published in Midwest Flyer – December 2017/January 2018

Cataracts are a common result of aging. Over 24 million Americans over 40, one-sixth of that population, have cataracts. More than half the people over 80 have them. Almost 4 million cataract operations are performed annually in the U.S.

I decided to write this article for two reasons. First, cataracts are a common problem and can impact aviation safety. Second, because of a fatal Cessna 172 accident in 2013 in which early cataracts played a role (NTSB #WPR14FA078), the FAA has been emphasizing the symptoms of cataracts, especially early ones, to AMEs.

What is a cataract? It is simply a clouding or opacification of the lens of the eye. The lens should be clear like a window. Cataract surgery involves removing the opaque lens and replacing it with a plastic one, called an intraocular lens implant or IOL. The most common cause of cataracts is age. Others are heredity, medication side effects (high dose steroids is an example), diabetes, some other diseases, and smoking.

There is an aviation connection to interocular lens implants. Gordon “Mouse” Cleaver was a World War II Battle of Britain Hawker Hurricane Ace. On his last flight, he forgot to wear his goggles. His canopy exploded resulting in plastic inside of his eye. His ophthalmologist realized that the plastic was causing no inflammation of the eye. This led him to conclude that it might be possible to make a plastic lens to put inside the eye. At that time, the cataractous lens was removed and not replaced. After surgery, the patient had to wear thick glasses which distorted vision. The first intraocular lens was implanted in England in 1950 and in the U.S. in 1952. Since then, the surgical technique and lens technology has gradually evolved. Modern cataract surgery is done under topical or local anesthesia and takes about 10 minutes. The recovery is rapid and the vision is generally excellent. Because refractive surgery techniques are frequently combined with cataract surgery, patients often wind up with weaker, more advantageous prescriptions for glasses than they ever had.

Some of the symptoms of cataracts are blurred vision, glare, halos, loss of contrast, dimming of colors, and trouble reading. From a certification point of view, the problem is that many people with early cataracts still have 20/20 vision. They can pass their flight physical, but are truly visually handicapped. They can be blinded by oncoming headlights or runway lights. If you have trouble driving at night or no longer do it, you probably don’t meet the FAA visual standards and shouldn’t fly.

If you have early cataracts, not causing symptoms, can your AME certify you? Sure, he should write in his remarks “early cataracts, not visually significant.”

What are the certification requirements after cataract surgery? It depends on the type of implant. If your implant is single vision, for distance only, and you need glasses to read, there is no waiting period. Your vision must be stable and you must be able to meet the standard. For implants designed to correct for distance and near vision, there is a 3-month waiting period. The FAA feels that it takes that long to adjust to these implants. One disadvantage to this type of IOL is that there are vision trade-offs. The vision frequently isn’t as sharp as with single-vision implants. Some people may not be able to meet the 20/20 requirement for 1st or 2nd class certification.

I hope this article has given you a better understanding of cataracts and FAA certification after surgery.

EDITOR’S NOTE: William A. Blank is a physician in La Crosse, Wisconsin, and has been an Aviation Medical Examiner (AME) since 1978, and a Senior AME since 1985. Dr. Blank is a retired Ophthalmologist, but still gives some of the ophthalmology lectures at AME renewal seminars. Flying-wise, Dr. Blank holds an Airline Transport Pilot Certificate and has 5600 hours. He is a Certified Instrument Flight Instructor (CFII), and has given over 1200 hours of aerobatic instruction. In addition, Dr. Blank was an airshow performer through the 2014 season, and held a Statement of Aerobatic Competency (SAC) since 1987.

DISCLAIMER: The information contained in this column is the expressed opinion of the author only, and readers are advised to seek the advice of others, and refer to the Federal Aviation Regulations and FAA Aeronautical Information Manual for additional information and clarification.

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