Phorias (eso, exo, hyper)

[Guest sauceyj5]

Hey Docs or anyone else who can help, I was awarded a pilot slot for the active duty, but just found out from the the people who gave me my F1C down at Edwards that I have exoporia which is supposed to be a divergence of my eyes at near vision. Now I'm not at all knowlegable in areas of vision problems because I've never had any, but I just don't want to give up on my dream without a fight. Is there anything at all that I can do or do just have to accept the inevitable. Your responses will be greatly appreciated. :confused:

[Guest F16PilotMD]

AFI48-123 says:

A7.8.2.2. Exophoria greater than 6 prism diopters is disqualifying

I can find nothing about waivers. I would talk to the flight surgeon/clinic that did your physical to find out the specifics of your exam.

[Guest sauceyj5]

Thanks Doc, from the research I've done, it seems that exophoria can be treated and corrected with therapy. Can you tell me if this is a condition that disqualifies me for good, or just until I can bring it within regs?

[Guest F16PilotMD]

I think the only therapy that will allow you to pass the test is surgery. I can't find any guidance on that. If you can correct this with non-surgical therapy, have at it. Good luck.

[Guest pilotsingerole]

The AFI says that over 6 prism dioptres of exophoria is DQ (beyond that needs waiver). I have 4 dioptres at far via the OVT machine and with prisms placed in front of my turning eye. However, my near is at about 10 - 12 dioptres. That is at about 12 inches from my face (ball on end of stick test). I was never given a waiver for this and I am wondering if the near exophoria is not what is important on an FC-1, but only the far exophoria. That the regs are saying under 6 dioptres of far exo not near.

I would assume that the closer you get to the face (i.e 12 inches as opposed to 20 feet) the harder it is to converge the eyes for people like myself. Therefor it is assumed that near phorias will be more extreme, and what is really important are phorias at distance. Please, anyone in the "know?"

I have no tropias and pass all depth and suppression tests. Just trying to understand what is considered more important and why I didn't need a waiver.

[Guest P27:17]

Technically you should need a waiver...but truth be told there is more emphasis placed on distant phorias. DQ's for excessive near phorias are rare and usually associated with other disease processes.

[Guest iloveflying333]

Does the OVT test phorias (eso,exo,hyper) seperately than the depth preception test, or is it assumed that if you can pass the depth preception test, your phorias are within the limits? Also, does everyone have to do the red lens test or just those that fail a part of the OVT?

Thanks!

[Guest pilotsingerole]

I assume you are talking about the FC-1 or 1a???

EVERYONE needs to take the Red Lense Test. The RLT tests for phorias and tropias (but it's really tropias that they want to find...phorias are rarely a DQ unless they are abnormally large/deviant).

The OVT does test for phorias as well...but more correctly, the OVT quantifies and phoria present. I.E. The OVT will give a rough idea of the amount of prism deviation there is (in all gazes - eso, exo, and hyper).

The AF regulations allow up to 6 prism diopters exo, 8pd eso, and 1pd hyper (not certain about the last one). That is all at distance...near phrorias are not as much of a concern as they are so common. That's for pilot (FC-1), for FC-1a it is a little bit more relaxed. In any event, I have heard from AF doctors that even with a phoria over those limits, it is a high chance for a waiver and often they don't even bother with a waiver, they just pass you and overlook it.

Hope that helps!

[Guest weaponsloader]

The AFI says that over 6 prism dioptres of exophoria is DQ (beyond that needs waiver). I have 4 dioptres at far via the OVT machine and with prisms placed in front of my turning eye. However, my near is at about 10 - 12 dioptres. That is at about 12 inches from my face (ball on end of stick test). I was never given a waiver for this and I am wondering if the near exophoria is not what is important on an FC-1, but only the far exophoria. That the regs are saying under 6 dioptres of far exo not near.

I would assume that the closer you get to the face (i.e 12 inches as opposed to 20 feet) the harder it is to converge the eyes for people like myself. Therefor it is assumed that near phorias will be more extreme, and what is really important are phorias at distance. Please, anyone in the "know?"

I have no tropias and pass all depth and suppression tests. Just trying to understand what is considered more important and why I didn't need a waiver.

I have a similar problem. I didnt pass the row of lines with the arrow pointing to it. So I had to go back to OPT and get a more advanced test done. The outcome was I scored a 6 on far vision and a 10 at near. Now my Force health is telling me I need to be evaluated by the othamologist because my 10 DQs me. Im so lost on what the rules are. What AFI does flight medicine follow to conduct my FC1? Do I have a good shot to still get my IFC1 approved? It really seems like my flight Medicine is not very competent.

[Guest awfltdoc]

I have a similar problem. I didnt pass the row of lines with the arrow pointing to it. So I had to go back to OPT and get a more advanced test done. The outcome was I scored a 6 on far vision and a 10 at near. Now my Force health is telling me I need to be evaluated by the othamologist because my 10 DQs me. Im so lost on what the rules are. What AFI does flight medicine follow to conduct my FC1? Do I have a good shot to still get my IFC1 approved? It really seems like my flight Medicine is not very competent.

AFI48-123V3 5 JUNE 2006 45

A4.9.2. Flying Class I, IA, II, II-Flight Surgeons, Inflight Refuelers and any other individuals required to perform scanner duties. If any of these are exceeded, then paragraph A4.12.2.1. applies.

NOTE: For the purposes of this AFI, scanner duties are defined by the requirement to assist with safety clearance checks of their aircraft from outside obstacles.

A4.9.2.1. Esophoria greater than 10 prism diopters, at near or distance.

A4.9.2.2. Exophoria greater than 6 prism diopters, at near or distance.

A4.9.2.3. Hyperphoria greater than 1.5 prism diopters, at near or distance.

A4.9.2.4. Heterotropia, including microtropias, at near or distance.

And here is A4.12.2.1. only cause I know someones gonna ask what it says (I don't think your question applies to A4.12.2.1.).

A4.12.2.1. Initial Flying Class III, AFSC Specific requirement. 1A0, 1A1, 1A2 (if they fail, they become AC-130 gunship loadmasters only), 1A7 (if they fail, they go to fixed wing only) all require depth perception. AFSCs 1A3, 1A4, 1A5, 1A6, 1A8, 1T2, 1C1 do not require depth perception.

[Guest P27:17]

I have a similar problem. I didnt pass the row of lines with the arrow pointing to it. So I had to go back to OPT and get a more advanced test done. The outcome was I scored a 6 on far vision and a 10 at near. Now my Force health is telling me I need to be evaluated by the othamologist because my 10 DQs me. Im so lost on what the rules are. What AFI does flight medicine follow to conduct my FC1? Do I have a good shot to still get my IFC1 approved? It really seems like my flight Medicine is not very competent.

Here is an answer from an "expert" in the field (not me)...take it for what it's worth.

"The regs are 6 prism diopters of exophoria near and far and 10 prism diopters of eso near and far. Does it make sense to have the same limits for near and far? No. But, bottom line is that I've never seen a hard DQ for phorias unless they were causing problems with depth perception or if the individual was having difficulty compensating and they were periodically going tropic / seeing diplopia."

[POKESC17]

So here is my story. Rated guy who is getting a lot of headaches, (going on several years and getting worse). Finally caved in and went to the doc. After talking with the doc he sent me to Optometry. After doing the prerequisite exam and reviewing my records he noticed something about a slight lazy eye in a previous exam. After playing with the little black stick for awhile he asked me some very pointed questions. Do you read with you head tilted, is your head tilted in photos, do you see double when tired. Answer to all the questions is yes. He suspects Vertical Phoria and I undergo about another 3 hours of various tests. His analysis is vertical phoria with a left gaze diopter of 16 and a straight and right gaze diopter of 8. He also discovers (and I can't believe I never noticed this) that I see double any time I look any father left than about 75 degrees and farther back. Of course I was immediately DNIF'd. I was told that the waiver process was being started but I was being recommended to be sent to Brooks to the folks over at ACS. After doing some initial research I see a waiver as being highly unlikely. I know it can be corrected with prism'd glass and even surgery (what I'm expecting since mine seems so severe). My question is what are the chances of me remaining on flying status if i have to undergo the type of surgery it seems I will need. Any input or additional information by those a little more knowledge than myself would be greatly appreciated.

Poke

[delivery onethirty]

Need some help from any docs or any one who can help on this subject.

Just went to Wright-Patt last week for an FC1 exam and was medically disqualified. All went well with the physical until I got to the optometrist. After completing the evaluation and work up, the doctor told me I have an excessive Esophoria at 16 diopters of deviation. At that point, he told me I was disqualified with no waiver that will be submitted. The optometrist told me my only avenue now is a congressional waiver which might be very hard to get since I am outside of regulations and acceptable standards. I did well on all other eye tests such as depth perception, red lens test, visual acuity and cycloplegic refraction. To my knowledge, this was the only issue I had during the eye exam in regards to ocular motility. I've set up an appointment with an optometrist next week to get a second opinion and possible consultation for surgery. I read that surgery is disqualifying, but may be considered for waiver given that you pass all eye tests. I'm definitely contemplating surgery but not sure if it is worth it or what risks are involved with the surgery.

I am a non-prior guy joining the Guard, slated to fly C-130's. I was just given OTS and UPT dates a few weeks ago.

[deaddebate]

That level of esophoria is too high for any waiver potential.  Surgical correction is possible but a waiver would then be needed for that surgery.  So your essentially switching from a condition with no waiver chance to a surgery and a waiver with little chance.

I personally think it's not worth getting a surgery that you probably don't need for your civilian life and probably won't get approved/waiver to become a flyer.  Talk to a civilian optometrist, and weigh your options.

[scascopes]

Hello Everybody,

I recently went to WP for an IFC1 as an OTS Civilian Hire for an AFR heavy Unit.

The ophthalmologist diagnosed me with an exophoria outside of the waiverable standards. I was told not to "change any plans" but it seemed that they were preparing me for a DQ or to get an ETP Waiver.

After consulting with the flight doc at the end of the week, I was informed that they would put in a waiver for my exophoria, as a I passed depth perception and every other portion of the IFC1. They seemed rather reluctant telling me the situation, even though I had heard from the ophthalmologist prior that it was outside of standard waiver guidelines.

This leaves me questioning the possibility of "exophoria outside of standard" being waived. I can't seem to find any information about this outside a few anecdotes posted on here in different threads.

One thing I regret from this is that I didn't ask either the ophthalmologist or FD how many diopters my misalignment was.

I understand that it's rather unlikely for the waiver to get approved by AETC but wondering if anybody had a similar experience or any flight docs have seen any similar circumstances that were either denied or approved.

Anyways, thank you in advance for any gouge or advice!

[stuckindayton]

23 hours ago, scascopes said:

Hello Everybody,

I recently went to WP for an IFC1 as an OTS Civilian Hire for an AFR heavy Unit.

The ophthalmologist diagnosed me with an exophoria outside of the waiverable standards. I was told not to "change any plans" but it seemed that they were preparing me for a DQ or to get an ETP Waiver.

After consulting with the flight doc at the end of the week, I was informed that they would put in a waiver for my exophoria, as a I passed depth perception and every other portion of the IFC1. They seemed rather reluctant telling me the situation, even though I had heard from the ophthalmologist prior that it was outside of standard waiver guidelines.

This leaves me questioning the possibility of "exophoria outside of standard" being waived. I can't seem to find any information about this outside a few anecdotes posted on here in different threads.

One thing I regret from this is that I didn't ask either the ophthalmologist or FD how many diopters my misalignment was.

I understand that it's rather unlikely for the waiver to get approved by AETC but wondering if anybody had a similar experience or any flight docs have seen any similar circumstances that were either denied or approved.

Anyways, thank you in advance for any gouge or advice!

As I'm sure the docs at WP explained, the concern with a phoria is that it may become symptomatic and result in headaches, blurred vision, double vision, etc.  Being tired and hypoxic only adds to this risk.

I don't know how they are doing things these days (it sounds like a lot has changed in the five years since I left), but when I was at WP we would do a bunch of tests involved in looking at how well the eyes work together and the amount of effort the person has to exert to overcome their phoria.  If we felt comfortable it wasn't going to be an issue years down the road we'd recommend a waiver and vice-versa.  Does any of this sound familiar?

The fact that you are going to a known airframe that happens to be multi-crew is in your favor since you are not in sole control of the aircraft at all times.  Beyond that, I really don't know the waiver climate right now.  However, historically, waivers for phorias did happen and it wasn't all that rare.

Good luck.

Steve

[scascopes]

1 hour ago, stuckindayton said:

As I'm sure the docs at WP explained, the concern with a phoria is that it may become symptomatic and result in headaches, blurred vision, double vision, etc.  Being tired and hypoxic only adds to this risk.

I don't know how they are doing things these days (it sounds like a lot has changed in the five years since I left), but when I was at WP we would do a bunch of tests involved in looking at how well the eyes work together and the amount of effort the person has to exert to overcome their phoria.  If we felt comfortable it wasn't going to be an issue years down the road we'd recommend a waiver and vice-versa.  Does any of this sound familiar?

The fact that you are going to a known airframe that happens to be multi-crew is in your favor since you are not in sole control of the aircraft at all times.  Beyond that, I really don't know the waiver climate right now.  However, historically, waivers for phorias did happen and it wasn't all that rare.

Good luck.

Steve

Thanks for the response doc!

That sounds pretty similar and they did go through with the waiver so I feel as though I have a chance, even if it’s not as easy to get as some waivers. 

The ophthalmologist did say if it I were to be approved that I’d have to be apart of a focus group (or something similar) to track my condition.

I just really hope it doesn’t get to the point of having to try and go for a medical ETP.

Thanks again!