Does anyone have any experience with decompensated/ing phorias?

So, the last few years I always doubted my eyes for Class 1 standard as I have Amblyopia in my left eye. I finally scratched that itch and went for a standalone eye appointment with Adrian Chorley at Heathrow Medical.

I must say he was fantastic, answered so many of my questions and the eye examination is really just genrally interesting.

Anyway, I passed. Morale of the story - don't be put off and speak to an expert. There's always hope.

Help Regarding My Eye Sight
 

Hello, I am 17 years old student from Nepal. While my dream is to be a pilot, some issues regarding my eyesight always puts me in doubt whether I can pursue to pass Class-1 Medical examination test or not. From what I know, i’ve intermittent exotropia in my eyes due to which it tends to squint or drift outwards. My left eyes vision is a bit blurry and I have hard times to focus. With that, I do get double visions too.

Yet, I’m not giving up. I go on therapies in hospital every week to improve vision and have been consistently doing brock string in home to improve it too. As a 17 years old still chasing for my dreams, its really hard for me to be completely sured whether I can pass Medical Exams for pilots or not. I really will appreciate any help or guidances from the experts in this website. I just found out about this websites and wanted to get help from people who have some ideas related with it. Even if I have to undergo surgery to fix my vision, I’m well determined to take the action as long as it makes me fit for a future Pilot.

Here are some details about my eye problems, given by my doctor:Cover Test:

• Distance (D): 12∆ XT / Alternating XT

• Your eyes deviate 12 prism diopters outward at distance.

• Near (N): Exo D/C (likely Exo Deviation/Control)

• You also have outward deviation at near, but it’s likely controlled better.



PBCT (Prism Bar Cover Test):

• Unaided Distance: 16–18∆ XT

• Unaided Near: 10∆ XT

• Confirms divergence excess exotropia — larger deviation at distance than near.


Accommodation & Vergence (Eye Teaming) Function:



NPC (Near Point of Convergence):

• 12 cm (OS) — Slightly poor convergence ability (ideally should be less than 10 cm).



Fusional Vergence Amplitudes (FVA):

• NFV (Negative Fusional Vergence) and PFV (Positive Fusional Vergence) are both reduced at distance and near.

• Indicates poor ability of your eyes to work together effectively, both for crossing (convergence) and separating (divergence).

Vergence Facility Test:

• With 12∆ BO (base-out prism) and 3 Base-In prism:

You had trouble clearing and sustaining fusion — consistent with exotropia and vergence insufficiency.



Management:

• Office Vision Therapy (VT)

• Home Vision Therapy (HVT)

• Exercises recommended:

• Brock String: 15 minutes daily

• Lens Flippers or Similar Vergence/Accommodation Workouts

It's great to see your determination. Vision challenges like intermittent exotropia and amblyopia definitely make the path more complex, but not necessarily impossible. You're doing the right thing by getting therapy early and consistently working on convergence and fusion, those improvements matter over time, especially at your age.

Since you're also open to surgical options if needed, just be sure to stay informed about all potential risks, especially with newer or less common treatments. For example, some eye injections used for certain retinal conditions, like Syfovre, have recently come under scrutiny. The FDA issued warnings after reports of serious side effects, including vision loss. Different context than your case, but it shows how important it is to stay updated and cautious when it comes to eye procedures.

Wishing you all the best!

Good morning, I'm looking for some advice. Has anyone had any success in achieving class 1 medical with substandard vision? My left eye corrects to the correct acuity 6/5 (albeit slightly over prescription - +5). my right eye corrects to 6/36. Binocular is 6/5. I have had the issue more or less since birth. My understanding is that for revalidation i would pass. I have booked my class 1 initial as a 'You never know'. Just interested to hear any stories of anyone in a similar predicament. Thanks

Adrian is great: professional, understanding, knowledgeable and pragmatic. If ever there’s anyone I would trust to be sympathetic and helpful with an issue, Adrian is your man!

Thank you! I will look into him.

I've recently had an eye test at my local optometrist for a Class 1 renewal which indicated ocular hypertension in one eye after a non-contact tonometry (air puff) test. From what I've read these tests aren't always reliable and I've had no prior history. I presume getting a second test is possibly a good idea but does anyone have experience of what I can expect regarding my current medical? I get the impression that it's not the sort of thing which should result in an immediate suspension of my Class 1 but I understand that AME opinions can vary.

Chris, elevated interocular pressure, IOP, is a precursor to glaucoma. I would first discuss with your optometrist when you should begin seeing an ophthalmologist as delay in obtaining treatment for glaucoma may lead to irreversible loss of vision.

The optometrist can administer a visual field test which consists of clicking a button whenever you see a flash of light. That will identify any loss.

Treatment begins with eye drops. There's also laser treatments and stents that are often placed during cataract surgery. I've had the lot.

The good news is that glaucoma can be well controlled.

Transport Canada Medical requires annual ophthalmologist reports.
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Thank you for the advice, I've got a second test booked next week to try and determine whether the first test was a false positive (I'm aware this can be quite common). If it is, I'll arrange a referral to an ophthalmologist through my GP (the optometrist I saw has already sent a referral), if it looks like a long waiting list I'll most likely try and see a specialist privately.

Glaucoma is generally slow acting. A few months on a waiting list is not likely to make a significant difference.

Hi Chris,

Increased IOP with a puff tonometer is quite normal. They are not as accurate as contact tonometers and use to give readings increased by +1 or +2. Having said that, the numbers mean little if you do not compensate them with the corneal thickness. A cornea thicker than 540 µm will increase the readings and a thinner one will decrease them. For example a 600 µm cornea will produce a +4 Hg mm reading, so if the reading was 23 the real IOP is 19. (look for a table with your browser).
A moderately elevated IOP does not translate into glaucoma. You need optic nerve damage (measured with an OCT), thinning of the GCL, affected VF, and sometimes elevated IOP, as a "normal" IOP can also produce glaucoma in some individuals (called normal tension glaucoma).
My advice is: forget about cheap optometrist review (typical in some undermanned countries)and get into good ophthalmologist hands.