Lattice degeneration

[Guest barshira]

I would like to become a fighter pilot but I have lattice degeneration.

I wander whether I can get a waiver for that problem?

Can you direct me to an appropriate reference?

Thank You

[Guest doctidy]

try this link

https://www.brooks.af.mil/web/consult_servi...egeneration.htm

[Guest apilot3]

My eye doctor told me that I had a tiny thin spot on my right retina (eye). It is on the far upper right side. I read the forum about lattice degeneration - I think this is what it is called. Hopefully one of the military MD's will see this. I am getting my information from here

Is having one thin spot on the upper right side of my right eye waiverable? I am getting my prk surgery in 3 days to correct my vision. With the prk my eyes will fall within the -5.50 pre-prk limit(-4.50). Just to make sure I am doing the right thing.. help me out.

I have read/researched a lot.. but I just need positive answer.

To add to that.. is there anything I should know about; time frame, ect. I should be aware of when applying for the waiver for the thin spot. I know that the prk is 12 months from day of operations + all the other conditions.

GO TIGERS

[ 21. October 2006, 23:03: Message edited by: apilot3 ]

[Guest P27:17]

What I was able to find out is:

"Regarding the lattice (which indeed is thinning of the retina), PRK should not exacerbate the condition nor change the waiverability.

Currently, lattice is disqualifying but waiverable if there are no associated tears, holes, or other high risk features that make a retinal detachment more likely. A single spot of lattice on its own is more than likely waiverable."

Now, once you get PRK, you must wait at least 3 months before getting an IFC 1 exam (any where but Brooks City-Base). If your IFC 1 is scheduled for Brooks or you only need the MFS, you must wait 1 year after PRK surgery before going. Make sure you get all the appropriate follow-ups. Once everything is said and done, you are looking at needing 2 waivers (as it stands right now) PRK and Lattice degeneration.

[Guest apilot3]

For the thin spot... do you konw what would make the lattice more high risk than others? locations maybe? There are no holes, or tears, but I was reading on other threads where people did have holes, and they got a waiver? maybe not. Do you know anything about that? Would that thin spot limit me on medical to which type of aircraft I am allowed to fly?

[ 23. October 2006, 10:50: Message edited by: apilot3 ]

[Guest P27:17]

I'm not sure of the stats for holes vs. thinning. I don't think LD, if waived, would limit you from certain aircraft...anything is possible...but here is the insight on "risks"...

"Retinal tears, sub-retinal fluid, or vitreous traction are high risk features. A tear is different than a hole as tears are more likely to lead to a detachment while a hole is typically stable. Thinning without other features (holes, tears, etc) is likely waiverable. There is also the issue about the area affected by lattice. You can have a small patch of lattice and it may not be a big concern. You can also have lattice throughout the peripheral retina that would be more significant."

[Guest apilot3]

I just spoke with my optmologist, and she said that it was a very slight thin dot on the far far (farthest) area up, on my retina. She said this is the outer most part of my vision, and isn't "thatt" significant. It is not large, and is only the one dot. It is not on the macula. She said, that if I went to the retinal specialist that if he/she felt it was necessary (probably not) that they could use a laser. She said I wouldn't be affected either way. I'm not going to do that.. cause I think there was a forum about retinal scars or something.. and that's a dq. I guess i'll let the flight surgeon decide what to do with it. Thanks for your help, definity feel better now. Thanks!

lattice = thinning. GOT IT! and I only have one tiny dot. I leaned that from here!!!

[Guest doctidy]

apilot3 -

You're on track. If you really want to be a pilot, get the PRK. Talk to the eye doc about contrast sensitivity and haze. Tell him preventing those complications is important. Ask if he uses steroid drops to prevent those complications. If he doesn't or won't consider it...talk to somene else.

You are gonna get ONE shot at this...make it count.

[Guest tempL]

Hello,

I am in the process of getting PRK and just had my first exams done by the ophthalmologist. He looked at both my eyes and said one eye had slight Lattice Degeneration and the other had a little de-pigmentation (sp). My understanding is that I would be possible to receive a waiver for LD (my diopters are -2.75 and -2.00 and I show no holes or tears with slight sliver of LD); however I am unsure about the little lack of pigment that he spoke of? Can anyone (Rage haha) help out?

On another note, this isn't the first time that a doctor has said something about my retina having something on it. However, this is the first time LD was mentioned. Before, I have had doctor's mention that I had tiny scar on my retina (in the same eye as the new doc found LD). It is my understanding that LD and a retinal scar isn't the same thing? Could my doc be misdiagnosing this? Should I receive a second opinion?

Thank you gentlemen!

[Guest goducks]

Hello,

I am in the process of getting PRK and just had my first exams done by the ophthalmologist. He looked at both my eyes and said one eye had slight Lattice Degeneration and the other had a little de-pigmentation (sp). My understanding is that I would be possible to receive a waiver for LD (my diopters are -2.75 and -2.00 and I show no holes or tears with slight sliver of LD); however I am unsure about the little lack of pigment that he spoke of? Can anyone (Rage haha) help out?

On another note, this isn't the first time that a doctor has said something about my retina having something on it. However, this is the first time LD was mentioned. Before, I have had doctor's mention that I had tiny scar on my retina (in the same eye as the new doc found LD). It is my understanding that LD and a retinal scar isn't the same thing? Could my doc be misdiagnosing this? Should I receive a second opinion?

Thank you gentlemen!

TempL,

Some retinal pathologies can occasionally be difficult to classify and some docs may use a different name for the same thing. Regardless, lattice is disqualifying but waiverable if there are no "high risk" characteristics that may make you prone to developing a retinal tear or detachment in the future. "High risk", by USAF standards, essentially means that the lattice is limited to no more than a couple of clock hours (e.g. lattice covering 1/4 of your retina would be equivalent to 3 clock hours), there is no fluid under the retina, there is no evidence of traction (or tension) on the retina, and your pre-op PRK refractive error is no more than -5.50. If your doc mentioned the LD in passing without indicating concern about it, it's probably not a big deal, but you could ask them to give you more detail regarding the USAF criteria and the potential for a full blown retinal detachment down the road. As far as the pigment goes, the doc could either mean that the LD is lacking pigment or he/she could mean that you have loss of pigment somewhere else on the retina. Pigment in association with LD means that the LD has been present for a while and is usually an indication of stability, however not having pigment with LD is not considered a risky finding either. De-pigmentation of the retina not associated with LD is a rather normal finding. It's no different than de-pigmented spots on your skin.

Some people may consider lattice a scar, especially in the presence of pigment. However, most eye docs don't use the term "scar" to mean lattice. Scars on the retina are not uncommon and 99% of the time they mean nothing.

Bottom line is that if the doc didn't seem particularly concerned about the LD then you're probably OK for a waiver, but I must caution you that LD is an area that is not fully clear cut. Essentially it comes down to the interpretation of how much risk there is for future tearing or detaching. I wouldn't really recommend a second opinion as your eyes are what they are. As you may find from other posts, when it comes to waivers the AF listens to its own docs on how to proceed.

Finally (and you didn't ask this, but I think it bears mentioning) having PRK will not have any impact on your waiverability for lattice. The waiver criteria is the same whether you have PRK or not.

Not exactly a yes/no answer, but it's the best answer I can give.

Cheers and good luck.

[Guest tempL]

Goducks,

I appreciate the well thought out response, that does help greatly. I do have one more question though. My doc did tell me to "let him know" if LD is waiverable or not for pilots. Would it be beneficial for me if he "left out" or failed to mention his finding of LD? Not to say he is purposely altering my records, but ya know.. just leave it up the gentlemen at brooks to find it down the road..Or on the other hand, do flight docs consider any recommendation/notes in my record at all?

Thank you again man

edit: spelling

Edited October 24, 2008 by tempL

[Guest goducks]

Goducks,

I appreciate the well thought out response, that does help greatly. I do have one more question though. My doc did tell me to "let him know" if LD is waiverable or not for pilots. Would it be beneficial for me if he "left out" or failed to mention his finding of LD? Not to say he is purposely altering my records, but ya know.. just leave it up the gentlemen at brooks to find it down the road..Or on the other hand, do flight docs consider any recommendation/notes in my record at all?

Thank you again man

edit: spelling

Ironically, this is one case where having documentation of a condition is in your favor. Anytime something like lattice is previously documented then it gives some evidence of stability. So full documentation is in your favor. The docs at Brooks aren't likely to miss it.

Any recommendation by your doc is not going to be given much consideration. Not to say your doc isn't highly competent- it's just the way the AF does business.

FYI- lattice is present in 5-10% of all eyeballs, although some more obvious than others.

[Guest FockeWulf]

I'm a recent college graduate and student pilot, working on completing my PPL before applying to the Air Force. I was somewhat myopic, -5.25 and -4.50, before receiving LASEK and having a successful outcome. Before surgery, however, my ophthalmologist noted that a retina specialist should take a look at my eye, as there was an area on the retina to keep an eye on. I've had optometrist's notice the same thing in the past, so I can be reasonably certain that this is a stable condition.

Last week the retina specialist told me that I had lattice degeneration in both eyes. He didn't mention the coverage area, but stated that it did not require any treatment and he recommended a yearly checkup. I called this afternoon for more information and the nurse told me my chart stated that there were atrophic holes present.

I was able to find an Air Force Waiver Guide online, dated August 2009, by Dr. Dan Van Syoc. The conditions that must be met in order for FC I/IA to receive a waiver are Lattice Degeneration in eyes with less than -5.50 diopters (check), and no untreated atrophic holes outside areas of lattice.

I was wondering, after I get a second opinion from another specialist, if I should receive treatment for these atrophic holes. Would such treatment then enable me to receive a waiver based on what the guide appears to be stating, or will the presence of atrophic holes totally disqualify me and make me entirely ineligible for a waiver? The doctor told me that things looked stable and he was not concerned that I would have any sort of retina tear at this time, but the waiver guide seems to be clear regarding the atrophic holes. I'd hate to see my dreams go up in smoke after all this, but I'm starting to worry that they have. I went through LASEK (which I know is waiverable), and have been working on getting the PPL, all with the goal of getting an aviation contract. Dangit all if that was all for nothing.

I also wasn't certain if the waiver guide pertained to new accessions or only current pilots. If anyone knows if waivers are available to individuals prior to UPT I'd be grateful to know.

Thanks in advance for any information anyone can provide.

Edited July 19, 2010 by FockeWulf

[Guest goducks]

I'm a recent college graduate and student pilot, working on completing my PPL before applying to the Air Force. I was somewhat myopic, -5.25 and -4.50, before receiving LASEK and having a successful outcome. Before surgery, however, my ophthalmologist noted that a retina specialist should take a look at my eye, as there was an area on the retina to keep an eye on. I've had optometrist's notice the same thing in the past, so I can be reasonably certain that this is a stable condition.

Last week the retina specialist told me that I had lattice degeneration in both eyes. He didn't mention the coverage area, but stated that it did not require any treatment and he recommended a yearly checkup. I called this afternoon for more information and the nurse told me my chart stated that there were atrophic holes present.

I was able to find an Air Force Waiver Guide online, dated August 2009, by Dr. Dan Van Syoc. The conditions that must be met in order for FC I/IA to receive a waiver are Lattice Degeneration in eyes with less than -5.50 diopters (check), and no untreated atrophic holes outside areas of lattice.

I was wondering, after I get a second opinion from another specialist, if I should receive treatment for these atrophic holes. Would such treatment then enable me to receive a waiver based on what the guide appears to be stating, or will the presence of atrophic holes totally disqualify me and make me entirely ineligible for a waiver? The doctor told me that things looked stable and he was not concerned that I would have any sort of retina tear at this time, but the waiver guide seems to be clear regarding the atrophic holes. I'd hate to see my dreams go up in smoke after all this, but I'm starting to worry that they have. I went through LASEK (which I know is waiverable), and have been working on getting the PPL, all with the goal of getting an aviation contract. Dangit all if that was all for nothing.

I also wasn't certain if the waiver guide pertained to new accessions or only current pilots. If anyone knows if waivers are available to individuals prior to UPT I'd be grateful to know.

Thanks in advance for any information anyone can provide.

It sounds like you need to find out where the holes are. If they're within the area of lattice and deemed to be low risk (no traction, sub-retinal fluid) then you should be fine. If not, then treatment is probably required. I can't recall ever seeing an FCI who was previously lasered for retinal holes, but my gut feeling is that if all the holes were successfully treated, you'd likely be eligible for a waiver.

Regarding waivers pre-UPT...that is what FCI (Flying Class I) refers to. FCIA are navigator trainees. FCII are trained pilots and flight surgeons and FCIII are other aircrew. So, yes you can get a waiver as an FCI.

FWIW- odds are very good that the holes are within the lattice. That's the most common presentation, especially for someone who was previously near-sighted.

[Guest FockeWulf]

It sounds like you need to find out where the holes are. If they're within the area of lattice and deemed to be low risk (no traction, sub-retinal fluid) then you should be fine. If not, then treatment is probably required. I can't recall ever seeing an FCI who was previously lasered for retinal holes, but my gut feeling is that if all the holes were successfully treated, you'd likely be eligible for a waiver.

Regarding waivers pre-UPT...that is what FCI (Flying Class I) refers to. FCIA are navigator trainees. FCII are trained pilots and flight surgeons and FCIII are other aircrew. So, yes you can get a waiver as an FCI.

FWIW- odds are very good that the holes are within the lattice. That's the most common presentation, especially for someone who was previously near-sighted.

Thanks Goducks, I really appreciate it. If I recall correctly, I think I heard the doc mention there was no sub-retinal fluid in passing. That's good. I'll followup again and see where the holes were located. Glad to hear I've got a shot, very heartening.

[Guest Jakemaican]

Great topic and answers! Been reading on here a lot and finally joined since I have tons of questions.

Does macular degeneration and lattice degeneration refer to the same condition? Experienced an impact injury to one eye from an airbag deployment, it put one tiny hole in the retina. Miraculously after a few months of healing vision went from 20/200 back to 20/20 negative in the injured eye, the hole has also closed. Have a glasses prescription for the left eye, never wear them since I've tested 20/20 on my FAA medical and don't have a corrective lens restriction on it. The eye doc says he can't see the hole whatsoever, there's no scarring, other eye is 20/20 uncorrected and eye pressure in both is normal. The doc has said several times it's as if nothing ever happened from what he sees looking at it. Go for checkups still and go through a pretty intense retinal exam and every time I'm told it looks normal. Just curious on an AF docs take on this.

Thanks!

Jake

[Guest goducks]

Great topic and answers! Been reading on here a lot and finally joined since I have tons of questions.

Does macular degeneration and lattice degeneration refer to the same condition? Experienced an impact injury to one eye from an airbag deployment, it put one tiny hole in the retina. Miraculously after a few months of healing vision went from 20/200 back to 20/20 negative in the injured eye, the hole has also closed. Have a glasses prescription for the left eye, never wear them since I've tested 20/20 on my FAA medical and don't have a corrective lens restriction on it. The eye doc says he can't see the hole whatsoever, there's no scarring, other eye is 20/20 uncorrected and eye pressure in both is normal. The doc has said several times it's as if nothing ever happened from what he sees looking at it. Go for checkups still and go through a pretty intense retinal exam and every time I'm told it looks normal. Just curious on an AF docs take on this.

Thanks!

Jake

Lattice degeneration is a thinning of the peripheral retina that is often associated with being nearsighted. Macular degeneration is a condition of the central retina that is typically associated with aging changes. Based on your description it's hard to say what happened. One can get a macular hole and it will result in a visual acuity of around 20/200. They don't usually heal on their own, but I guess it could happen. You may have had commotio-retinae, which is inflammation of the retina often associated with direct trauma. It will often heal on its own.

Bottom line is that I don't think you've got anything to worry about at this point.