Eye Pressure / Glaucoma

[Guest EZ206PILOT]

I got my FCI physical yesterday and everything went good except for the pressure in my eye was a little higher than normal. I have never had any problems with this and there is no history of glaucoma in my family. I now have to get a consultation with an opthomologist. Has anyone here had the same problem. If so how was the consultation? Any help would be great. I have my consultation tomorrow and I am a little nervous about the whole thing.

[Guest EZ206PILOT]

My eye pressure was around 23.

[Guest EZ206PILOT]

It turns out the pressure in my eye was fine. Just in case any one is curious the maximum intraocular eye pressure is 22mmHg. Anything above 22mmHg but not greater than 30mmHg must have a waiver. I know it might sound stupid, but I would recommend going to a civilian opthomologist before taking you physical if you can afford to. That way you there are no suprise on the one that really matters.

[Guest deanrancourt]

I have gone through a bunch of crap concerning this because my corneas are slightly thicker than normal and that causes eye pressures to seem higher when using the stupid air puff test. After going to an opthamologist, who used the more scientific methods, my pressures were 17 and 18 not 23-24 like on the puff test. Also, take the puff test in the afternoon, pressures are usually a couple of points lower then.

[Guest BlueSky99]

Hi sir. I have a friend who is not a member of this forum, but would like me to post a question for you. Here is is:

I have a question about waivers in the Air Force/ANG. I want to get either a pilot or nav slot after I complete college, however my vision is not-so-perfect. I had glaucoma as a child and it has reduced vision in my right eye to 20/200. My left is 20/20 corrected to 20/15, however. As a result of this, though, I am considered by the FAA to have monocular vision. This does not keep me from getting a medical, however, as I currently hold an FAA 3rd class medical with the restriction that I wear corrective lenses. I would just like to know if it's possible for me to get a waiver with the AF as I would with the FAA? Also, if I can't get a pilot slot, would vision problems obstruct me from getting a nav slot in the ANG?

Thanks!

[Guest F16PilotMD]

20/200 is okay for a flying class 1A, which is what you need to be a Nav. I see now way to get a waiver for flying class 1 (pilot).

You may have trouble, however, just enlisting based on the reg cited below. The "visual field loss associated with glaucoma" is what I'm concerned about. You would need a full eye exam to determine just what changes have occurred to your eye as a result of the glaucoma, if it's normal pressure now, etc.

AFI48-123:

A3.10.9.4. Glaucoma, primary or secondary, or preglaucoma as evidenced by intraocular pressure

above 21mmHg, or the secondary changes in the optic disc or visual field loss associated with

glaucoma.

A7.15. Intraocular Pressure, Flying Classes I, IA, II, and III.

A7.15.1. Glaucoma. As evidenced by intraocular pressures of 30 mmHg or greater, or the secondary

changes in the optic disc or visual field associated with glaucoma. Trained aircrew with glaucoma

require consultation (review or evaluation) with the ACS prior to waiver consideration.

[Guest BlueSky99]

Here is my friend's response. Thanks:

I get a full eye exam every 6 months, and have since I was 1 year old. The pressure in my eye has never increased and has remained normal. Furthermore, my field of vision is tested at least once a year, most recently 2 months ago, and it is perfectly fine. With both eyes open, I can see perfectly fine. My optomitrist actually says the periferal vision in my "bad" eye is better than most people. So based on this, you don't think getting a nav slot is a problem?

PS - Do you think laser surgery could be an option if I want to apply for pilot?

[ 07 March 2004, 17:03: Message edited by: BlueSky99 ]

[Guest F16PilotMD]

I'd give you a "maybe" for the Nav slot (flying class 1A) with the info you've provided. Your history of eye "damage" might do you in...the specifics would be important. It would also be predicated on the USAF eye doc's eval.

As far as laser surgery goes, I don't think it would help you. I'm no eye doc, but it seems to me that you have optic nerve damage from glaucoma...correct? I think the laser will only help your average near/far sighted eye which is corrected by changing the curvature of the cornea. That's purely off the top of my skull...not worth much. Need to ask an eye doc that does PRK.

[Guest Tokyo]

Got the word from AETC today...pilot slot gone for now. My internal occular pressure is too high, and they don't want to waiver it, and I know a waiver does exist because I am looking at it right now. Is anyone in the same boat or know anything about this condition?

Any input would be great, thanks.

[Guest F16PilotMD]

This is the waiver guide you are probably referring to. You will find a sentence in here that says NOT waiverable for IFC-1.

CONDITION: OCULAR HYPERTENSION AND GLAUCOMA

I. Overview. Aeromedically, ocular hypertension (OHT) is defined as intraocular pressure greater than 21 mmHg on two or more determinations and the following conditions: no evidence of optic nerve damage, ie. no disc changes, no cup asymmetry greater than 0.2, no nerve fiber layer loss, no visual field defects, and no related afferent pupillary defect. Glaucoma is defined as any evidence of optic nerve damage as a result of intraocular pressures, ie. disc changes, cup asymmetry greater than 0.2, nerve fiber layer loss, visual field defects, or related afferent pupillary defect. Although pressure-related nerve damage can occur at any level, ie. low tension glaucoma, the term glaucoma is usually reserved for obvious high pressure related effects. Semantically, the term glaucoma has been used in aircrew with pressures of 30 mmHg or greater even in the absence of objective nerve damage. Statistically, the risk of inducing optic nerve damage with pressures that persist at these levels increases significantly.

The etiologic differential diagnosis of OHT and glaucoma is diverse and broad. The glaucomas are divided into open angle (primary, secondary, normal tension) and closed-angle types. Thus, a thorough history and physical exam, ophthalmological exam, and appropriate laboratory studies are essential in determining the etiology for the disease.

Therapy is dependent upon the specific cause. However, in general, the management of the condition is initially medical. Other therapeutic modalities include laser therapy and surgical therapy, eg. filtration surgery, placement of setons, goniotomy, trabeculotomy, trabeculectomy and cycloablative procedures.

II. Aeromedical Concerns. OHT and glaucoma may result in difficulty with night vision with the appearance of halos and flares around lights, loss of contrast sensitivity, loss of color vision, loss of central or peripheral visual fields, loss of visual acuity, and blindness. All of these visual disturbances may significantly impair the visual performance of the aviator and would present a significant safety hazard. This impairment of performance is usually not associated with subjective complaints.

III. Information Required for Waiver Submission. For an initial waiver request, the following information is required:

1. Complete history and physical.

2. Complete ophthalmological examination to include; refraction to best visual acuity, cycloplegic refraction, automated or Goldmann peripheral visual fields, applanation tonometry with diurnal recordings, dilated funduscopic exam, and optic disc photographs.

For a renewal waiver, an ophthalmology consult is required. The evaluation should include quarterly measurements of intraocular pressure, unless the ophthalmologist specifies less frequent assessment, and bilateral visual field exams. Aeromedical Consultation Service (ACS) evaluation by the Ophthalmology Branch is required (as part of the Ocular Hypertension/Glaucoma Management Group). A Medical Evaluation Board is required for glaucoma but not for ocular hypertension.

IV. Waiver Considerations. OHT is a disqualifying condition for Flying Class I, IA, II or III (Flying Class I, IA, initial II, and initial III not waiverable). Waiver criteria include; acceptable visual performance on ophthalmologic examination, stabilized intraocular pressure no greater than 29 mmHg, and no evidence of optic nerve damage (as defined above). Rarely, OHT may require pharmacological intervention to control pressures as a preventive strategy.

Glaucoma is also disqualifying for all flying classes. Glaucoma waiver criteria for Flying Class II or III (Flying Class I, IA, initial II, initial III not waiverable) include: glaucoma stable and controlled by waiverable medications or surgical modalities, no aeromedically significant defect within the central 30 degrees of the visual field of either eye, a full binocular field, and no visual or systemic side effects of the medication. Waiverable topical medications include epinephrines, beta blockers, epinephrine precursors, and alpha agonists. Pilocarpine or related medications are not waiverable, nor are oral agents, such as carbonic anhydrase inhibitors, ie. Diamox.

Argon laser trabeculoplasty (ALT) or peripheral iridotomy (PI) by laser procedure may be performed on aviators with demonstrated uncontrolled OHT or progressive glaucoma, ie. progressive visual field loss or optic nerve cupping, on maximum tolerated medications ( a beta-blocker and epinephrine compound), who then elect an ALT procedure in lieu of grounding or treatment with non-waiverable medication, such as a miotic compound (pilocarpine, carbachol). A waiver recommendation may be made once their glaucoma has been demonstrated to be under control by the Ophthalmology Branch of the Aeromedical Consultation Service (ACS). Individuals will be required to return to the Ophthalmology Branch, ACS, usually within six months of the procedure.

Should medical therapy and ALT or iridotomy be unsuccessful in controlling their glaucoma, aviators may be considered for a categorical waiver following filtration procedures (trabeculectomy with or without adjunctive antimetabolite therapy) if the intraocular pressure is controlled for six months post-trabeculectomy with no evidence of further glaucoma damage, and providing they only require aeromedically acceptable medications. A six month observation period prior to ACS Ophthalmology Branch evaluation is indicated to allow for healing and stabilization of the filter. If the condition is uncontrolled, the individual should remain grounded until control is adequately demonstrated by whatever therapeutic modality is required.

V. USAF Experience. The Ophthalmology Branch at the ACS has followed over 550 aviators with the diagnosis of either OHT or glaucoma. Aeromedical experience reveals that approximately 90% of aviators are granted waivers for these conditions.

[Guest Tokyo]

Ok, so I am little confused still. Is this saying "you can't fly due to OHT, but you can still commission and here is the criteria for that"?

Or, are they saying that it is disqualifying for flying at first, but waiverable for flying if you meet the criteria and pass all the additional eye exams?

Thanks F-16PilotMD

[Guest bmx]

I have higher then normal eye pressure. Can a doctor tell whether or not I have been using eye drops to lower my pressure? Thanks.

[Guest F16PilotMD]

Your eye pressure can be up to 30mmHg. I would not recommend using anything other than what has been prescribed by a physician. I doubt there is any way to "tell" you have been doing this.

No, I'm not saying you should lie about it...

[Guest Tokyo]

bmx,

Are you a rated aviator right now or a cadet seeking a pilot slot? It makes a difference in how the AF grants waivers. I know a little about this whole eye pressure thing as I have just lost my pilot slot through ROTC for "occular hypertention."

[Shut up 'n color]

OUCH, RT that sucks.....sorry about that...

Well according to my FC1 results High Eye pressure is not rare....i have never heard of it until i got to Brooks and had to do additional testing. Apparently i got a waiver for it and am go....i'd be VERY pissed if i got DQed for something not even relating to vision...BTW my vision is 20/15...so to be DQed would be very ironic

[Guest Dirt Beater]

They don't give ocular hypertension waivers for initial physicals, so your waiver must be for something else, caliice. Did your physical come back with the AETC/SG stamp that said "FC1 approved with waiver for etc etc"?

[Shut up 'n color]

Yes...there is a stamp talkin' about a wavier for some medical condition I really dont understand, but maybe it's not ocular hypertension....something about increased disc to cup ratio...either way i had to go for extra Eye pressure tests while @ Brooks...so i assumed the waiver was for that.

[Guest Taehun]

I'm a cadet right now going through my grad physicals and was just told that my eye pressure is at 23 mmHg. Apparently if you don't have it at 21 or under, it DQs you for a class I flight physical. I'm going back to the clinic in a few days to be retested because I had my pupils dilated at the time for other tests, and the doc said that sometimes this can throw the numbers off. Does anyone have any experience with this and know what I should do?

I don't know if this matters at all, but as an added note my vision is completely fine otherwise...

[ 06. September 2005, 22:47: Message edited by: Taehun ]

[Guest Dirt Beater]

My roommate had the exact same issue. It was only AFTER the fact that he figured out that a huge factor was his water intake. One or 2 days before the test, drink as little as you can without really feeling sick and that should bring your numbers down.

[Mike Honcho]

This hit me as well. I'd reccomend RIGHT NOW, before the next exam, go get checked by an opthalmologist (eye doc with an M.D.) that you trust for the bottom line.

Having your eyes dilated will increase your IOP. So will multiple tests. The puff test isn't the best way to test pressure, you need something called applanation tonometry, where they touch a piece to your eye and measure it - that's dumbed down, but you get the picture.

This almost cost me my flight physical and entry into OTS. Don't think it's something like being 2lbs overweight, they wanted to DQ me based on this. If you need more info, PM me.

[Guest Dirt Beater]

JR, how did you end up testing within the limits?

[Mike Honcho]

When he tested me the first time, my eyes were dilated with that cycloplegic ungodly-last-for-3-days crap they use during flight physicals. When it was a couple of points high, he performed the puff test 3-4 more times. THEN he figured out my corneas are thicker than normal, which gives a false positive on the test.

After all that, he did a test called applanation tonometry, which is the gold standard. Of course it was high too.

All these things (dilation, multiple tests) will raise pressures, and by the time he did the good test, it was way high.

I went to a civillian opthalmologist for a full workup, thinking I had glaucoma, and got the rundown, which is that I'm fine.

Of course it threw some light on the situation when the doc doing the original tests told me that if I was winged already he'd just give me drops to lower the pressure and it wouldn't be a big deal at all... :rolleyes:

[ 08. September 2005, 16:17: Message edited by: JReyn ]

[Guest ericvano]

I had this happen too. I had the puff test the first few times and I got way high IOP readings, fortunately they let me retest a couple times, and passed, but the flight doc still wanted the applanation done. For my own peace of mind, I went to a personal eye doc and had the applanation tonometry done and was well within the limits. When I had the applanation done by the opthomologist on base again, I was also within limits. Try to relax your eye as much as possible, hard to do do, but it makes a difference in the readings.

[Guest chinezero]

Trying to figure out how to get around this. I got DQ'd from Brooks for OHT but have gone to Docs and they are telling me that I don't have OHT and all pressures in my eyes are completely normal. I can't get help from Brooks, Can't get AETC to do anything because they say talk to Brooks and Brooks says talk to AETC; Been told I need to see a Flight Doc(which I'm "trying" to do, but I'm not on "flying status" so it seems a act of congress) in order to get his/her sign off on it and do an Exception to Policy someplace in my whole "call them no call them circle". Anyone with a Clear concise answer to this? And the proper method to go around getting this reconsidered/looked into.

Thanks.

[Guest MizzNav]

Thread Revival!

I had my FC1A supplemental yesterday, It was just all eye tests. I had gone through this already for my comissioning physical but i crept up again. In the puff machine, my pressures were 23 and 24, but i went to a eye doc back home at my own expense and he found my corneas were thicker than normal and my eye pressures were 18 and 19. I have already given them a letter from the doc ststing i am not a candidate for glacoma. What alse should i give them for my waiver? I have to go back next tuesday for a field of vision test as well.

Should i be worried?

Sorry if the spelling is bad, i can't really read very well yet (less that 16 hours since dialation)