LASIK (General Discussion) [Archive]

waterpau

5th May 2006, 11:43

Interesting question.

I can't answer it, but some encouraging news is that in April 2006 the UK's National Institute for Clinical Excellence issued guidelines for laser treatment through the NHS, effectively endorsing laser treatment as effective and safe (bar the normal surgical risk)... http://www.nice.org.uk/download.aspx?o=308514

I'll be writing to the CAA to point this out. It will be interesting to see whether they push at the next meeting of the medical sub-committes for the 'pre-operative dioptre limit' restriction to be lifted...

I'm not holding my breath, though...

waterpau

Gnirren

5th May 2006, 13:00

My AME looked it up in sweden, it's not against regulations to do it but the method has to be approved by the aviation authorities and one year after the procedure you have to get evaluated by an aviation approved eye examiner. If you get the green light you retain your medical, otherwise no more flying. This also means as I understand it that from the time you have lasic to the examination one year later you're not allowed to fly which basically means you'd have to quit your job while waiting.

I'd say stick with glasses.

femaleWannabe

5th May 2006, 14:26

slightly off topic but has anyone tried orthokeratology? You wear gas permeable contact lenses during the night which reshape your cornea, meaning you can see without lenses/glasses the next day.

I don't know what the CAA think of this, but some opticians seem to be marketing it towards pilots/people who need good stable vision and sports players who find contacts get in the way.

All sounds too good to be true I think, but I might ask my optometrist next time I go!

waterpau

5th May 2006, 14:31

Glasses / contact lenses obviously work for most people, but if the level of correction is beyond the limits, even though your sight may correct to 6/6, you won't acheive class 1.

This is potentially where the value of laser treatment lies: It is possible to correct your underlying vision and therefore meet acuity standard, without the levels of correction which previously prevented your eyes meeting the standards.

The CAA currently accepts certain methods for laser treatments, but on the proviso that if they're to give you a class 1, the pre-operative correction must've been within limits. This makes laser treatment useless for acheiving class 1 if you couldn't do so before your operation.

With any luck, NICE's acceptance of laser treatment as an effective and safe alternative to spectacles and contact lenses should put pressure on the CAA to lobby for removal of the pre-operative limit requirement. If there are no long term adverse effects of treatment, it's difficult to justify holding your previous correction levels against you.

Having said that, the grounding for one year is pretty onerous and could deter those that are already flying; I suppose it depends whether your career is at risk due to deteriorating sight.

waterpau

waterpau

5th May 2006, 14:36

female wannabe,

Would be interesting to hear the opinion of your optometrist. I've got an Ortho-K consultation booked for next week, but as you say, it all depends on the authorities... :bored: At the risk of sounding cynical, I can only guess that the CAA's response will be negative given that Ortho-K is relatively new...

waterpau

Fair_Weather_Flyer

5th May 2006, 17:12

I had LASIK in 2000 and the UK CAA certified me as fit for a Class 1 medical in 2002. I am a professional pilot so if you press the right buttons with the CAA, LASIK is acceptable.

niknak

5th May 2006, 23:53

As Fairweather says, the CAA require a minimum of one year between laser treatment and issuing a Class one medical certificate.
My understanding is that the reason for this is to allow for any adverse reaction which may occur, their research has concluded that there is no "normal" recovery afterwards i.e. everyone is different in that respect.
In this world of "sue at a drop of hat", you can hardly blame them for wanting to be absolutely sure.

To put it bluntly, if you pay £2 - £3K for the treatment, expect a year off work.

AlexEvans

6th May 2006, 05:58

The CAA currently accepts certain methods for laser treatments, but on the proviso that if they're to give you a class 1, the pre-operative correction must've been within limits. This makes laser treatment useless for acheiving class 1 if you couldn't do so before your operation.
waterpau
This is an over simplification because it is possible to gain a class 1 after having LASIK that you could not have achieved with galsses alone if the reason you can not get a class 1 is due to astigmatism.

Also niknak - are you sure it takes a year after LASIK to get your class 1 issued? I was under the impression it was 3 months.

waterpau

6th May 2006, 08:08

AlexEvans

The guidance on refractive surgery states that "the certification limits of eye correction with glasses and the limits of refraction before surgery are the same (+/- 5 diopteres) so it is not possible to gain a medical certificate by having refractive surgery, that you would not have obtained by wearing glasses".

Your point about astigmatism is interesting (astigmatism is what is stopping me from getting a class 1). I've never discussed this with the CAA, and it doesn't actually mention astigmatic correction in any of the guidance. Have you had experience of this, and know that you can correct astigmatism with LASIK and obtain a class 1?

The same guidance states that class 1 will not be considered until three months after LASIK, and one after other types of operation.
http://www.caa.co.uk/docs/49/SRG_MED_JAR_C1_Initial_Visual_Stds.pdf

waterpau

AlexEvans

6th May 2006, 08:20

Yeah, I'm sure about this. I've seen those guidence notes before and I remember thinking that they should re-write that part because it is misleading.

I've been to see gatwick AMD and I have it in writing that should I will get a class 1 after LASIK if it goes ok. My astigmatism is -3.5 which is .5 over the renewal limit and 1.5 over the initial limit.

Hope that helps - I think you should speak to Gatwick AMD.

Get LOTS of qualified advice before having refractive surgery and don't expect the CAA to encourage you.

I hope this is good news and good luck.

Fair_Weather_Flyer

6th May 2006, 09:09

My astigmatism was about the same as yours alex i.e. above the limits. They still let me in. It took time and patience though. It was the only way I had any chance of obtaining the Class 1.

AlexEvans

6th May 2006, 09:35

Please tell me more! :)

Did you have refractive surgery or did you just persist? If the latter, it's very interesting to me... Did prior experience sway their decision? I was advised that because my astigmatism in my left eye is beyond renewal limits they would not be able to bend the rules.

Please elaborate.

AlexEvans

6th May 2006, 09:38

Ah - I see from your post above that you did have refractive surgery. How long did your eyes take to stabilise, were there any complications and how long after everything settled down did it take for them to issue your medical?

waterpau

6th May 2006, 09:40

Thanks chaps, that's really encouraging news. My astigmatism in one eye has varied over the last few years between 2.5 and 4 (not entirely sure why). The retinoscopy I had yesterday at the Institute of Optometry gave 2.5, and I only discovered recently about the restricted class 1 with a limit of 3.

If I have no joy with the restricted class 1 (I guess the wide variation won't help my case), then I will definitely re-consider LASIK now that I know the CAA accept correction for astigmatism.

Thanks for your advice AlexEvans - you might have just made my weekend!

waterpau

Fair_Weather_Flyer

6th May 2006, 09:49

The eyes were stable pretty much straight away. I never had any complications of any kind and I have been free of corrective lenses for six years now.

How to sway the CAA? I can't be 100% sure. First up if you ask them prior to surgery if they will certify you the answer will probably be no, but you should try anyway. I had the surgery and obatined an FAA Class 1. This entailed getting my surgeon to fill in the appropriate FAA form. This meant that I was able to send the CAA an official surgeons report to the CAA in a format which was relevant to aviation. They invited me along to Gatwick and after some deliberation they agreed to give me the Class 1. This is a very abreviated version of what happened and it wasn't all smooth. Still, I'm living proof that the CAA can be swayed. Have the procedure fully documented, with all your notes and perscriptions prior to LASIK and that will help your case.

Oh, by the way, the only experience that I had before I obatined the Class 1 was glider time. I'm still in my twenties as well.

waterpau

6th May 2006, 12:47

Thanks for sharing that Fair_Weather. Sounds like it was hard work, but very encouraging...

waterpau

Briza

6th May 2006, 23:27

I just would like to point out that the legislation even in the JAA states is NOT always the same. I will give you an example:
The German JAR-FCL 3 'Medicals' is supposedly writting i.a.w. the JAR 3 regulations. Even in the foreword it states 'This is a translation of the original ...'
But if you have a closer look (no pun intended :) at the EYE section, you would find that most eye surgerys are EXCLUDED from being approved! Currently in Germany you can get only have an excemption permit after a PRK Laser treatment - one year after the surgery - of course :)
So if we have any ppl from outside the UK, just beware to check the facts in your country once more.
All the best,
~b

waterpau

12th May 2006, 09:58

If it helps anybody, I visited the institute of Optometry this morning for a consultation for Ortho-K.

I might be stating what has already been said elsewhere, but it seems that it is only suitable for those with asigmatic and myopic errors. Because the cornea is flattened, it is not suitable for those with hyperopia.

I've hyperopia and astigmatism; if I were to pursue a course of Ortho-K, my long-sightedness would become more acute. I pushed the consultant to see if they would treat the astigmatic component, as it's this that is stopping me getting a class 1; a side-effect of this woud be to increase my long-sightedness, meaning I would need to continue to wear spectacles during the day to correct this. However, she advised against this as, although she would anticipate that my long-sightedness would still be within limits, natural variation in the treatment may push it beyond the initial class 1 limits, thus rendering the treatment pointless.

She wasn't aware of whether the CAA issue class 1 medicals to individuals who use Ortho-K. Also given the flattening of the cornea, it would be obvious to any examiner so you would have to disclose the fact that you had attemped to treat your eyesight. The rule about all lenses being removed would not in itself prevent you from correcting to the standards, as if the lenses are used over a period of time, the flattening of the the cornea can be maintained for considerable periods of time.

Strictly speaking, Ortho-K is only designed to treat those with astigmatism upto -1.5D and short-sightedness upto -4.5D. Although errors may be reduced for errors beyond this, total correction is not usually possible. These are within the limits required for a CAA class 1, so anybody who is actually suitable for Ortho-K will probably already be able to a gain a class 1... :ugh:

waterpau

bebe188

13th May 2006, 07:42

AlexEvans

13th May 2006, 10:05

Thanks for that. I was curious about those lenses myself.

Is it back to plan A (LASIK) for you now?

I've booked (yet another) LASIK consultation for June 12th, with surgery sure to follow soon after. I know the surgeon will treat me in this case because he has already examined my eyes. I'll let you know how I get on.

AlexEvans

13th May 2006, 10:09

I'm no expert, but I have personal experience in this area.

If I HAD to answer yes/no I would answer 'yes', but it really isn't as simple as that.

You should read the 'why no lasik in aviation' thread (towards the bottom) and look at the 'vision other than colour vision' thread on page 2 for lots of relevant information.

AlexEvans

14th May 2006, 00:25

YES or NO :confused:

I learned yesterday that LASIK is accepted only if your astigmatism level, before this procedure, was less than the allowed by ICAO :D .
:8 Isn't it a bit ( i don't want to use the words stupid, idiotic....) weird?

Hi. Can you explain exactly what you mean by this please? How many dioptres of astigmatism are allowed pre-LASIK? Thanks.

Jimmy The Big Greek

14th May 2006, 09:28

bebe188 you are wrong.

I am pretty sure that the maximum pre op value is 5 diopters of astigmatism.

Fair_Weather_Flyer

14th May 2006, 14:17

The way it's supposed to work is that if your astigmaitism, pre-surgery was outside of Class 1 limits (3.0D) they would not grant you a medical post surgery. Simple............except that in my case I was outside of the pre-surgery limits and after much head scratching they let me in anyway. It's a leap of faith. First you have to have the surgery and THEN convince them you are fit.

waterpau

14th May 2006, 17:27

Is it back to plan A (LASIK) for you now?

We'll have to wait and see. The only thing holding me back is the astigmatism in my left eye. In August 2005 it was measured at -3.25D, but a couple of weeks ago it was down to -2.5D. It seems as though I'm back within the limits for a deviated class 1, but I gather that to get one of those your eyes need to have been fairly stable for the last three years. I've gleaned this from pprune, not the CAA. I'm waiting for a response as to whether they would consider me for a deviation, but I can only guess that they won't be happy with a 0.75D swing in 9 months. The optometrist couldn't explain the large swing, but he checked and double checked and the current prescription is definitely correct...

If that's no good, then I will consider options with LASIK.

Alexevans - would be good to hear how you get on, both with the surgery (if you definitely go for it) and the CAA...

waterpau

AlR

22nd May 2006, 23:40

I started Ortho-K in 1974. CRT in 2004. Both work great for me and allowed me to drop FAA waiver and get Class One Med. Each has it's limitations, but was an advantage when considering Glasses. I'm researching Lasik in the States and finding quite a few Pro-Pilots who have successfully returned to work after Lasik. Not quite ready to go for it yet. But soon.

TwinAisle

19th Jun 2006, 13:43

Something about laser surgery which may or may not be true....

My optician (who I appreciate has a vested interest in these things) made the following point. He said that most people get longer sighted as they get older, and the typical eyesight deficiency in the young is short sightedness. He suggested that what laser surgery does is "move the datum" point. That is, in my case, my worst eyetest gave me -1.5 in both eyes, when I was 22. I'm now 38, and have hit -1.0 in both eyes, and he expects me to be at zero by about 44, then I drift off into the long sightedness of old age, and I should get (worst case) to about +2 by the time I push up the daisies. BUT - if I had had my eyesight lasered to zero when I was at -1.5, my worst case would have been 1.5+2=3.5 - rather worse....

As I say, he is an optician, and has a vested interest in keeping me in contact lenses and solutions for the foreseeable future. But an interesting viewpoint (scuse the pun) anyway.

Lou Scannon

25th Jun 2006, 16:43

I have just been for assessment and I have the procedure next month. Interestingly, as I have good near sight but my long sight is downgraded by myopia and astigmatism, they will just zap my right eye. That way my left will take charge for reading and my right for distant work.

When I tried it with a corrective lens on the right eye it seemed to work just fine.:8

PhilM

26th Jun 2006, 06:00

Lou, one thing to watch when having one eye zapped if your are wanting to obtain or retain a Class1 medical is the prescription between both eyes must be relativly balanced! (Within 2D if i recall?)

I have had sucessful LASIK, and today my prescription stands at -0.5D in both eyes, however only one retains enough corneal thickness for an enhancement to be possible, I have decided against that for now anyway, as it would unbalance my eyes and may mess up my chances of Class1 (if there are any!).

Something to think about....

Lou Scannon

26th Jun 2006, 11:34

Thanks PhilM, omitted to mention that my class one days are all behind me and the only thing I use the eyeballs for these days are excitements such as reading, television and driving.

I have decided to go ahead on the recent recommendations of NICE, an organisation that I have more than a passing acquaintance with.(There is a life after flying!).

Assuming that I can still see the screen clearly I will report back at the end of July!

L'aviateur

8th Jul 2006, 20:57

Roger Willco

9th Jul 2006, 23:46

would like to know if is dangerous for the eye that had sufered a LASIK procedure to perform aerobatic flying (someone told me something about the corneal flap and thikness)
Do you know someone that had lasik and fly aerobatics??
Is Better not to operate and fly with glases or contants??
In your opinion which one is the best method..
THANKS:confused: :confused: :confused:

kluge

12th Jul 2006, 04:26

Yes - I've had LASIK and still fly aerobatics - although not as regular as I used to as I'm living in a non GA freindly country at present. So far no problems.

However 12 years ago when I was flying hard aerobatics (+6 -4) type stuff I did suffer an injury by flying outside loops. Basically I burst a blood vessel in my right eye. Up shot was I was grounded for about six weeks. Vision came back fully but I have lost around 10% peripheral vision in right eye. When tired I see a small arc from 10 to 11 o'clock which I am told is scarring from the damage. This was approx 9 yrs before LASIK - my vision then was about -ve 1.25 in both eyes corrected with contacts

AMD also recommended no more -ve g and go easy on the +ve. Bang went the competition career. Thus I now fly gentleman's aerobatics - much more graceful and at one with the energy. aahhh.

Eye specialist told me that burst retinal blood vessels was the most common incident in bungee jumping. Another reason not to do such zero survivability option stuff.

Would recommend you give it at least six months after LASIK before aeros. However that's my opinion and not based on any medical advice.

K

AlexEvans

17th Jul 2006, 10:17

For people who are already well within limits and already have a Class One but wish to take laser surgery simply to remove the need for spectacles or contact lenses, does anybody know the procedure with the CAA? How long you will lose your medical for? Whether you can get a Class 2 in the meantime?
Has anyone done this?

Any advice appreciated;

Hi. I believe for initial issue of a class 1 you need to wait 3 months after the procedure before attending aviation house. Not sure about class 2 or what the policy is for exisiting holders of either, you'll have to ask them.

If you are within the limits already and especially if you're already making your living from flying IMO you'd be mad to risk having LASIK because there are significant risks. 1 in 20 chance of permanent corneal haze = will never fly again in the pointy end. There are other risks too such as infection. Are you sure you are prepared to take the risk?

I'd only ever consider LASIK if it was the only way to become within the limits, not for aesthetic reasons.

kelle

18th Jul 2006, 12:43

For people who are already well within limits and already have a Class One but wish to take laser surgery simply to remove the need for spectacles or contact lenses, does anybody know the procedure with the CAA? How long you will lose your medical for? Whether you can get a Class 2 in the meantime?
Has anyone done this?

Any advice appreciated;

Hello L'aviateur,

I don't know the exact procedure with the CAA, but I can tell you how
the procedure works in Germany at the LBA. I'm in the same situation as you, I've a Class one, I'm well within the limits, but I consider to have a Lasik to remove the need for glasses. In Germany, you're unfit for minimal 6 months. In GB, I think, it's 3 months.
You can find a lot of Lasik on the CAA page www.caa.co.uk (http://www.caa.co.uk).
Simply type in Lasik in the search field on the top of the right side.
Look at CAA Paper 2001/4, Point 9 "Conclusions": "...PRK and Lasik appear
to be safe for use in commercial aviation, ... ."
At my medical, the eye specialist told me, in general it's no problem to
recertificate you, when an experienced doctor with modern equipment performs the surgery.