Medical Work-up: A good history, to include all visual complaints is paramount. The diagnosis of cataracts is made with direct ophthalmoscopy or slit lamp examination. Cataract extraction is generally reserved for visually significant cataracts. The resulting aphakia is then corrected with either aphakic contact lenses or intraocular lens implants. The operative noted is required as is the model number and type of intraocular lens utilized; also need to prescription for any aphakic contact lenses or spectacles if applicable as well as the best corrected visual acuities at distance and near. A good dilated retinal exam is also important.
Aeromedical Disposition:
Air Force: Early consultation with a reliable ophthalmologist is recommended to avoid procedures, which would render the aviator unwaiverable, and to assure that timely surgery is performed. Because of the potential complications of iridocyclitis and end-ophthalmitis, close ophthalmological follow-up is usually required for 3 months after surgery until visual acuity stabilizes and final corrective lenses are prescribed. All trained aviators who have had a surgical procedure for a cataract can be considered for a waiver and will need to be evaluated at the ACS. This evaluation cannot occur any sooner than 90 days after the surgery or 30 days if the only procedure was laser treatment. Waiver requests for untrained aviators are not likely.
Army: Cataracts are considered disqualifying in AR 40-501 Standards of Medical Fitness. They are discussed in the Cataract Aeromedical Policy Letter which articulates similar aeromedical concerns as the USAF. With regard to waivers, initial applicants with cataract are rarely waivered, even if they are asymptomatic, because most cataracts are progressive; however applicants are considered on a case by case basis. Waivers for rated personnel are usually granted after successful surgical correction. The medical work-up and post operative evaluation for Army aircrew is similar to that in the USAF. However the Army APL specifies the Mentor Brightness Acuity Test be performed prior to and after surgery with visual acuity documented for each eye separately at low, medium and high settings. The Army prefers extracapsular lens extraction with intraocular lens (IOL) implants as the treatment of choice, but there are no written limitations on the type of IOL used.
Navy: The condition is considered disqualifying. Once vision has deteriorated to less than 20/20 correctable or the patient has a positive Glare test, the flier should be disqualified from flying until successful surgical removal of the cataract. Waiver to Service Group 1 may be considered after surgery provided the VA returns to 20/20 corrected, is within refraction limits, and the Glare test is negative (normal).
Civilian: Return to flying status may be considered after surgery provided the visual acuity has stabilized, spectacles prescribed, and the candidate meets appropriate military and/or FAA standards. Adequate history and physical examination to exclude conditions such as Wilson's disease, diabetes mellitus, hypothyroidism, systemic steroid use, and hypoparathyroidism should be accomplished. The airman must meet the vision standards of their respective class. They should not have any side effects that are incompatible with flight, such as glare. . The airman is expected to provide the FAA with an Eye Evaluation on Form 8500-7. All classes of medical certificates are allowed. The airman's visual acuity must correct to standards for the medical class requested and if they do not, corrective lenses are required. For a non-multifocal intraocular lens the AME may issue providing the airman does not have any adverse side-effects and they meet FAA vision standards for the class requested.
In the past several years the FAA has felt that the multifocal lenses have been perfected enough to allow them both external and intraocular. The FAA is also accepting the use of the accommodating lenses described above. The requirement for these lenses is that if they were surgically inserted the airman must be grounded for 3 months and then is followed with a special issuance. The airman also must have a one-month period of grounding in order to adjust to the lenses. If the airman does not meet vision standards in one or both eyes a medical flight test and Statement of Demonstrated Ability will be required.
Waiver Experience:
Air Force: Prior to 1962, the Air Force aviator with visually significant cataract was doomed to be disqualified without waiver. In 1962, the first aphakic aviator was returned to full flight status and in 1979, the first military pilot with an IOL was returned to flying. In 1974, the first aphakic aviator was returned to full flight status and in 1979 the first military pilot with an IOL was returned to flying. A review AIMWTS showed 110 cases of cataracts for initial flying training and active flyers, all aeromedical summaries were reviewed. Twenty-five (25/110 – 23%) were disqualified; seven initial aviation training candidates, eight from the pilot/navigator populations and ten from the non-pilot/navigator population. Of the seven disqualified aviation candidates, six were for cataracts and the seventh was for another eye condition. Of the eight disqualified pilot/navigators, five were for cataracts (initial or not correctable to 20/20) and the other three were for other medical conditions (e.g. rheumatoid arthritis, alcohol abuse). Of the other ten disqualified aviators, four were for cataracts (initial or not correctable to 20/20) and the other six were for other medical conditions. Aviators with IOLs are flying unrestricted in high performance aircraft without complications or difficulty reported.
Army: The Aeromedical Epidemiological Data Repository (AEDR) catalogs all Army flight physicals since 1960. There have been approximately 160,000 individual aircrew entered in this database. During this period of time, there have been 114 cases of cataract discovered in either one or both eyes. Of those 80 were retained.
Navy: Precise statistics are not available at this time.
Civilian: As of 2010 the FAA had 521 first-, 992 second-, and 4,670 airmen who are currently issued with a cataract that they were following or who had surgical removal. The FAA also maintains a Path code for airmen issued who have an intraocular lens implanted and as of the same time period there were 398 first-, 792 second-, and 3,302 third-class airmen currently issued.