Air Factor Denied

[wongerz]

Anyone have any experience regarding air factor medicals? CFEME denied me since my pre-op refractive error was -6.75 and -5.75. I underwent lasik surgery last year but apparently my pre-op prescription exceeds -8.00 so they won't grant me my air factor. They also apparently don't do appeals either so am I just unlucky to have bad eyes from the past. I have 20/20 vision currently so I don't understand why the medical standard is so high when I have perfect vision with no complications for the past year since surgery. It's just frustrating when that is the only thing stopping me from entering the competition list since my aircrew/reliability status are already completed and I had spent a year and a half waiting to enter my preferred trade. My medical section said there's no way to contact or appeal to the CFEME compared to the RMO so I guess I'm just curious why they are so strict with air factor.

 

[dimsum]

Anyone have any experience regarding air factor medicals? CFEME denied me since my pre-op refractive error was -6.75 and -5.75. I underwent lasik surgery last year but apparently my pre-op prescription exceeds -8.00 so they won't grant me my air factor. They also apparently don't do appeals either so am I just unlucky to have bad eyes from the past. I have 20/20 vision currently so I don't understand why the medical standard is so high when I have perfect vision with no complications for the past year since surgery. It's just frustrating when that is the only thing stopping me from entering the competition list since my aircrew/reliability status are already completed and I had spent a year and a half waiting to enter my preferred trade. My medical section said there's no way to contact or appeal to the CFEME compared to the RMO so I guess I'm just curious why they are so strict with air factor.

I’m not in the medical side but perhaps the stresses of flying does something to your eyes, even with laser surgery.

Having no ill effects on the ground doesn’t mean they might not happen in the air.

 

[ModlrMike]

LASIK is essentially ablation of the corneal tissue. The amount of material vaporized when the refractive error approaches 7.00 diopters is substantial, and the cornea is correspondingly much thinner than it would be with a more mild correction. Flying, and diving require one is exposed to extremes of atmospheric pressure. A ruptured eyeball would not be a good thing.

 

[Blackadder1916]

Anyone have any experience regarding air factor medicals? CFEME denied me since my pre-op refractive error was -6.75 and -5.75. I underwent lasik surgery last year but apparently my pre-op prescription exceeds -8.00 so they won't grant me my air factor. They also apparently don't do appeals either so am I just unlucky to have bad eyes from the past. I have 20/20 vision currently so I don't understand why the medical standard is so high when I have perfect vision with no complications for the past year since surgery. It's just frustrating when that is the only thing stopping me from entering the competition list since my aircrew/reliability status are already completed and I had spent a year and a half waiting to enter my preferred trade. My medical section said there's no way to contact or appeal to the CFEME compared to the RMO so I guess I'm just curious why they are so strict with air factor.

Whether or not "luck" has any bearing on your life is a personal conclusion, but as to whether or not you would have any grounds on which to appeal this, probably not. In most cases of individuals appealing decisions to the RMO their argument is often based on differing opinions of specialists as to the history, diagnosis and/or outcome of an applicant's particular medical condition. In your case, your vision (pre-refractive surgery) was measured; the medical/vision standard required for CAF aircrew is clearly stated. You do not meet that standard.

AMA DIRECTIVE 400-02
LASER REFRACTIVE SURGERY FOR CAF AIRCREW

https://divsurg.afod-pofa.com/DIVSURG/APP/F/AMA/AMA400-02.pdf

17. Pre-Op Refractive Errors.
a. Aircrew candidates with a pre-op refractive error ≥- 6.00 diopters spherical equivalent must undergo a specific, dilated retinal assessment to assess for any underlying retinal pathology. The presence of any retinal pathology including lattice is disqualifying for aircrew selection with a pre-op SE ≥ - 6.00 diopters.
b. For Group A aircrew (Pilots, Search and Rescue Technicians and Aerospace Controllers), the pre-op refractive error must not exceed -8.00 diopters or +3.00 diopters spherical equivalent
c. For other aircrew, the maximum per-op myopic error may exceed -8.00 diopters but there must be no evidence of retinal pathology. The maximum hyeropic limit is +5.00 diopters SE.
d. Civilian aircrew candidates must provide their pre-op refractions when applying for CAF enrolment by completing DND2778 – Refractive Surgery- Information for Recruitment

And the requirement is similarly listed in Aircrew Medical Standards.
AMA DIRECTIVE 100-01
MEDICAL STANDARDS FOR CAF AIRCREW

https://aerospacemedicine.ca/AMA100-01.pdf

 

[wongerz]

Whether or not "luck" has any bearing on your life is a personal conclusion, but as to whether or not you would have any grounds on which to appeal this, probably not. In most cases of individuals appealing decisions to the RMO their argument is often based on differing opinions of specialists as to the history, diagnosis and/or outcome of an applicant's particular medical condition. In your case, your vision (pre-refractive surgery) was measured; the medical/vision standard required for CAF aircrew is clearly stated. You do not meet that standard.

AMA DIRECTIVE 400-02
LASER REFRACTIVE SURGERY FOR CAF AIRCREW

https://divsurg.afod-pofa.com/DIVSURG/APP/F/AMA/AMA400-02.pdf

And the requirement is similarly listed in Aircrew Medical Standards.
AMA DIRECTIVE 100-01
MEDICAL STANDARDS FOR CAF AIRCREW

https://aerospacemedicine.ca/AMA100-01.pdf

Thank you for the resource. I do have retinal pathology in my one eye so reference 17a. My pre-op 6.75 would be too high since SE would need to be under -6.00 hence why I got denied. I just wanted to confirm that since my med tech said that my combined refractive error of both eyes can't exceed -8.00 which I didn't quite understand since I have a friend who is currently a pilot who had -6.00 in both eyes before laser surgery. I might email my medical section but if I get surgery to remove that pathology, that would let me meet the standards. Since without retinal pathology, the standard would only be -8.00 for my preferred trade (17b) Would my CFRC let me send another air factor medical or am I just barred from ever having it regardless of what I do? I know I'm best asking my CFRC but just wanted some opinions.

 

[Good2Golf]

LASIK is essentially ablation of the corneal tissue. The amount of material vaporized when the refractive error approaches 7.00 diopters is substantial, and the cornea is correspondingly much thinner than it would be with a more mild correction. Flying, and diving require one is exposed to extremes of atmospheric pressure. A ruptured eyeball would not be a good thing.

If time in the chamber simulating explosive decompression in a pressurized aircraft is anything to go by, a thin cornea rupturing would be pretty undesirable…almost as much as having prime rib and the bloomin’ onion at Tony Roma’s the night before the chamber ride…

 

[Blackadder1916]

Thank you for the resource. I do have retinal pathology in my one eye so reference 17a. My pre-op 6.75 would be too high since SE would need to be under -6.00 hence why I got denied. I just wanted to confirm that since my med tech said that my combined refractive error of both eyes can't exceed -8.00 which I didn't quite understand since I have a friend who is currently a pilot who had -6.00 in both eyes before laser surgery. I might email my medical section but if I get surgery to remove that pathology, that would let me meet the standards. Since without retinal pathology, the standard would only be -8.00 for my preferred trade (17b) Would my CFRC let me send another air factor medical or am I just barred from ever having it regardless of what I do? I know I'm best asking my CFRC but just wanted some opinions.

Firstly, you have no idea what they are talking about in those directives. The "-8.00" is "Spherical Equivalent". (Spherical Equivalent SE= ½ cylinder + sphere). On an optical prescription "sphere" is the first number, "cylinder" is the second number.



My assumption is that your pre-op "-6.75" is the sphere of your right eye (o.d.), to exceed an SE of -8.00 the cylinder was probably -3.00 (i.e., -3.00/2 + -6.75 = -8.25). Using an example of the same cylinder for your "pilot friend", -3.00/2 + -6.00 = -7.50.

 

[Blackadder1916]

. . . I do have retinal pathology in my one eye so reference . . . I might email my medical section but if I get surgery to remove that pathology, that would let me meet the standards. Since without retinal pathology, the standard would only be -8.00 for my preferred trade (17b) Would my CFRC let me send another air factor medical or am I just barred from ever having it regardless of what I do? I know I'm best asking my CFRC but just wanted some opinions.

. . .

Regarding my eyes, I have epiretinal membrane in one eye which is supposedly rare for my age as I am currently 23. This condition usually occurs in people older than 50 due to the vitreous pulling away and stretching the retina causing scarring. I am unsure why I have it but it has no impact on me. I had lasik done . . .

The usual procedure for surgical removal of epiretinal membrane (or any surgical repair of the retina) is by "vitrectomy"

While it's been 40 years since I had direct involvement (as a medic) with enrolment medicals or ophthalmology patients, my personal experience with vitrectomy has been more recent.

My doctor forbade me from visiting this website.

Well, actually, he recommended that I stop all computer use. He also restricted sexual intercourse, so eliminating computer use also eliminated one form of that activity. Maybe it was true that doing it too much can make you go blind. I also was not to drive, fly or make a change in altitude (2000 ft either up or down). Reading was out, so was texting or playing video games. While watching television was allowed (as long as the screen was a minimum of five feet away), having to maintain a "face down position" made that activity a little difficult. So I was limited mostly to listening to the radio or TV for the past two weeks.

To be honest the doc wasn't being mean, he had my health in mind so there was a good reason to avoid what (like for many on these means) is usually a daily activity - visiting this site - often multiple times during the day. Well, after a two week absence I'm back.

I woke up one morning a little over two weeks ago and on opening my eyes there were a significant amount of "floaters" in my left eye which were soon followed by a black haze over the whole vision. Visits to my family doctor and then to Emerg soon followed and then to the Eye Clinic at the hospital. Luckily they determined that that it wasn't a retinal detachment (yet) but that a tear was likely. The extent of the damage couldn't be determined due to the amount of blood that blocked visualization of the damaged area of the retina. That also limited the effectiveness of treating it with laser. So after a couple of days of waiting and visiting the clinic to see if the blood had cleared enough to see the damage (it hadn't), I was booked for surgery.

That was a long day. I was admitted early in the morning and since my procedure was tentatvely booked to fit around his already scheduled surgeries (he had a full day) I was the last one of the day. I probably entered the OR shortly before 1800 and they were finished a little after 1830. As I was being readied to be wheeled out the retinal surgeon and anaethestist were chatting about another case that had come in and were wondering if they could fit him in before calling it a day. I finally got home around 2030 hrs.

Yes, I was awake for the surgery. It's done under a local - an eye block. They do offer sedation (I declined), but the anaesthesist did say that he doesn't like giving enough that it puts someone asleep - snoring can cause movement and individuals could suddenly wake up mid procedure in a panic and move. Movement when the sugeon is inside your eye ball with instruments is contraindicated . While the non-affected eye is draped and you can't see what's going on in the OR, I was able to see in silhouette the procedure going on inside my eyeball. It was interesting watching the cutter-aspirator cleaning out the debris, the laser repairing the tear and the air bubble being injected (the bubble functions as a sort of pressure dressing on the retina).

Other than the frustration of needing the surgery (and the potential for other vision problems resulting from this) it was interesting to get a look at the improvements in opthalmic surgery in the 35+ years since my time at NDMC when the ward I worked on dealt with eye surgeries.

In the two weeks since the surgery, I've had to follow the restrictions outlined above. It takes a long time for eyes to heal. While I'm now allowed back on the computer and can start reading again, it'll be another couple of weeks before I can do any heavy (more than 5 to 10 lbs) lifting and it may be two months post surgery before any strenuous activity (i.e. contact sports, etc) is recommended. I still have to wear an eye shield taped over the eye when I sleep, and will probably continue doing so for another week or two. I also have a higher potential for cataracts in that eye needing surgery in the near future.

Oh, the "air bubble" and "face down position". The positioning is required to keep the bubble centred and against the affected area of the retina. It's like having a spirit (carpenter's) level in your eye. Movement of the bubble becomes more noticeable as it shrinks (it is gradually absorbed and replaced by vitreous jelly); my bubble finally disappeared two days ago.

How did this happen? There was no blow or fall or external injury to the eye. Apparently, as we age (but I still don't think of myself as an old guy) the jelly in the eye shrinks and contracts. When part of the jelly that is in contact with the retina contracts, it can tear the retina causing bleeding. If not treated that injury can lead to detachment (a much, more serous problem). I still have a couple of small floaters in the left eye - it's difficult to remove all debris from the eye unless one sucks it completely dry. Was there anything that could be done to prevent it? I don't know, haven't found any preventive protocols but I would suggest that regular routine exams by an optometrist (glasses wearing pers would normally be covered for every two years) may identify developing problems that could be treated rather simply by laser instead of surgery. It had been several years since I've been to the eye doctor, my glasses prescription didn't need updating. I'll now be making that visit a more routine activity.

Not having been on the site for the last two weeks, I missed the discussion on some interesting events in the world.

One of the most common sequelae of vitrectomy is cataracts.

The Post Vitrectomy Cataract - PMC

To review the recent literature regarding risk factors for cataract formation after vitrectomy, the challenges and management strategies for anterior segment surgeons when facing post-vitrectomy cataract surgery, and the visual outcomes of patients ...

pmc.ncbi.nlm.nih.gov

. . . It is estimated that within one year of vitrectomy, as many as 52% of patients will undergo cataract surgery while 80% of patients will develop a visually significant cataract within two years. . . .

From the med stds directive linked above, other disqualifiers.

4.6 Lens:
a. Aphakia;
b. Opacities of the lens that interfere with vision or are considered progressive are evaluated on a case-by-case basis;
c. Lens dislocation, partial or complete; and,
d. Intraocular implants or intraocular contact lenses.

That means cataracts or the IOL implanted to correct the vision.

You're grasping at straws if you think by one more surgery, you'll get to end up in a cockpit.