Eye and Vision Items

Items 8, 17.b., 18.d, 31-34, 50-54 : Index to Ocular and Visual Parts of FAA Pilot Medical Exam & History

Abbreviated Briefing:

Overview of the Eye and Vision parts of the FAA Guidelines.

Because visual perception is so critical to aviation, the FAA has devised complex and highly structured components of the pilot medical exam devoted to the eyes and vision. There is a dedicated history component (item 18.d) plus 10 separate exam areas and 8 sections of medical flight test (MFT) description.

The process begins with Medical history--personal information provided by the applicant or other doctors who submit this information through the AME on the applicant's behalf. Starting with Item 18.d (Eye or vision trouble except glasses), this is a yes/no attestation on the FAA Form 8500-8 which is filled out in advance through the FAA MedXPress system. If "yes" is indicated, details must be provided and these elaborations will be discussed with the AME at time of the exam. The AME will inquire about changes in vision, unusual visual experiences (halos, scintillations, etc.), sensitivity to light, injuries, surgery, or current use of medication

The exam portion represents objective data that the AME collects and discovers through clinical inspection and testing. Items 31-34 are components listed in the observable "eye" sub-section, and all of these areas will be checked by the doctor during the flight physical. Items 50-54 are located in the demonstrable "vision" sub-section. Vision components will be assessed by the doctor or a technician through various performance tests such as the familiar eye charts and color vision testing equipment. Although there is some overlap, the eye portion is roughly an assessment of anatomy (structure), and the vision portions are measurements of physiology (function).

Also included below are links to the color vision flow chart which graphically describes options for applicants who fail the office color vision test but still want to acquire or maintain a pilot certificate. Finally, there are several pages dedicated to the special Medical Flight Test (MFT) process for aspiring pilots with only one eye or pilot applicants who have difficulty with color discrimination (color blind pilots). Most pilots will not need to take an MFT, but these more extensive (and expensive) medical certification options are available for pilot applicants with specific problems who are interested in demonstrating their ability to function while airborne but cannot otherwise pass the in-office eye and vision screening tests.

Guidance is compiled and interpreted by professional pilots and physicians at FlightPhysical.com from the 2014 AME Guide pages 53-65, FAA and FDA web data (www.FAA.gov & www.FDA.gov), instructions specified in the Aeronautical Information Manual, Federal Air Surgeon Bulletins from 1999-2015, and 14 CFR Part 61 and Part 67 (the FARs).

I. Code of Federal Regulations (Legal Source)

For Overall Guidance for all classes, refer to: 14 CFR 67.103(e), 67.203(e), and 67.303(d):

No acute or chronic pathological condition of either the eye or adnexa that interferes with the proper function of the eye, that may reasonably be expected to progress to that degree, or that may reasonably be expected to be aggravated by flying.

For Specific Legal Guidance, you may refer to the actual legal code as stratified below by Class of Pilot Medical Certificate

First Class Standards 14 CFR 67.103

Second-Class Standards 14 CFR 67.203

Third-Class Standards 14 CFR 67.303

For practical, non-legal guidelines on the clinical exam techniques, the sections below are helpful to AMEs and pilots alike. These instructions are paraphrased from the 2014 AME Guide which is a useful interpretive manual provided by the FAA.

AME Examination Techniques

During the eye examination, your AME checks for diseases or defects that may cause a failure in visual function while flying or pain sufficient to interfere with safely performing airman duties. Tell your AME about any changes in vision, unusual visual experiences (halos, scintillations, etc.), sensitivity to light, injuries, surgery, or current use of medication. Report inordinate difficulties with eye fatigue or strain ort any history of serious eye disease such as glaucoma or other diseases commonly associated with secondary eye changes, such as diabetes.

The AME will consider the following clinical signs during the eye exam:

  1. External Inspection:
    1. Color — redness or suffusion of allergy, drug use, glaucoma, infection, trauma, jaundice, ciliary flush of Iritis, and the green or brown Kayser-Fleischer Ring of Wilson's disease.
    2. Swelling — abscess, allergy, cyst, exophthalmos, myxedema, or tumor.
    3. Other — clarity, discharge, dryness, ptosis, protosis, spasm (tic), tropion, or ulcer.
    1. Cornea — observe for abrasions, calcium deposits, contact lenses, dystrophy, keratoconus, pterygium, scars, or ulceration. Contact lenses should be removed several hours before examination of the eye. (See Item 50, Distant Vision)
    2. Pupils and Iris — check for the presence of synechiae and uveitis. Size, shape, and reaction to light should be evaluated during the ophthalmoscopic examination. Observe for coloboma, reaction to light, or disparity in size.
    3. Aqueous — hyphema or iridocyclitis.
    4. Lens — observe for aphakia, discoloration, dislocation, cataract, or an implanted lens.
    5. Vitreous — note discoloration, hyaloid artery, floaters, or strands.
    6. Optic nerve — observe for atrophy, hemorrhage, cupping, or papilledema.
    7. Retina and choroid — examine for evidence of coloboma, choroiditis, detachment of the retina, diabetic retinopathy, retinitis, retinitis pigmentosa, retinal tumor, macular or other degeneration, toxoplasmosis, etc.

    Additionally, designer contact lenses that introduce color (tinted lenses), restrict the field of vision, or significantly diminish transmitted light are not allowed.

    FAA note: the use of binocular contact lenses for distance-correction-only is acceptable. In this instance, no special evaluation or SODA is routinely required for a distance-vision-only contact lens wearer who meets the standard and has no complications. Binocular bifocal or binocular multifocal contact lenses are acceptable under the Protocol for Binocular Multifocal and Accommodating Devices .

    The FAA realizes that these procedures have potential adverse effects that could be incompatible with flying duties. Potential side effects include corneal scarring or opacities. Other concerns include worsening or variability of vision over time and night-glare.

    The FAA expects that airmen will not resume airman duties until their treating health care professional determines that their post-operative vision has stabilized, there are no significant adverse effects or complications (such as halos, rings, haze, impaired night vision and glare), the appropriate vision standards are met, and reviewed by an Examiner or AMCD. When this determination is made, the airman should have the treating health care professional document this in the health care record, a copy of which should be forwarded to the AMCD before resumption of airman duties. If the health care professional's determination is favorable, the applicant may resume airman duties, after consultation and review by an Examiner, unless informed otherwise by the FAA.

    An applicant treated with a refractive procedure may be issued a medical certificate by the Examiner if the applicant meets the visual acuity standards and the Report of Eye Evaluation (FAA Form 8500-7) indicates that healing is complete; visual acuity remains stable; and the applicant does not suffer sequela such as; glare intolerance, halos, rings, impaired night vision, or any other complications. There should be no other pathology of the affected eye(s). If the procedure was done 2 years ago or longer, the FAA may accept the Examiner's eye evaluation and an airman statement regarding the absence of adverse sequela.

    If the procedure was performed within the last 2 years, the airman must provide a report to the AMCD from the treating health care professional to document the date of procedure, any adverse effects or complications, and when the airman returned to flying duties. If the report is favorable and the airman meets the

    appropriate vision standards, the applicant may resume airman duties, unless informed otherwise by the FAA.

    Conductive Keratoplasty (CK): CK is used for correction of farsightedness. As this procedure is not considered permanent and there is expected regression of visual acuity in time, the FAA may grant an Authorization for special issuance of a medical certificate under 14 CFR 67.401 to an applicant who has had CK. The FAA evaluates CK procedures on an individual basis following a waiting period of 6 months. The waiting period is required to permit adequate adjustment period for fluctuating visual acuity. The Examiner can facilitate FAA review by obtaining all pre- and post-operative medical records, a Report of Eye Evaluation (FAA Form 8500-7) from a treating or evaluating eye specialist with comment regarding any adverse effects or complications related to the procedure.