Minnesota Flyer - Serving Midwest Aviation Since 1960

By James D. Lakin
Phd,MD, FACP, CFI, CFII, MEI, 

Flying with Glaucoma: A CACI Condition

"Traffic 9 o'clock. Type and altitude unknown."

 

December 1, 2017

Photo courtesy of NIH

Fluid Pathways

I don't know about you but that kind of call from ATC always gives me the willies. Someone is buzzing around out there. They don't have enough sense to turn on their transponder, if they have one, and I'm not picking them up with my peripheral vision. It makes you realize how difficult "See and Avoid" really is. Imagine how much more so that would be if hunks of your peripheral vision were gone. That's what happens in early glaucoma. That's why the FAA is really concerned if you have it.

Glaucoma is a common problem, especially in pilots over 60. It's caused by a buildup of pressure within the eyeball, which, in turn can damage the receptors in the retina and the optic nerve. Normally, the front of the eye or anterior chamber produces a nutrient-rich fluid that feeds the nearby tissues. The fluid leaves the chamber at the angle where the cornea and iris meet. It flows through a spongy meshwork, like a drain, and leaves the eye. As you get older, the drain can sometimes clog and pressure in the eye builds up. To begin with, you usually don't have any symptoms. Vision seems normal. There is no pain. If this goes on for a while however, progressive damage to the back of the eye results. Initially parts of your peripheral field of vision are lost. Then, a sort of "tunnel-vision" occurs as more and more of the peripheral field is lost. Finally, the central optic nerve can be damaged causing complete blindness. Yikes!

So how do you find out if glaucoma's creeping up on you? It's really pretty easy. A quick trip to your local eye doctor should do the trick. She will measure your visual acuity-the eye charts you read when you get your flight physical-measure your eye pressure, check your peripheral vision, dilate your eyes and look around. That should tell you if anything is wrong. It's really a good idea to get an eye exam just before your next flight physical. Even if you don't have any serious eye problems, you can be confident that your glasses are up to par and you can pass the AME's eye exam.

So, let's say you are found to have some glaucoma. Are your flying days over? Probably not, especially if things are caught early on. There are a number of eye drops that can slow down or halt the progression of most types of glaucoma before it causes any serious vision problems. Also, there are surgical procedures that can help. Talk with an MD ophthalmologist about your options. They are the experts and can give you a comprehensive picture.

Photo courtesy of NIH

Optic Nerve

What about the FAA? If you have CACI (Condition an AME Can Issue) qualified glaucoma, your AME will be able to issue a medical certificate on the spot. There are a number of conditions that have to be met, however. You'll need an FAA Form 8500-14 report from your treating ophthalmologist stating your condition is stable and well controlled, your eye pressure is OK, you are on acceptable medications, you have no visual field or optic nerve defects, and you don't have other eye problems leading to glaucoma. These are a lot of hoops to jump through. Many folks have to go through the Special Issuance (SI) process, deferring to the FAA's panel of eye-doctors to get the thumbs up. Stick with it though. Give them all the reports and studies they ask for. Assuming you don't have a lot of eye damage, you should get the SI and be good to go!

Fly wisely. See you next month.

As always, comments, questions and suggestions are welcome:

jdlakin@mnallergyclinic.com

 

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