Merged Keratoconus thread

[GulfStreamV]

Nav1,

Found it! - Disregard above nonsense...

Keratoconus, also known as Conical Cornea, is a non-inflammatory condition of the cornea in which there is progressive central thinning of the cornea changing it from dome-shaped to cone-shaped. Keratoconus comes from the Greek word meaning Conical Cornea (Cone shaped- Cornea). The cornea is the clear windshield of the eye and is responsible for refracting most of the light coming into the eye. Therefore, abnormalities of the cornea can severely affect the way we see the world, including simple tasks such as: driving, watching TV, or reading a book.

Keratoconus is not a blinding disorder, per se, but does result in a greatly increasing near-sightedness (things far away are out of focus) and irregular astigmatism (things look tilted) that can significantly distort your vision.

It is almost always bilateral (affecting both eyes). It is a slowly progressive disorder, taking years to develop, and may halt at any stage from mild to severe.

Check out:-
http://www.kcenter.org/Keratoconus/what_is_keratoconus.html


Good luck

GV

[BadMan]

Be greeted fellow aviators.

You think bad vision is a problem, try this a year ago I had a corneal transplant and have been grounded since.19 december 1999 ! The doctors and the medical board keep inventing new excuses to keep me on the ground. After all if they say I should go and fly again and I wipe out a mountain it it is their danglies on the block. Is there any body with a similar problem or with any advice ?
By the way I am a Keratoconus sufferer for the last 9 years.

[Blindside]

4 & 5 year post op patients are now returning in worrying numbers to laser clinics across Europe and the US. One of the main areas of concern is corneal ectasia developing into keratoconus. Ther are many others such as the incidence of scleral and retinal detachments due to the high vacuums required for the micro-keratomes to cut the corneal flap.

My remarks are based on fact. Numerous papers have been presented on subjects such as these at national and international ophthalmological meetings.

The procedure is non-reversible and carries serious potential risks. This is my point. The decision to undergo refractive surgery should not be made lightly. Many patients have enjoyed tremendous results, but the long term effects are not thoroughly understood and do not let anybody tell you otherwise.

Best regards

[Rogaine addict]

Blindside: You do sound very knowledgable on the subject so I checked your profile, no occupation listed. Optometrist? opthamologist? I did pose the question of higher incidence of corneal extasia and keratokonus for LASIK/PRK patients vs. general public to the National Keratoconus Foundation (NKCF). I'll share their reply when I receive it. RA

[inverted flatspin]

Probably the best advice at the moment is to wait. A new proceedure is in development that will probably do away with most laser techniques. It is called corneaplasty and according to the Doc who is developing it, the final product will involve using eye drops to soften the cornea then a special hard contact lens to reshape the cornea and finally another set of eyedrops to return the cornea to its original firmness.

Here I have copied more detailed info.
What is Corneaplasty
Corneaplasty, is a non-surgical procedure that changes the shape of the cornea (the front part of the eye) using modern Ortho-K contact lenses as corneal molds, in conjunction with certain medications to prepare and final-set the cornea. This is a mechanico-chemical procedure.
Corneaplastytm is essentially a 3-step process. First, the cornea is “prepared” by applying a proprietary (ACS-005 enz) concentration of the human enzyme, hyaluronidase, which absorbs into the cornea, making it softer and more “malleable” for a period of time, says Hampar Karageozian, senior vice president of research and development at Advanced Corneal Systems. The drug temporarily alters the molecular bonds between proteoglycan molecules in the cornea. This enzyme has a long history of safe use in ophthalmic (eye-related) and other applications. Second, the “prepared” cornea is then molded to the desired shape with custom fitted AOK contact lenses worn during the treatment period. Thirdly, a proprietary cross-linking agent “fixative” drop is administered to “set” the cornea in its optimum shape. It effectively “glues” the collagen fibrils until they re-grout naturally.

Moreover, the procedure is reversible, i.e. it can return the cornea to its pre-altered state if desired; and, it (the cornea) is alterable indefinitely throughout life, so the procedure is repeatable. You can “fix,” “reverse” or “alter.” There is no ablation or cutting of tissue. There is only a bending of the cornea and a migration of corneal epithelium.

The term “Corneaplasty,” as determined by the U.S. Department Of Commerce Patent And Trademark Office, is merely a conjunction of the two descriptive words, “cornea” and “plasty.” Corneaplastytm (both REFRACTIVE CORNEAPLASTYtm and THERAPEUTIC CORNEAPLASTY), are marks sought after by the founding company, Advanced Corneal Systems, and are defined as follows:

REFRACTIVE CORNEAPLASTY: Goods and services to non-surgically change the deficient vision in a healthy eye by changing the shape of the cornea in individuals suffering from refractive error including myopia, hyperopia and astigmatism.

THERAPEUTIC CORNEAPLASTY: Goods and services to non-surgically change the shape of a damaged or diseased eye in individuals suffering from optic diseases such as ocular herpes, keratoconus, or extreme astigmatism resulting from corneal transplant surgery or cataract surgery.

The Attorney for the Trademark Trial and Appeal Board (T.T.A.B.) contends that the word “refractive” is a descriptive adjective that refers to correcting refractive errors of the human cornea. The applicant’s (ACS, Inc.) “pharmaceutical preparations” have a refractive purpose, because they are used to correct refractive errors of the eyes. So, for now, we have a new non-surgical category of refractive correction, know as “corneaplastytm,” which may or may not undergo a future semantic change.

The Procedure:

This is the probable case scenario.

The treatment period lasts approximately 2 weeks with 5–7 patient visits.

Day 0: Patient examined, then trial fit with AOK lenses, then enzyme administered and patient sent home.

Day 1-3, or when cornea is prepared: Patient returns and lenses are dispensed. This procedure will most likely be a Nightwear, End Result Ortho-k (NERO, a term coined by Roger Tabb, O.D.) or worn daytime and removed at night. Expect 4-5 diopters change from 8 hours to a few days. 1-3 diopters can change in a matter of hours.

Day 4-10: Stabilizing drops or gel is administered by the patient QID (4 times a day) in conjunction with a custom contact lens retainer.

Day 11-14: D/C stabilizing drops and lenses when stroma is altered and “set” to new desired contour.

Since the procedure deals with altering the stroma, greater degrees of refractive change are possible, as compared to Ortho-K, which only deals with about a 50 micron layer of epithelium.

The procedure can apparently be repeated, if necessary, throughout one's lifetime of refractive changes, without any damage done to the cornea. The tissue is said to remain pristine, as the hyaluronidase only temporarily alters proteoglycen bonds between the lamellae to soften the tissue, and does not actually affect the collagen lamellae themselves.

Who started Corneaplastytm?
Corneaplastytm is the brainchild of Advanced Corneal Systems (renamed ISTA Pharmaceuticals, Inc. in July 2000), Irvine, CA 92618; (949) 788-6000; (949) 788-6010 fax., the proprietary company seeking patents and marks initiated circa 1994. Introduced to the international community, circa 1995, lectures by Ortho-K pioneers such as Don Harris, OD, Charles May, OD and Stuart Grant, OD, presented materials and unpublished information at UAB and NERF conferences. At that time, mathematical functions for corneal molding, including tear layer plots, design comparisons, and computational methods were also discussed by such notable optometrists as Jim Day, Roger Tabb, the Roger Kame, and Joe Barr.

Where Is The FDA Investigational Status?
In the off-shore clinical trials that started in January 1994, phase I and II have been completed in 1997 and 1998 and yielded exceptionally good results. Expected in the first quarter of 2000, large scale clinical studies will enter 3rd phase in US and so far, right on track. Optimum lens design as well as dose/response studies are ongoing. A new stabilizing agent has been added to the trials that dramatically shorten the time from months to weeks to stabilize the cornea after it has been reshaped. Reducing the recovery time should also limit noncompliance.

When Will Corneaplastytm Be Available?
The large pharmaceutical company, Sandoz, is helping Advanced Corneal Systems, through the FDA clinicals. They expect approval (from what I have been led to believe) within a year or two. They are also working on an alternative drug delivery systems such as a "needle patch," to try and keep this procedure totally within the scope of optometry.

Why is Corneaplasty So Significant?
Extremely low complication rate, especially when compared to refractive Surgery. Corneaplasty is a Non invasive, non-surgical, procedure. The cornea is never cut and no tissue is ablated. There is no pain, no risk of infection, haze, starbursts, double vision, glare, ghosting, etc. associated with laser or other refractive surgeries. Anthony B. Nesburn, MD, director of Ophthalmology Research Laboratories at Ceders-Sinai Medical Center and clinical professor of ophthalmology, Jules Stein Eye Institute, University of California, states, “The beauty of this technique is that Bowman’s layer remains intact.” His studies indicated that the collagen fibrils themselves are untouched, just the substance that holds them together is affected. Nesburn added that the clarity of the cornea is unchanged pre- to post-treatment.

An additional noteworthy benefit is that the new corneal surface is more pristine than ever before. That is to say that the corneal molding smoothes out the natural anatomical undulations found on the cornea and facilitates an improvement in VA to 20/10ths (i.e. two lines better than 20/20) in some cases. The treatment zone with Corneaplasty is bigger and better than LASIK.

How Much Will This Procedure Cost?

The cost for this procedure is significantly less that LASIK and PRK because there are no laser, facility or royalty costs. However, just like all new procedures, the cost will be in line with what the free market allows. It will probably range from $750.00 to $1,250.00 per eye to begin with, roughly half the cost of LASIK. Enhancements and further alterations will carry modified fee schedules.

The major deterrent to LASIK is both cost and fear related. Corneaplasty is safe, effective and relatively inexpensive. It is destined to become more main stream than the invasive surgeries existing now. As it becomes more commodity-like and delivered in a more ubiquitous fashion, costs will seek a lower level.

[gas_man]

don't rub your eyes too much ..it could distort the cornea and distort vision by causing a condition called keratoconus.

[gas_man]

in myopia , your eye balls is longer than usual so things are out of focus. but mypoia is generally stable .
keratoconus is weakeness of the cornea of the eye ..and the cornea being thin bulges and becomes irregular. ...the cornea is the clear window that you see outermost in the eye...... or rather , becoz it is transparent ..you don't see !
the problem with keratoconus is that it may progress. it behaves differently in people . in most in progresses and then stops ...but in some it goes on progressing.
many can be corected with contact lenses , but some will need a corneal transplant.

you can join some of these friendly email discussion groups dealing with keratoconus:

http://groups.yahoo.com/group/keratoconics/


or send an email to these friendly and focussed groups .... each dealing with an specific aspect of keratoconus ...

[email protected]

[email protected]

[email protected]

[gas_man]

if you have keratoconus ....some places to visit ....



http://groups.yahoo.com/group/keratoconics/


or send an email to these friendly and focussed email discusion groups .... each dealing with an specific aspect of keratoconus ...

[email protected]

[email protected]

[email protected]

[Oscar Xray]

I know this has come up before, but the search did not come up with anything conclusive.

Basically I have today been told that I have a mild form of Keratoconus in my left eye, which can be corrected by wearing contact lens. Can anyone please shed any light as to how this will affect my current medical 1 status.

Your help and advice will be appreciated

ox

[Buster the Bear]

gas_man, did you get your licence back.

I am an ATCO that needs this treatment following 13 years of keratoconus.

[Ka8 Flyer]

Hi there!

Is there a chance to pass the medical with this eye disorder? (FAA or even JAA)?

[benwizz]

I found this on the CAA website,

The proposed changes are that:

Refractive error limits for class 1 initials – will become +5 to –6 dioptres.

Refractive error limits for class 2 initials – will become +5 to –8 dioptres.

Near esophoria limit for class 1 initials - will become 8 dioptres.

Keratoconus for all classes - will no longer be disqualifying for initial class 1 if the applicant meets the visual acuity requirements. Additionally at revalidation/renewal the frequency of follow-up will be at the discretion of the AMS.

Visual field defect for all classes – applicants may be considered fit if the binocular field is normal.

Ambylopia - The visual acuity in the other non-amblyopic eye should be 6/6 with or without correction. (Previously the 6/6 acuity had to be achieved without correction)

http://www.caa.co.uk/default.aspx?categoryid=49&pagetype=90&pageid=4764

Yet to be approved I presume but a step in the right direction :cool:

[Gearup06]

I am in my late 20's and fly for a major U.S. airline. I recently was diagnosed with mild-advanced Keratoconus. I was fitted for RGP (Gas Permeable) contacts, but could not tolerate those when duty days were between 10 - 15 hours. I opted to have whats called the intacs procedure and my vision although not a whole lot better has improved and now I am able to wear soft contact lenses. This condition is rare and it happens to 1 out of every 2000 people. Just curious to see if any one else is in this elite club, and would like to share their thoughts.

[The Jolly Roger]

Hello all,

I am 26 years of age and an Air Traffic Controller. I have keratoconus in both eyes for the past 7 years approx. I don't wear correcting lenses and the condition is relatively stable. I am wondering if there is anyone out there who has this condition and is either a pilot or controller. I would be very interested to know your experience with medicals etc.

Many thanks

[The Jolly Roger]

Hi all,

I am 27 years of age...an air traffic controller and have keratoconus for the past 7 years. I don't wear correcting lenses, however, i do have my medical at the end of the month and may be asked to get some!! I am waiting to go to Germany for Crosslinking treatment to stop the progression. I am desperately trying to find someone who has this eye condition so as I can get their experience of it as eithera controller or pilot.

Many thanks

[Blues&twos]

I had keratoconus - successfully treated, although that was back in the early eighties. I have PM'd you.

(PS: I'm not a controller or a qualified pilot - although I've had some lessons recently - but it's quite a rare condition, so you might not find anyone with it who is...)

[SebastianRys]

Hello, I also have been suffering from keratoconus and I am a pilot. I pretty much have given up on flying because I could only get 20/25 to20/30 in my left eye. I also am desperately seeking advice as far as what can I do to have this condition under control. I just have had the C3R treatment (collagen crosslinking) done about 4 months ago. I was also fitted with RGP lenses about a few days ago and my right eye was just fine with 20/20, even reading most of the letters from the 20/15 line. But my left eye just will not give up. The best result that I am currently able to achieve is 20/25 in my left eye and that’s with missing a few letters. Could you also PM me or email me at [email protected] ([email protected]) as far as what can I do to get 20/20 in each eye. THANKS a BUNCH

[papang]

Hello, I am a pilot and I also have been suffering from keratoconus. I wear a correcting lense on my right eye althought I usually don't wear it because I wear it with difficulty. What is the C3R treatment ? Does it give good results ? Is this treatment allowed by a civil aviation authority ?
I intend to convert my ICAO commercial licence into JAR licence (British CAA). Did someone experience a class 1 medical check in CAA with a keratoconus ?

Many thanks

[bluesfan]

Hello Everyone:

I have recently been diagnosed with Keratoconus so you are certainly not alone guys! I have discussed the possibility of undergoing collagen cross-linking (C3-R) with my ophthalmologist. After doing a full set examinations, she thinks that I could be a very good candidate for this treatment especially as the corneas in both of my eyes still have enough thickness. I am in real need of feedback from those of you who have had this treatment and/or recommendations for a specialist in cross-linking who I can go to. As I am pressed for time (my health insurance expires soon) I would appreciate feedback from anyone as I need to have the treatment done as soon as possible. Many thanks in advance!

[bluesfan]

Hello Everyone:

I have recently been diagnosed with Keratoconus so you are certainly not alone guys! I have discussed the possibility of undergoing collagen cross-linking (C3-R) with my ophthalmologist. After doing a full set examinations, she thinks that I could be a very good candidate for this treatment especially as the corneas in both of my eyes still have enough thickness. I am in real need of feedback from those of you who have had this treatment and/or recommendations for a specialist in cross-linking who I can go to. As I am pressed for time (my health insurance expires soon) I would appreciate feedback from anyone as I need to have the treatment done as soon as possible. Many thanks in advance!

[qnh78]

Hi,

I have diagnosed slight but stable Keratoconus (right eye) but have perfect vision with normal glasses. It is not even clear if it is Keratoconus but they assume so. I also have good vision without glasses. I have PPL(A) with NVFR and I'm active private pilot. I feel kind of frustrated as my vision is great but regulations say I can't have Med Class 1.

Have you guys heard any changes for this issue as it says in original post? I really would like to go through ATPL-scheme as I'm now 29 years old.

Will EASA ease these regulations? Anyone? Please, keep us updated.

Thank You!
-Qnh78

[bucks]

Hey all,

Does anyone else on here suffer from this ?

I have it in my left eye, im 26 and it doesnt effect me when using my both eyes, i have glasses but only use them on the computer and they give me normal vision in the effected eye.

My question, is it possible to get a commercial pilots licence with this condition ?

If its not possible with the JAA then how about the FAA ?

Idealy im looking for advice from pilots out there who also have this condition, as flying for a career has being my dream for years, i started training on fixed wing when i was 17 but stopped when i was 18 as i noticed a change in my left eye and was afraid of spending a fortune on training and then being told down the line that i couldnt fly anymore.

Any help would be great.

[Blues&twos]

I used to suffer from kc, fixed back in the eighties by corneal grafting, but there is another treatment these days - there was a thread about this a few months ago. I'll try to find it for you...

Edited to add link to previous thread:

http://www.pprune.org/forums/showthread.php?t=274613&highlight=keratoconus

In fact, use of the Search facility has turned up a surprising number of other kc threads/sufferers on PpRuNe, some with medical/licence issues...give it a try!

:ok:

[Howey]

Hi folks. Failed my medical there about four months ago after being diagnosed on the day with keratoconus. Real shock as I'm sure some will know. Could anyone who has had a similar experience shed light on any steps I could now take? I've been seeing an opthamologist, but that's still in the early stages. What's the consensus on how likely it is to pass an initial medical having previously failed one? All and any musings appreciated...

[bluesfan]

I just came across the following and I quote it from page 4 of Vol.42, No. 1 of the "Federal Air surgeon's medical Bulletin" issued by the US FAA. It's a bit dated as it goes back to 2004 but it indicates that it is possible for pilots with Keratoconus to continue flying provided certain requirements are met. Below is the relevant excerpt. If you want to read the whole thing you can go to:
http://www.faa.gov/library/reports/medical/fasmb/media/F2004_1.pdf


"The Aerospace Medical Certification
Division has also been in discussions
with the Medical Specialties Division in
Washington about the use of Orthokeratolgy
for correction of refractive error.
This procedure is already permitted for
the treatment of keratoconus in airmen
upon receipt of a favorable FAA Eye
Exam (Form 8500-7). The guidance is
as follows:
Orthokeratology is acceptable for medical
certification purposes, provided
the airman can demonstrate corrected
visual acuity in accordance with medical
standards defined in 14 CFR Part
67. When corrective contact lenses are
required to meet vision standards, the
medical certificate must have the appropriate
limitation annotated (MUST
WEAR CORRECTIVE LENSES).
Advise airmen that they must follow
the prescribed or proper use of orthokeratology
lenses to ensure compliance
with vision standards. Airmen should
think about how they wear their lenses
to modify their corneas in relation to
their flying habits so that their visual
acuity is within standards during the
time period of flight. Airmen should
also consider changes or extensions of
their work schedules when deciding on
orthokeratology retainer lens use.
Another inquiry since the last Bulletin
concerned the Crystalens, a model AT-45
accommodative intraocular lens (IOL).
Per the Ophthalmology Times, the lens affords
patients clear, uncorrected vision at
near, intermediate, and distance. Once
inserted, it was found that the ciliary
muscle allows it to adjust the vision.
The lens was approved in November
of 2003. Now that it is in wide use,
there have been some issues with glare.
Prior to accepting it for flying, we are
going to wait one year to evaluate the
secondary effects.
We also need to reiterate that the uses
of multifocal lenses, either as contacts or
as intraocular lenses, are unacceptable
at this time. They can cause glare and
halos at night, even requiring the use
of the unacceptable topical medication
Pilocarpine!
Now, let’s do some cases. Note, only
the Federal Air Surgeon or his designees,
the Regional Flight Surgeons, and the
Manager, Aerospace Medical Certification
Division, can authorize a waiver or
special issuance."

[qnh78]

Hi,

any news form anyone about EASA side? I'm looking forward to these liberalizations http://www.caa.co.uk/default.aspx?catid=49&pagetype=90&pageid=4764 speaking of Keratoconus.

Thanks!
-QNH78

[Casablanca85]

Hi,

I am really interested in working as a pilot!!!! Actually I am cabin crew in the Middlea East and I have a slight keratoconus whoch is treated with high gas permable rigid contact lenses! I do not have any problems and my prescription has not changed within the last 4 years after I was diagnosed with this condition! I fullfill the visula acuity standards and I understand in the CAA Homepag ethat Keratoconus will no longer be disqualifying if applicants meet the visual acuity!!! Who can help me by confirming this? I just checked the above link in the last posting!

Thank you and all the best for our eyes:-)))))

[mau mau]

Hello guys.... as my experience.... keratoconus is a little thin into cornea.
To identify it, is necessary a corneal topography as to identify any laser surgery as well.
At Gatwick they didn't use corneal topography when they've check my eyes and I didn't saw any equipment for this test.
So I think if you have a keratoconus they will never know it.

[bucks]

Whats the CASA stance on Keratoconus ?

I heard that once you can get 20/20 with glasses you can pass the class 1 eyesight test for the australian medical, any truth to this ?

[zondaracer]

You can fly FAA Class I with keratoconus as long as you still meet the vision requirements. Check out C3-R corneal collagen crosslinking, it's not approved yet in the states but it is in europe and I hear it will stop the progression of keratoconus

[qnh78]

Great Bucks,

I'm going to have mine crosslinking done in a month. Was it any painful? Did you get any kind of eyeband or anything? How was the following day?

Anyways, I heard that EASA will release new flight crew licensing rules (ex- JAR-OPS3) in March 2008. Have anyone has any news if Keratoconus will be no more disqualifing for initial Class1 medical?

BR,
QNH78

[bucks]

Any idea on what the new regulations will include ( removing keratoconus as a fail for initial class 1 perhaps ?? )

[qnh78]

Hi,

I would also like to know about keratoconus "removal". I'm suffering keratoconus but I have perfect vision with eyeglasses and good vision (Class 2) without eyeglasses. I will go for C3-R crosslinking operation soon and still wanting to fly for living.

Any news about new regulations...please, share!
Thanks!

-Qnh78

[Phenom100]

Guys and Girls,

Just about to start my IR next week but been for an eye test today as i felt my vision is degrading and have been told i have Keratoconus in both eyes.

My Eyes are

SPH CYL AXIS

RIGHT +1.75 -2.50 65
LEFT +3.25 -3.50 105


:mad: :mad::mad:

They are refering me to the eye hospital next week. I had my initial C1 medical 1 year ago and i cant believe this was not detected. What i would like to know is:

Is this going to be a problem, should i continue with my IR. Is their anyone else out there with this rare problem??.

Any help advice would be much appreciated.

Cheers
Danny

[Blues&twos]

Danny, Welcome to the KC club! (PPRuNe chapter).

There have been a number of threads covering KC (a couple quite recent). You could search for 'keratoconus' or I'll find some links and post them here.....

Treatment is available these days which seems to be very successful. If you get the chance to get it treated (i.e. stop it progressing) I'd definitely do it.

When I had mine treated back in the eighties I was told it was a "very rare condition" but thanks to the power of the internet, I've discovered quite a number of pilots and ATCOs have this condition...

EDIT: Actually, having just used the Search function, there are a large number of KC related threads, so probably best to check it out that way. :ok:

[colt_pa22]

Hi Bucks,

It's been a few month since your treatment, how are your eyes going?

I'm 23 and was first diagnosed with this condition at the age of 17, and was then only just was able to obtain my initial Class 1 medical without eye correction. I obtained my CASA PPL(a) when I was 19, but have not flown for the past 18 months due to angst caused by this condition. My current vision is 6/7.5 left and 6/6 right corrected with spectacles. As you can see my vision has deteriorated over the past 5 years.

Distance correction: SPH CYL AXIS

RIGHT -0.25 -1.00 80
LEFT -0.50 -1.75 105

My question is directed to professional pilots who have keratoconus in regards to night flying. While driving at night I see halos extending down from around the head lights of on coming traffic, from around a distance of 200-500 metres. I work airside at Melbourne Airport, which includes driving on the taxiways and aprons but these lower intensity lights don't seem to produce any significant halos at all. I'm wondering if anybody else has similar problems with their keratoconic eyes from lights they encounter while flying at night?

I have 250 hrs TT and would like to begin flying again and study for a CPL. My condition is not advanced enough to be considered for intacs surgery due to the associated risks and I will have an initial consultation in the coming months for C3-R collagen cross linking.

mm

[bucks]

Hey colt_pa22,

I just had another checkup two days ago and the increase in vision in my affected eye has been amazing. I dont have my current exact figures to hand but i can now see 6/9 un corrected in the eye with keratoconus.

(I got a small bit of laser followed by the crosslinking)

The doctor was very impressed at the improvement and as my eye is not 100% healed yet there is a chance of further improvment.

Im delighted i got the procedure done and it was worth every cent. It pays to go to the best aswell !!

[bucks]

Hey Danny,

I was training for my PPL when i was first diagnosed with the condition, one day my eyesight was fine then the next my left eye had become weaker then my right. Gradually over time it became worse.

I assume there is a "no fly time" following the procedure but you would be best to find out from Gatwick as to what length of time this is and whether they approve the procedure or not.

If your condition has only recently started then i would suggest getting crosslinking done as soon as possible to ensure your sight doesnt degrade further. Im sure you already know but rubbing your eyes will help deteriorate your eyesight so its a big no no..

I got the procedure carried out in the Wellington Eye Clinic in Dublin and its costs around €1500 per eye, the procedure is quick and pain free.

http://www.wellingtoneyeclinic.com/treatments/cccl.asp

Luckily you already have a class 1 so getting a renewal with this condition should not be a problem, unfortunately for me i have to live in the hope that the CAA will one day allow initial class 1 applicants who have keratoconus gain a medical.

Regards,
John.

[bluesfan]

Hi guys, just an update... I just learned from a friend who is also a pilot in Canada that people with Keratoconus can pass a Category 1 medical provided that they meet the Visual and medical requirements as set by the standards of Transport Canada. Therefore, just like in the US, Keratoconus is not a disqualifying factor. I am not sure if the JAA in Europe still considers it a disqualifying factor??

[DingerX]

I've have keratoconus symptoms since I was teenager, but wasn't diagnosed until my mid-20s. It's been over a dozen years since then, and my condition has not degraded. Of course, I've never flown anything.

Keratoconus as a disease has enjoyed a renaissance of late. Corneal topography has allowed even minor forms to be diagnosed with incredible accuracy, whereas in the past, only severe cases would be noted. I'm serious: I went through several years of being told it was "normal" to see ghost images of everything. At the same time, they now make keratoconic RGP lenses that are considerably more comfortable than the old bog-standard ones, so they don't pop out or bring dust right to the cornea as easily as they used to. Although, to be honest, I've done just fine with glasses the last three years, and my job requires extreme visual acuity.

Effectively, the increase in diagnosis rate has revealed that, alongside the "old school" keratoconus, the chronic, degenerative cornea disease that ultimately requires transplants, there's a much more common version with an onset in the teenage years that stabilizes in the mid-twenties with minor cornea degradation. It's a nuisance, but shouldn't be an obstacle.

[bluesfan]

thanks for the input Dingerx and all well said :-) I amhappy to hear that you are carrying on well with glasses and indeed with all the new developments in opthalmology, such as more accurate topography and Crosslinking and state of the art lens materials, Keratoconus shouldn't be an obstacle indeed.

Just wanted to note that in addition to the modern RGP Lenses there are now some seriously viable soft lens options for Keratoconics as well, such as the Kerasoft3 lenses. Such lenses are an answer to the prayers of pilots and crew who would otherwise suffer with RGP's in the dry cabin/cockpit air.

Although I am not a doctor but I just wanted to clarify that Keratoconus does not necessarily always lead to the point of requiring a transplant. Statisitcs show that about 20% to 25% of Keratoconics reach the stage of requiring a transplant, and with things like early detection and crosslinking, the number of transplant-needing cases is likely to decrease.

[kaptene]

Guys
I have a Keratoconus in my right eye (vision of 6/10), and I'm afraid that this will affect obtaining a Medical class 1.
For improving the vision, there is glasses, contact lenses, or surgery, and I'm not sure that eye surgery will be well appreciated by an aviation eye specialist.
This, broke my heard, If anyone had a class 1, please advise us what we can do.

My other problem, is that I have a small mark in the other eye (made by a small object 1 year ago), Please, guys , what do you think?

[GSJMH]

Keratoconus (a progressive distortion of the clear window of the eye) can be stopped by means of corneal collagen cross-linking with riboflavin (C3-R). C3-R is an out-patient treatment (it does not require a stay in hospital), but it takes about a year for the full effect to take. It is the only treatment that can arrest the progress of keratoconus. Whether the CAA will approve remains to be seen, but my understanding presently is that they will require evidence that the corneal shape has stabilised before issuing a conditional certificate.

Keratoconus is progressive. It probably affects about 1 in 7000 people. If left untreated the vision may deteriorate until a corneal graft is needed. Corneal grafts are far from perfect: apart from the risk of rejection, about 45% of people who have a corneal graft still need a rigid contact lens to meet the UK driving standard!

I am an eye surgeon and I have been doing C3-R since it was first approved in Europe. Today I treated a patient who has been turned down for a Class I certificate. I do not think that the treatment is available on the NHS yet.

[rmoller]

Applicants for class 1 medical certificate with a clinical diagnosis of Keratoconus may be assessed
as fit subject to a satisfactory examination by an ophthalmologist.

http://hub.easa.europa.eu/crt/get-file/f_NPA%202008-17c.pdf

EASA is less strict with keratoconus then JAA... I also have Keratoconus and got rejected for a class 1 with 10/10 vision, quite frustrating.

[Gerald_83]

Hi everyone, its been almost 2 years since the last post. Sorry for bringing up an old topic, but i am curious as to whether there have been any more cases of pilots with keratoconus in the past two years?

I have keratoconus in my right eye which was diagnosed in mid 2006 and it has stabilized while my left eye has 20/20 eyesight without any optical aids. I am currently using RGP lenses for my right eye that can also be correctable to 20/20.

When i was first diagnosed, i was told by my 'respected' eye specialist that i could not be a pilot. My dream of becoming a commercial pilot was rekindled again recently when i heard that my friend would be going for the local ATPL course.

I did some research over the internet recently and found that intacs are FAA-approved for pilots (Federal Aviation Administration - USA). So i am just wondering that if my RGP lens are not suitable, then would a solution such as using intacs be enough for me to pass Class 1 medical exams? I am willing to go to the extent of a cornea transplant as long as i become a pilot.

Intacs, Intac, intra-corneal rings, Ferrara rings, Ferrara ring, Keratoconus (http://www.centreforsight.com/Procedures/Other/Intacs.aspx)
Intacs® Corneal Implants For Keratoconus Available Soon | BenseVision, St. John's, Newfoundland (http://www.bense.ca/keratoconus.php)
Keratoconus: Learning About Intac Corneal Implants | Free Eye Surgery Tips By Dr. Brian Boxer Wachler (http://freeeyesurgerytips.com/keratoconus-learning-about-intac-corneal-implants.php)
A Safe, Flexible Alternative To Laser Surgery - Intacs Corneal Implants for Keratoconus and Myopia (http://www.getintacs.com/)
Virtual Flight Surgeons Inc. -- Your One Source for FAA Medical Certification Waiver Assistance! (http://www.aviationmedicine.com/articles/index.cfm?fuseaction=displayArticle&articleID=60)

Ps: Just providing some websites that talk about the FAA-approved Intacs for pilots

[Gerald_83]

Sorry if i am bringing up a post that is too old, wondering if you guys are still on this forum. I just had a class 1 medical done and the eye specialist that saw me apparently does not come to this forum to read.

His main quip is that i have keratoconus in my right eye, and it IS a pathological issue. So unless i have a cornea transplant to treat the problem then he thinks it would be difficult for me to fly.

Or i could consult the advise of a cornea specialist to certify me fit to fly (i think he just did not want to put his reputation on hold for certifying me in case i bring down a plane in future and he has to answer for certifying me).

Next, it would be up to the FAA to risk their reputation for certifying me. And lastly the airline that employs me, for risking their reputation to hire me. I am under the impression that i am a severe liability to whoever that certifies me.

The next issue is that he cannot guarantee that my eye condition will not progress in the years to come, as such, even if i am ok for a few years now, my condition may worsen and i might need a transplant and i would be a liability then, so all the training would have come to naught.

Whatever happened to the phrase, keratoconus is just a nuisance not an obstacle.

[bluesfan]

Hi Gerald!
Its interesting that you brought this thread "back to life" :)
I am no medical or eye specialist here, so please don't take my feedback instead of expert medical advice, it's just my personal experience as someone who has had quite a bit of experience with this...however what I do know for sure is that in many places (the FAA system included) Keratoconus is NOT a disqualifying factor as long as you are able to achieve and maintain proper eye correction that meets the licencing standards and use it while excercising the priveleges of the licence, and that there are no other eye problems that may jeopardize safety of flight. So if anyone tells you otherwise, make sure you do your homework and understand it the rules. Now I don't know how this applies to your situation because you didn't give us details, however it all depends on factors like how much your Keratoncuns has progressed and how it has affected your visual acuity so far, what your visual acuity is like at the moment, your age (usually Keratoconus stops progressing at around the age of 40, so once past this point it is not supposed to get worse) etc. Many Keratoconus patients are still able to achieve acceptable (and even better than acceptable) vision with proper treatment and using glasses or contacts (either soft or hard, that are epsecially designed for Keratoconus, there are so many options out there) and continue to fly safely and lead normal lives. And with new techniques like collagen crosslinking now available, patients whose keratoconus is detected early enough and qualify for the procedure, may be able to stop the progress of the keratoconus once and for all. ( I belive I have touched upon all this in previous posts). A corneal transplant is usually only required in roughly 20% to 25% of Keratoconus cases, and these are normally cases where functional vision can no longer be attained using glasses nor contacts and the corneas have become extremely thin and irregular, so it is normally seen as a "last resort" kind of thing for the more extreme cases. Reaching the point of needing a transplant doesn't just happen right away. Bear in mind that corneal transplants or grafts do not necesarily mean that a person will have perfect vision or near perfect vision! Even post-graft patients might still need some kind of vision correction (usually in the form of contacts), it's just that it won't be as bad as if someone didn't have the graft/transplant altoghether.
So going back to what you said about what that eye specialist told you, I think he/she was right to suggest that you see a corneal specialist. It has nothing to do with "reputation" or "liablibility", it's just the right thing to do. Any professional doctor is expected to do that, otherwise it would be bad practice, that's just usually how it works and its for your own good. However about what the specialist told you about needing a transplant, I must say it sounds rather strange. It's not something that an eye specialist would say, no offense to him/her. As I said I am no doctor, but this sounds rather odd to me. Having a transplant without reaching the point of actually needing it, is not reccommended as far I know and it certainly doens't make you "more medically fit to fly" if you are able to meet licencing requirements using other forms of correction and treatment that are out there. Your cornea specialst should be able to advise you better on this.

Having said that, I must say the biggest lesson I have personally leanred is that it is important to see a corneal specialist who has a very good understadning of keratoconus and the medical developments surrounding it. I cannot emphasize enough how important it is! In the fight against keratoconus, your best friends are going to be a cornea specialist (i.e. an opthalmologist who secilaized in corneal and refractive surgery) and an optometrist who both have the knowledge and the patience and genuine desire to work with you. Unfortunately such people are far and few (especially optometrists who are familiar with keratoconus patients), so make sure you do your homework. Going into this at 1st, I thought all corneal specialsits should be the same at least in terms of understanding keratoconus. I was very surprised at how much difference there was. Bear in mind that keratoconus is a condtion for which there have been no new developemts for an extedned period of time, and only recently have new developements for treatment and correction began to appear. Therefore many doctors aren't aware of what's out there and the tendency is to steer patients in one direction without giving it much thought. Some specialsits I saw had knowledge that was so outdated it's almost scary to think that had I just followed their advice wihtout getting another opinion, that I would be regretting it right now. So take your time to find a specialist that understands keratoconus very well and the various treatment and correctionm modalities that are out there.
I am sorry for the long message! but I hope this helps. I know when I was 1st diagnosed finding 1st hand experience from others was helped me most. Just one last word of advice though, I wouldn't say its good to think of oneself as "liability", its not such a positive or healthy way of seeing things. The only "liability" in avaiation is an airman who exhbits poor airmanship and poor judgement and lack of repsonsibility!

[Gerald_83]

Thank you bluesfan (chelsea?) for your words of encouragement! :O

I read up on the rules and regulations but i am not too sure if i understand it correctly. This is the statement from the licensing body where i come from (it is somewhat similar to the FAA & the CAA of UK). "The function of the eyes and their adnexa shall be normal. There shall be no active pathological condition, acute or chronic, nor any sequelae of surgery or trauma of the eyes or their adnexa likely to reduce proper visual function to an extent that would interfere with the safe exercise of the applicant’s licence and rating privileges."

The eye specialist i saw had the view that keratoconus is an active pathological condition. He, along with 2 other eye specialists, also ruled me out from flying. However, he readily admits that he is no cornea specialist nor is he an expert on Keratonconus. In fact, he mentioned that he had only encountered about 20 keratoconus patients in his career and he is at least 60-70yrs of age! I think the next step for me would be to seek out an expert on Keratoconus and work with him to fight/argue my case like what you suggested.

A bit on my keratoconus: I think i started to develop it in my right eye when i was 17 but it was only detected when i was 23. I was immediately prescribed the Rigid Gas Permeable lens and my eyesight with it has always been correctable to 20/20, left eye still remains 20/20 unaided. I do not know if this means anything to you, but my myopia is 2.50, astig is 5.00 for the right eye. Three years have since passed and my keratoconus has not progressed any further.

So much has been mentioned on Keratoconus, but it is still a mystery as to what actually causes it. In my case, i used to rub my eyes a lot when i was younger. I would rub it till it went blood sore red! And i think that since i am a right hander, my right eye suffered the brunt of it. So please tell your loved ones not to rub their eyes!

Thank you for stressing the part on finding an expert. I live in the tiny island of Singapore by the way, so i think i would have to extend my search further out.

[cats_five]

It has just come up on the BBC News website as well:

"A boy whose sight had deteriorated so badly he could no longer play rugby is making good progress after undergoing pioneering surgery.

The corneas in Daniel Beresford's eyes changed shape due to a degenerative disorder known as Keratoconus.

The 11-year-old from Sketty in Swansea has had special implants inserted by eye expert Mohammed Muhtaseb at the city's Singleton Hospital.

He said the case had interested eye surgeons around the world"


Full story:
BBC NEWS | Wales | South West Wales | Pioneering eye op for schoolboy (http://news.bbc.co.uk/1/hi/wales/south_west/8049960.stm)

[Gerald_83]

Allow me to quote another eye specialist that I had contacted recently,

"Dear Gerald,

I personally would not advise a pilot’s licence for anyone with keratoconus. RGPs are unstable in the eye and spectacles will not provide adequate vision, so this will be a safety factor. I doubt anyone will certify a pilot who has keratoconus, even an individual who has mild, stable disease. If your condition requires RGPs, this means spectacles do not provide adequate good vision and your keratoconus could be considered as moderate rather than mild. Most will refer to mild keratoconus as individuals who can see perfectly well with spectacles or soft contact lenses, and do not require RGPs.

Please note that this opinion has no medical foundation, as I have not had the opportunity to examine you."

He has done some research on keratoconus and intacs. Just wondering how i should proceed. Cos i have apparently heard of pilots wearing RPG lens... any suggestions? :ugh:

[Gerald_83]

Hi, is there anyone willing to furnish me with evidence that they passed class 1 medical with Keratoconus?

Really appreciate if you could scan and support me with the documents because i need proof!

Thank you!

[The Jolly Roger]

Hello boys and girls...here's my two pence worth:

Someone once said : "I owe my success to having listened respectfully to the very best advice, and then going away and doing the exact opposite." I read Gerards posting with annoyance quoting a letter from a specialist. With every respect to the medical profession, sometimes the opinions and advice they lend their patients is somewhat to be desired. Letters like this one have unnecessarily detered young men and women from realising their ambitions to be pilots. Truth is, many pilots the world over, fly for a living and do so with Keratoconus. They wear glasses, RGP's. Some have even had corneal grafting. Some have heart conditions, diabetes and other such illnesses yet continue to hold valid medical certificates and fly everyday. Some have even had a corneal graft. The FAA is one example of a regulator who issues initial class 1's to people diagnosed with KC. The specialist who wrote this letter expresses an opinion. A narrow one if you ask me. He shows some ignorance to the rules that regulate the aviation industry. Rules that are routinely bent, twisted and interpreted. Gather a few opinions. Opinions from doctors who specialise in KC. I mean if you have a heart problem your treated by a cardiologist. Not your family doctor. Talk to your regulator. Have your research done. Know what the rules say and ASK questions!!

I do hope that European regulatory bodies will take their heads out of the sand on this one. The advent of Corneal Crosslinking is akin to finding a cure for cancer. Albeit on a much smaller scale. The moment KC is diagnosed, crosslinking should be like taking a pill for your headache....it should be a matter of course. Why take the "lets just wait and see" approach? If you do that, your eyesight WILL deteriorate, either slowly or quickly and you inevitably end up fiddling around with glasses or RGP's for the rest of your life only because you decided to have crosslinking done when it was too late. STOP IT EARLY. EASA, I hope, will acknowledge crosslinking for what its worth. There is unmistakeable evidence over the past 10years, that crosslinking stops the progression of KC and in some cases even reverses it.

I am an Air Traffic Controller. Have been for years. My KC is mild. I was lucky it didn't progress quickly. Rather slowly. I wear glasses for reading and doing my work but get around without them ordinarily. I have had crosslinking done. Its the best decision I ever made. I also held a JAA class 2 medical for private flying. Got it without any issue. Why should a class 1 be any different. The doctor in the letter proports that safety would be an issue. Why? I can fly a Cessna 172 on my own with KC. But I can't fly a 737 with state of the art equipment and a right hand man??

Again I refer you to the quote above. Its your body, your health and ultimately your decision based on sound advice.

[rwhartop]

Hey everyone,

My first post, I have mild Keratoconus in my left eye, I have been down to the CAA at Gatwick today (19/10/09) and all i can say is anyone with K bad news! I saw the ophthalmology consultant Mr duguid and he said that anyone with any sort of eye disease such as K , will not be eligible for a initial class 1 (devastated) because they don't want people to go and spend £50,000+ on training then in a few years fail a medical. that's from the horses mouth. I met all the visual standards unaided but still couldn't have a class 1! I originally wanted to join the RAF so i start to compare my eyes (as you do) and i noticed a slight weakness in my left so i went for an eye test and was luckily enough to pick an optician who specializes in K, :(, he said if he wasn't studying it, i would have passed my initial and they wouldn't have been then wiser but i stupidly told the CAA. I have been strongly advised by a consultant at Moor Field eye hospital against C3-R for the time being. There maybe is an option that if i get an FAA Class 2 then apply for a class 1 and get it, i can convert it back and it will then be a renewal with the CAA not a initial and I will most probably be ok. I hope the rules change!:ugh::ugh::*

[kaptene]

Hello folks
Sorry for bringing this up again,
Through the CAA website, it says that Keratoconus will no longer be desqualifying for JAA Medical initiall class I

LSST - Licensing Sub-Sectorial Team (Medical) News 2005 | Medical | Safety Regulation (http://www.caa.co.uk/default.aspx?catid=49&pagetype=90&pageid=4764)

Anyone has had any assesment, with Gatwick guys? or failed
cheers

[afskullz]

hello, i am an air traffic controller in the air force and was just told i have keratoconus. I have never noticed my vision as being bad, and am only less than 20/20 in my right eye. If i get disqualified from ATC in the air force, what are the chances of me being able to continue my atc career in the faa?

[rmoller]

try EASA... in their new regulations they kind of are less strict for people with Keratoconus...

[ivesy]

Hey guys,

So I have keratoconus in both eyes. It wass progresive in my left eye and my vision had unfortunately gotten as worse as 6/12 in my left eye and 6/6 in my right eye corrected. So the good news, this all happened in September last year. I had Colagen cross linking done on my left eye in November and I now have 6/5 vision in my left eye. Best decission I have ever made. Not only that but I got my initial class 1 medical from casa with keratoconus. It is not a hurdle in Australia as long as you meet the visual accuity which for casa is 6/6 binocular and 6/9 in each individual eye. If anyone in the Melbourne area wants details for a good opthamologist just email me. My opthamologist has done tons of cross linkings on pilots. Keratoconus is only a small hurdle which is easily passed.

[Gerald_83]

hi guys, i cleared my FAA medical class 1 with some conditions, here's what my letter wrote: "The medical evidence reveals a history of keratoconus. You are ineligible for medical certification under Title 14 of the code of federal regulations, revised part 67; specifically under paragraphs 67.113(b), 213(b) and 313(b). I have determined, however, that you may be granted Authorization for special issuance of the enclosed first-class airman medical certificate under Title 14 of the CFR's, section 67.401."

I would still need to visit my AME every year to apply for a first class medical. I would also need to see my eye specialist to provide updates of my condition along with the application.

Hope that this would provide some light for those with my condition. The authorization is valid for 2 years while the certificate is for 1 year. Cheers!

[Blues&twos]

A similar picture to the one you have posted appears in the following thread:

http://www.pprune.org/medical-health/305482-dreaded-k-keratoconus.html

I don't know if it's of interest to you. See post number 50, the poster is also talking about corneal topography at Gatwick.

[sec1]

Hey Guys,
I am too suffering form corneal irregularities. The Doctors say its not keratoconus but i really bothers me at night. Can any of you who have the K post his experiences with seeing in the dark. What do bright light sources look? And all those led lights and the taxi way markings? Especially the ones for the taxi way you're on (black background and yellow letter). I just wanna see if anyone else has problems with clearly seeing those. greets, sec1

[Luis David]

Hi there! well i´m new in this forum and let me introduce myself, I´m Luis, I live in United States,mexican, 16 y.o. ,permanent resident in the US and I love aviation, I´ve been reading pprune many years ago, but never decided to be part of this, nevertheless I´m now here and I´m expecting to have fun and learning things about aviation, that´s why I´m gonna ask for some help. I know there´s some much time lefting before I start flight trainig but i want to be prepared.

Well, firstable, I live in sugar grove IL, near aurora and chicago, since I have concience, I always wanted to be a commercial pilot, I trully love aviation, I think I´m taking this passion in my blood;), but there are some little problems.

firstable, the horrific HEALTH ISSUES:eek::eek::eek:! one year ago, I went to my ofphalmologist, but SURPRISE, he diagnosed me with KERATOCONUS:uhoh::uhoh:, in both eyes, but in the right one, the disease was very advanced (KC level 3) but I didnt have hazes or injuries in my chornea, except for the classical striations., inmediately, my doctor proposed me to take the Crosslinking surgery (C3-R CXL) in order to stop the chorneal deformation, so I took the desicion to take the surgery in mexico, wich I think, was the best decision I made. Well, after the surgery i went to a contactologist (a doctor who is specialized in keratoconus an contact lenses adaptation) and prescribed me Gas permeable rigid lenses, wich really fit mé and are very comfortable ima ble to use them for 14 hrs., so, In my left eye i reached more than 20/20, but in my right eye just 20/25, both eyes 20/20+. then I fell in an emotional crysis and I cant get out of it, now, my dctor told me that I was able to reach 20/20 in both eyes separately with visual therapy, I think this are good news, actually i´m in the process of the final adjustments of my lenses an expecting directions of taking the visula therapy or other, I really hope I can reach 20/20 with my 20/25 eye, that is the main problem. nowadays I was like crazy reading forums, visiting the FAA webpage, asking people in order to have some info about how my condition would affect my dreams to become an airline pilot but nothing. I just know that i have to have 20/20 in both eyes, but they dont say nothing about keratoconus, Can I be an airline pilot with this disease? can i approve my first class medical exam with this condition, would it limitate my dreams, my career? I´m so confused an walking in the dark because of this disease, i fell that all my chances of being a pilot are falling down. but I´m waiting for a haze of light, I´m a good student and I think it can help me, I dont drink, I dont smoke, I dont have diabetes, hearing problems. I´m healthy except for this. My contactologist says that she thinks this might not be a problem in flying but she doesnt knows nothing of aviation.

2. LEGAL ISUUES, can I be an airline pilot if I´m mexican but I´m legally a permanent resident in the US? I ask this because in mexico, you have to be born-mexican in order to fly or control airspace.

3.SCHOOLS? I was thinking in American flyers Chicago, some pople say that its schools are good, in fact I know a friend of mine who has his brother working in Aeromexico Connect (E-145 and E-190 A/C´s) what kind of school would you recommend me and wich is the cost approximately?

4.SCHOLARSHIPS. Is there a chance to get a scholarship?

Well then thank you for your help and pardon me if this is bothering, but I think its better to get some knowledge taha keeping me all my boubts.

[HEATHROW DIRECTOR]

Little further down the pages:
http://www.pprune.org/medical-health/305482-dreaded-k-keratoconus.html

[zondaracer]

The FAA does not disqualify for Keratoconus. If you are a legal resident but a Mexican citizen, you can still fly for an airline in the US.

Concerning the Keratoconus, the FAA will test you to make sure that you can see 20/40, with OR without correction. They don´t really care if you wear glasses or contacts or not, just that you can see 20/40 IN EACH EYE SEPARATELY.

Next, they don´t actually have to know that you have Keratoconus. I´m not advocating anything but you can PM me if you have further questions. I would ask the doctors who did your C3R if the C3R procedure can be detected by a slit lamp.

As far as the training, go to a local place near your home and shop around and take a look at the airplanes, talk to the owner and the people who work there and the other students and see what place works best for you. no need to go to a ¨flying academy¨ or anything like that. In the US, the airlines don´t care where you got your training, they care if you have lots of hours, the right personality, and that you can fly and make the right decisions. If one of those flying academy places is for you, then by all means go to one, but pick a place that fits you. most importantly, DON´T PAY UPFRONT.

As far as scholarships, they don´t exist in aviation in the US for the most part. There are some rare scholarships out there like the Daedalian Scholarship which are given to Air Force cadets who are exceptional but it is rare and hard to come by.

The approximate cost will vary depending where you go, but you can figure that if you are going to get your Commercial/Instrument Single engine and Multi Engine Airplane Land ratings, it will cost you close to $45,000 to $60,000 depending where you get your training and how efficient you are/motivated.

Best of luck.

[Bad medicine]

As there is some renewed interest in the topic, we'll try to put it all in here.

[Satoshi13]

Hi guys, sorry for disturbing again for after so many years, i've been diagnosed with keratoconus on my both eyes as i m having almost the similar case with Gerald 83, i am going for the Cross-Linking surgery, and my doc told me that even if i went for the surgery and i would still not able to proceed for my pilot application, this was so sad until i found this forum, my question is, am i still able to apply after my cross linking surgery? is there any proof that i need to convince the doctor? Thanks in advance .. :{:{

[AvMed.IN]

Satoshi13
though ICAO manual does not speak of correction of keratoconus, JAR manual categorically says that during the early stages, keratoconus may be treated with spectacles, and later with contact lenses. The surgery is the final resort.

However, before undergoing surgery (when you may have relief either with spectacles or Contact Lens), please contact your Aviation Medical Examiner or the Malaysian Civil Aviation Authority to seek clarifications.
IMHO, if spectacles/Contact Lens assure you aviation fitness, why undergo surgery?

[Satoshi13]

AvMedIn, Thanks bro, my situation here in my country is different, i am from Malaysia, the panel doctor from the DCA apartment here doesnt allow keratoconus patient to wears corrective lenses such as RGP, i was told that it is a condition where it will become even worst. i had no choice so i ve decided to go for the surgery.. kinda sad ... i hope my vision will be improve or maybe alt least maintain and i will try again. :\:{

i've also called all the ophthalmologist specialist in DCA Malaysia, and they said that they never accept any application that has Keratoconus, so i had no choice but doing alot of research from the internet and i've been to one of the hospital here and the doctor clarifies me that its better i go for the surgery. as my left eye is KK3 which i have a high astig and my right eye has a good vision in KK2. however, i've made an appointment to the surgery on next week Wednesday 12.1.2011, i have no idea what can i do right now, as i ask the DCA doctor again, if i went for the Cross Linking surgery, would i still able to apply for the application? well, he told me they really never accept anyone with this sickness, but he says maybe i could try.. and the doctor from the hospital says that, i will not good enough to apply anymore after the surgery, as he told me that my eyes will be very sensitive with glares and lights at night. my feelings now is so unexplainable ... i don't know what to do and no one could give me any advice http://images.ibsrv.net/ibsrv/res/src:www.pprune.org/get/images/smilies/worry.gif ... i also told them that FFA approves application with Keratoconus, but do we apply it in Malaysia? as the doctor told me that UK and US is different with Malaysia, where there's alot of application who applies for PPL so they have to accept the patient with it, but in Malaysia there's not much people apply for pilot courses for PPL, so they are being more strict than any others. http://images.ibsrv.net/ibsrv/res/src:www.pprune.org/get/images/smilies/wibble.gif

EASA = Applicants with keratoconus may be considered for a fit assessment if the visual requirements are met with the use of corrective lenses and periodic review is undertaken by an ophthalmologist.

This is weird why the DCA doesn't accept this which i can simply fit for the corrective lenses? they insist they don't accept applicant just with keratoconus. I am going to the surgery soon, should i proceed? i ve told that after Cross linking i might having a difficulties of glares at night. since the DCA don't want to approve me or maybe should i go for the surgery and hopefully if my condition is going to gets better? :suspect: :{ i m definitely lost

[kaptn]

All
Anyone has tried the collagene Cross linking and got his JAA medical initial Class 1?
Cheers

[zondaracer]

Kaptn, I might be able to give you some info. I didn't have crosslinking done but still got a JAA class 1.

What is your current eyesight? How were you diagnosed? Do you wear corrective lenses/RGPs? What is the thickness of your corneas?

[bucks]

Has there been any developments with this yet for JAA medicals?

I got cross linking and mild laser surgery on my left eye (right eye is un affected by Keratoconus) over 2.5 years ago in the Wellington eye clinic in Dublin.

Have no need for glasses or contacts and my eyesight in the affected eye has remained the same since treatment. Vision was greatly improved after surgery. Best money i ever spent :)

Would love nothing more than to qualify for an initial class 1 medical with it.

[Danny212]

I just got my initial CAA Class 1 Medical certificate a few weeks ago.
However i recieved some scary news.

The not so scary one was that I have high cholesterol. The only worrying this is that I'm 18, however I personally feel my diet isn't that bad.

The main fear is off a mild stage of Kerataconus..(thinning of the Cornea). Has anyone got an insight into this? I've been advised to visit an opthamologist to get a treatment called CXL Crosslinking (a form of laser eye surgery)

Shocking, and I'm just eighteen. It's a good thing I went for the test before applying to any FTO's to commence training!

Thanks for any advice in advance :)

[Josh90]

Hi all,

After completing my degree at Leeds University I was accepted onto the CTC Cadet Programme. I was due to start in Dec 2011 but had to withdraw my application as I was diagnosed with Keratoconus. I was told that I would not pass the Class 1 Medical as Keratoconus is a 'disqualifying condition for an initial Class 1 application' (JAR-FCL 3.220(b)(3)). After some research I found that this is not the case for an FAA Class 1 medical. I don't want to give up my dream of becoming a pilot, and would be willing to travel to America for training. Would it be possible to convert the Class 1 medical from FAA to CAA after training, thus meaning it's not an initial application for the CAA Class 1 medical but a renewal? I have been informed by the medical examiner that the JAA regulations allow recertification of an individual with Keratoconus provided that they meet the Class 1 medical standards, but this clause does not apply to initial applicants for the Class 1 medical examination.

The medical examiner did mention that in 2012 the CAA will be implementing new European medical standards (EASA). Although these are not finalised, it is possible that there may be a change to the certification of initial applicants with Kerotoconus. Is it likely that the CAA regulations regarding Keratoconus will change?

Thanks for any help in advance :)

[zondaracer]

Danny212... so you were issued an initial class 1 even though you were diagnosed with mild keratoconus? That sounds reassuring for other folks who might be in the same position. I would recommend you do some research on collagen crosslinking (CXL, C3R) and consult with several different clinics that perform the procedure. Also, consult with the medical folk at the CAA, because I heard that having the crosslinking procedure can ground you from flying for a year.

Josh90... Yes, it is true that the FAA does not consider keratoconus a disqualifying factor, however, I have heard of people who reported it at their Class 1 medical and were denied, not given a special issuance, etc. Is your keratoconus mild? When I ask this, I am asking if your vision is still normal (20/20, 10/10). If so, I would see an ophthalmologist and ask for a second opinion. This way, you can do your FAA medical with a clean bill of health.

I have heard that the recommendations for EASA medicals was going to remove keratoconus as a disqualifying factor for initial class 1 medicals, however I don't know if that will come into effect or not. Best to keep in touch with the CAA medical personnel to keep updated.

[Josh90]

Hi zondaracer,

Thanks for the quick reply! I only have Keratoconus in my left eye (6/36) and the vision in my right eye is perfect (20/20). My vision overall is normal, but with my right eye closed I struggle to meet the CAA visual requirements. I have been prescribed a hard contact lens from an ophthalmologist which has made the vision in my left eye significantly better. After notifying the CAA, however, their response was that Keratoconus is still disqualifying for an initial application. If I were to pass the FAA medical, would it be possible to convert this to a CAA medical in the future? I'm assuming then it would be classed as a renewal and not an initial application? It seems silly that Keratoconus is disqualifying but if diagnosed after passing the Class 1 medical then it is okay. Hopefully they change the regulations to allow people with Keratoconus that has been corrected to pass the initial medical.

[mantisboomtang]

Hello,

Although the posts go back 4 years I have no doubt that many people will be reading this thread. This is the top rated thread on Google for a search about kerataconus in pilots.

Some years ago someone wrote that "I will even consider a cornea transplant to get me flying"

I have Kerataconus in both eyes. Severe enough that I have had a full thickness cornea transplant in one of them. I do not fly and gave up the hope about 10 years ago when RGPs became my treatment. To be honest, even if they gave me a medical, I would not feel safe flying with RGPs! We've all had them cloud up, pop out of the eye when you quickly look fully left or right and in dry conditions slide off the centre of the eye.

Anyone reading this should take note, CORNEA TRANSPLANTS ARE A LAST RESORT AND BY NO MEANS DOES IT 'FIX' YOUR EYE SIGHT. The whole process takes 18 months to two years and there is pain, loads of eye drops and visits and at the end of it, guess what, I'm going to have an RGP fitted. For me this is fine because this is an improvement on what I had before but please be clear that seeing cornea transplants as this golden chalice is just mistaken.

[kaptn]

All
Anyone passed his Medical class 1 at Gatwick or somewhere else, with a Keratoconeous eye?...It seems it's no longer a disqualifying condition with the EASA...any idea?
Thank you.
Regards,

[zondaracer]

Why don't you call Gatwick and ask?

[starsrocket]

Hi All,

I am a US pilot flying for a major carrier for the last 23 years. Last year I was diagnosed with a form of keratocouns called pellucid marginal degeneration. I was just barely able to be corrected to 20/20 at that time. this spring I noticed my vision deteriorating and found I was not correctable to 20/20.

I had been researching Corneal Cross Linking, especially epithelium ON, for the last year. In July, I went to Boxer Wachler in LAX for his patented procedure, Holcombe C3-R. Within 3 days, my vision had improved dramatically. Where headlights while driving at night had become intolerable, they were back to normal and I could see the road with oncoming traffic. I can read the computer again without bifocals ( I am 51). I can read the ticker tape on the bottom of the TV form my couch again. I can read roadsigns from a normal distance. Yes, I still need glasses, but I have needed glasses for the last 40 years.

I am currently waiting for the FAA to reply to my record submittal for a 1st Class medical certificate.

Laura

[zondaracer]

Hello starsrocket, did you get it with intacts or without?

[sharwan]

hi. Please i need a valuable information from you. Since you are already a cabin crew can u plz tell me if patients with keratoconus and who wear hard lenses are allowed to work as cabin crew. i really want to work as an EK crew but am least afraid i may be unfit because of my keratoconus. plz any information u have do convey me. Thx and also wish u all the very best in your quest of becoming a pilot god bless it will be soon. :ok: Thx

Neil.

[landmass]

I was diagnosed with Keratoconus 5 years ago and was told there was no cure for it, so subsequently my eyes got worse. I continued to fly until my new employer (the airline I always wanted to work for) said no. I discovered and underwent Corneal Cross Linking in both eyes, and had a Keraring implanted in my right eye. The surgery was interesting, but uneventful, the recovery was the worst pain and discomfort imaginable. The surgeon was top notch although lacking in bedside manner. All in all I was grounded for 7 months, but once able to meet the vision requirements they let me back into the skies and back to work. Take it from me, it is stoppable, and In some cases fixable, have the surgeries before its too late!

[sharwan]

this is so motivating. thx for sharing ur experience. will def go for the cross linking. hope something positive will crop out :)

[Qviator]

Hi all!



I'm having issues with Keratoconus. There is some context on the CAA visual requirements page which I don't quite understand.


The sentence below for a Class 1 medical highlighted in Italic is relevant to me. It states that cross linking is acceptable but I don't understand what it means when it says 'Refraction at 2 months'.
Class 1 - Refraction at 2 months and then full ophthalmological review at an AeMC at 3 months, before returning to flying.
Class 2 - Refraction at 2 months and then again at 3 months, before returning to flying.
Due to a risk of corneal haze following this procedure, an assessment is required of contrast sensitivity together with any history of symptoms such as glare, halos or starbursting before a decision is made to recertificate.




Thank you for any replies!

[RedBullGaveMeWings]

It may mean that you must hand in a report filled by the opthtalmologist who operated you after two months from date of surgery?
Have you tried contacting the CAA?

[Phororhacos]

Refraction | Ask the Optician ? Specsavers Opticians UK (http://www.specsavers.co.uk/ask-the-optician/refraction/)

Refraction at two months means, I think, what would your spectacle prescription be at two months after the procedure.

[tolgattt]

I was diagnosed with Keratoconus 5 years ago and was told there was no cure for it, so subsequently my eyes got worse. I continued to fly until my new employer (the airline I always wanted to work for) said no. I discovered and underwent Corneal Cross Linking in both eyes, and had a Keraring implanted in my right eye. The surgery was interesting, but uneventful, the recovery was the worst pain and discomfort imaginable. The surgeon was top notch although lacking in bedside manner. All in all I was grounded for 7 months, but once able to meet the vision requirements they let me back into the skies and back to work. Take it from me, it is stoppable, and In some cases fixable, have the surgeries before its too late!

Did you get your medical from New Zealand Authority or any JAA country? If it's JAA, than that's a very promising post for us.

[kaptn]

in the UK, they should be more flexible with the EASA new stuff...as long as you can meet the vision requirements....

any pilots with keratoconus who are flying without particluar problems ?

[reeko]

Kaptn,

I know your frustration, however it would seem that this restriction has been lifted with the CAA/EASA on the condition you can meet the visual acuity levels for the initial.

see here (do a search ctrl+F for keratoconus): Visual System GM | Medical | Personal Licences and Training (http://www.caa.co.uk/default.aspx?catid=2499&pagetype=90&pageid=13885)

[Luke Ocana]

I was diagnosed with Keratoconus in 2014 and have since undergone Collagen Cross-Linking. My eyes are now stable and my consultant (who was actually part of the development team of cross-linking) says I reach all CAA requirements without a problem, I just need a slight correction of vision on my left eye with a hard contact lens, with the right eye exceeding 20/20 vision.

[flyjet787]

Dear fellow Aviators,

I have been recently diagnosed with Keratoconus in both eyes. My binocular visual acuity is 6/6 without correction while my Right eye is 6/9 uncorrected and 6/6 corrected with spectacles and my Left eye is 6/6 without correction. The Keratoconus in my right eye is in the mild to mederate range while in the left eye is in very early stage.

My ophthalmologist suggested I get Collagen Crosslinking (c3r) done in my right eye to arrest the progression of Keratoconus and monitor the left eye for one year for progression. While I do meet all the visual acuity requirements of my regulator I am worried about the keratoconus and my regulator doesn't have a laid down procedure in handling Keratoconus patients.

I wanted to hear from any fellow aviators who have been diagnosed with keratoconus and have undergone C3R. What has been your experience been like in dealing with keratoconus. What is your aviation regulators stand on Keratocnus and what are the approved or recomended treatment options.

It would be great to hear from any docotors on this forum who have the experience in treating pilots with Keratoconus.

Thank you.

[Finbarr61]

My 17 yr old son is looking to become a commercial pilot in the UK in the next few years.

We were advised to get him 'checked out' and as part of his Class 2 medical (he has to be 18 + for a Class 1 apparently) , it was identified that although he has perfect (6x6) vision, he has a condition called Keratoconus in both eyes.
We are returning to the Eye Consultant shortly to seek further information, as the Consultant is saying that my son will require remedial action (?) on both eyes in the next 3 - 6 months
Apologies, I have no further medical details that I can supply to indicate the severity of the condition or what the Consultant is proposing

We are concerned to what affect this may have on his ability to gain a Class 1 medical and thus become a Commercial pilot in the UK

Has anyone had similar experiences or information or the CAAs take on this condition please ..?

[Phororhacos]

https://www.caa.co.uk/Aeromedical-Examiners/Medical-standards/Pilots-(EASA)/Conditions/Visual/Visual-system-guidance-material-GM/

see (g) for UK CAA guidance material.

[marioair]

although only class 2, i had keratoncus and needed to have an operation on both eyes (CXL).

CAA were happy for my AME to deal with the whole thing. I was grounded for a period (3 months) until things had settled down but after than it was not problem at all.

i would definitely check the linkin previous post to see what the additional (if any) implications are for class 1, but once you know what the ophthalmologist is recommending then I would highly recommend consulting a local AME who should be able to help.

[Finbarr61]

Thank you very much for your prompt replies here ...

We have now had an opportunity to visit the Consultant again, who has explained in more detail the condition, its affect and how he proposes to resolve it

The CXL procedure he is proposing will strengthen the cornea and hopefully should not affect my sons current '6x6' eye rating and thus allow him to proceed with his ambition to become a commercial pilot .....

[marioair]

That's good news. As previously stated though...ensure an Aviation Medical Examiner confirms the implications for a Class 1 medical - the ophthalmologist will not be able to confirm this.

[Danny212]

When i went for my initial Class 1, I was told I had Keratoconus however i still got my Class 1. That was when I was 17. A year later, I went through collagen cross-linking (CXL), and my medical was suspended for 6 months (as it used to be back then). Now, aged 24, I'll be undergoing CXL for my right eye, and my AME has said there's no issues, just grounded for 3 months! I fly commercially, so that gets me off work for 3 months....winner!

You should have no issues, just keep your AME informed at all times. Good luck!

[africanbrit]

Hi Guys,

Hope Im not flogging a dead horse with this thread...

I got diagnosed with KC in Feb 2018. It came as quite a surprise, I am almost finished my ICAO CPL, problem is I haven't done my Class 1 medical yet. I did let my AME know of my diagnoses and he said It shouldn't be a problem as long as each eye is 20/30 or better and binocular vision is 20/20. Problem is KC is a degenerative eye disorder as many of you know...

I am seriously considering going for Collagen Cross linking, would any of you vouch for the procedure? Or do the threats outweigh getting the procedure done?
I have also heard of Intac rings which can be inserted on the cornea. Is this procedure disqualifying for a class 1?

I really hope someone can help me as I'm stressing at the possibility of my flying career being cut short :(

Thanks
James

[cjones12]

Last year I was diagnosed with keratoconus in both my eyes, therefore to slow down the progression I had corneal cross lining (CXL) done in January. The latest scans of my eyes showed that I had 20/20 (6/6) vision in my left eye, and 20/32 vision in my other eye with refraction error of 4.25D, both unaided. With a hard contact lens, I almost attained 20/20 vision in my bad eye. I contacted a medical examiner from the CAA and he said that, with the condition that I have (keratoconus), I would not qualify for a class 1 as I would have to attain 20/20 with a contact lens and glasses? I find this weird as I have been informed that glasses can't help someone that has keratoconus, but hard contact lenses can, as they help reshape the cornea. I would be very thankful if someone can inform me what to do, and if its worth doing the initial class 1 exam?

[DESDI OR BUST]

I’d be interested to know why the CAA would have told you that correction is only possible with contact lens and glasses. Are you positive that’s what was said?

The EASA regs are fairly clear. Vision corrected to 6/6 of correction is used. They don’t stipulate how you attain that correction. I have keratoconus and achieve 6/6 in both eyes separately (in fact slightly better) with glasses only.

I’d check with them again and check the regs too. Good luck!

[charls45]

Hi all,

I have an eye condition called keratoconus which affects the shape of the cornea. Have had this condition for about 10 years now in which I have had the cross linking procedure done which has halted the progression. Currently wearing hard rgp contact lenses to correct the vision to 6/6.

My question is, does anyone know of anyone who has this condition who holds a EASA class 1 medical.

Im thinking if I am able to pass the class 1 medical will it be worth all the money of commercial flight training to one day get told I will need to stop flying due to loosing my medical.

Currently have a PPL and will be booking my class 1 in next couple of months.

Would appreciate your feedback and advice on this matter.

Thanks again.

[pkormann]

Managed to get class 1 for ATPL course with VDL and RXO conditions (glasses+extra glass in bag always; annual specialist evaluation - )

Haven't changed much degrees in the last 2 years, and from a 6 months (so far) follow up, the KC is stable - I'm 32

I can foresee that a job in a major airline will be tough. But might score some LCC or stay in ferry/GA market.

How have any other fellow KC'ers been?

Best regards and merry xmas to all

[pkormann]

Renewed in Portugal for another year with no issues at all. Had a very tranquilizing talk with the AME this time.
On my initial I was sent to an outside doctor who freaked the hell out of me

[Tufan]

Hi all,

I have an eye condition called keratoconus which affects the shape of the cornea. Have had this condition for about 10 years now in which I have had the cross linking procedure done which has halted the progression. Currently wearing hard rgp contact lenses to correct the vision to 6/6.

My question is, does anyone know of anyone who has this condition who holds a EASA class 1 medical.

Im thinking if I am able to pass the class 1 medical will it be worth all the money of commercial flight training to one day get told I will need to stop flying due to loosing my medical.

Currently have a PPL and will be booking my class 1 in next couple of months.

Would appreciate your feedback and advice on this matter.

Thanks again.
ı am diagnosed with KC and I have class 1 Easa and Non-Easa medicals. KC is not a factor to fail on medical if doctor is satisfied that there is no great problem with your eyesight. I pass the medical examination since 2013 through Europe. Noreover, I have licence insurance with diagnose. Keep in mind though, I was told Emirates for example doesn't hire pilots with KC. So your job opportunities could get narrow.