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-fi...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
Intacs® Corneal Implants For Keratoconus Available Soon | BenseVision, St. John's, Newfoundland
Keratoconus: Learning About Intac Corneal Implants | Free Eye Surgery Tips By Dr. Brian Boxer Wachler
A Safe, Flexible Alternative To Laser Surgery - Intacs Corneal Implants for Keratoconus and Myopia
Virtual Flight Surgeons Inc. -- Your One Source for FAA Medical Certification Waiver Assistance!

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!

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

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?

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!

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

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...ratoconus.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