Opthalmic (eye) fitness for civil aviation pilots and shipping

 

Eye and opthalmic criteria

DR VIJAY BADE

MBBS,AFIH

Email drbvb111@gmail.com, www.drbadevshl.com ph 9881398048

Refractive Surgeries: Candidate who have undergone  photo refractive keratotomy (PRK)/ Laser in setu Kearomileusis (LASIK) may be considered  fit for commissioning  in the Air force in all branches.

Post PRK/LASIK  candidates must meet the visual requirements for the branch as laid down in below  para

The following criteria must be satisfied prior to selecting post-PRK/LASIK Candidates.

1.       PRK/LASIK surgery should not have been carried out before the age of 20 years.

2.       The axial length of the eye should not be more than 25.5 mm as measured by IOL master.

3.       At least 20 months should have elapsed post umcomplicated stable PRK/ LASIK with no history or evidences of any complication.

4.       The post PRK/LASIK corneal thickness as measured by a corneal pachymeter should not less than 450 microns.

5.       Individuals with high refractive errors (>6D) prior to LASIK are to be excluded.

Radial Keratotomy surgery for correction of refractive errors is not permitted for any Air Force duties. Candidates having undergone cataract surgery with or without IOL implants will also be declared unfit.

OCULAR MUSCLE BALANCE

Individuals with manifest squint are not acceptable for commissioning.

The assessment of latent squint or heterophoria in the case of aircrew will be mainly based on the assessment of the fusion capacity. A strong fusion sense ensures the maintenance of binocular vision in the face of stress and fatigue. Hence, it is the main criterion for acceptability.

a.       Convergence (as assessed on RAF rule)

i)        Objective Convergence Average is from 6.5cm to 8cm. It is poor at 10cm and above.

ii)       Subjective Convergence (SC) this indicates the end point of binocular vision under the stress of convergence. If the subjective convergence is more than 10cm beyond the limit of objective convergence. The fusion capacity is poor. This is specially so when the objective convergence is 10cm and above.

Disposal after Kerato- refractive surgery: All personnel undergoing Kerato refractive surgery (PRK/LASIK/Femto LASIK/ SMILE) would be initially observed in temporary low medical category A4G4 (T-12).

a)       Thereafter ground duty personnel may be upgraded to A4G2 (T-12) and aircrew may be upgraded to flying category A3G2 (T-12), fit to fly under supervision, subject to following conditions.

i)        The axial length of the eye should not be more than 26.0 mm as measured by IOL master or equivalent or equivalent automated non contact interferometry method.

ii)       The corneal thickness post surgery as measured by a optical corneal pachymetry method should not be less than 450 microns and normal post refractive corneal topography. This will be checked at every review postoperatively. Individuals with a corneal thickness less than 450 microns will not be upgraded to flying categories and will not be upgraded to A4G1 either.

iii)     Individuals should    not have had more than 2 diopter change in refractive power since the first month postoperative review.

iv)     Review for upgrading such cases will be done at IAM/ AFCME/ MEC(east) only with the opinion of Sr Adv ophthalmology or cornea specialist at each review. Upgradation will be subject to suitable recommendation recommended by the Sr. Adv Ophthalmology/Corneal specialist.

b)      Further upgradation to full medical category A1G1/A4G1, provided all the criteria laid down in above are satisfied and the visual parameters for the branch are maintained. Aircrew will be reviewed with an executive report with special emphasis on performance during night flying and NVG use since refractive surgery can degrade contrast sensitivity under low light conditions.

c)       Kerato Refractive surgery undertaken by any other method will be dealt with on a case to case basis.