(a)Eye examination
(1)At each aero-medical revalidation examination, the visual fitness should be assessed and the eyes should be examined with regard to possible pathology.
(2)All abnormal and doubtful cases should be referred to an ophthalmologist. Conditions which indicate ophthalmological examination include but are not limited to a substantial decrease in the uncorrected visual acuity, any decrease in best corrected visual acuity and/or the occurrence of eye disease, eye injury or eye surgery.
(3)Where ophthalmological examinations are required for any significant reason, this should be imposed as a limitation on the medical certificate.
(4)The effect of multiple eye conditions should be evaluated by an ophthalmologist with regard to possible cumulative effects. Functional testing in the working environment may be necessary to consider a fit assessment.
(5)Visual acuity should be tested using Snellen charts, or equivalent, under appropriate illumination. Where clinical evidence suggests that Snellen may not be appropriate, Landolt ‘C’ may be used.
(b)Comprehensive eye examination A comprehensive eye examination by an eye specialist is required at the initial examination. All abnormal and doubtful cases should be referred to an ophthalmologist. The examination should include:
(1)history;
(2)visual acuities — near, intermediate and distant vision; uncorrected and with best optical correction if needed;
(3)objective refraction — hyperopic initial applicants with a hyperopia of more than +2 dioptres and under the age of 25 in cycloplegia;
(4)ocular motility and binocular vision;
(5)colour vision;
(6)visual fields;
(7)tonometry;
(8)examination of the external eye, anatomy, media (slit lamp) and fundoscopy;
(9)assessment of contrast and glare sensitivity.
(c)Routine eye examination At each revalidation or renewal examination, the visual fitness should be assessed and the eyes should be examined with regard to possible pathology. All abnormal and doubtful cases should be referred to an ophthalmologist. This routine eye examination should include:
(1)history;
(2)visual acuities — near, intermediate and distant vision; uncorrected and with best optical correction if needed;
(3)morphology by ophthalmoscopy;
(4)further examination on clinical indication.
(d)Refractive error
(1)Applicants with a refractive error between +5.0/-6.0 dioptres may be assessed as fit provided optimal correction has been considered and no significant pathology is demonstrated. If the refractive error exceeds +3.0/-3.0 dioptres, a four-yearly follow-up by an eye specialist should be required.
(2)Applicants with:
(i)a refractive error exceeding -6 dioptres;
(ii)an astigmatic component exceeding 3 dioptres; or
(iii)anisometropia exceeding 3 dioptres; may be considered for a fit assessment if:
(A)no significant pathology can be demonstrated;
(B)optimal correction has been considered;
(C)visual acuity is at least 6/6 (1.0) in each eye separately with normal visual fields while wearing the optimal spectacle correction;
(D)two-yearly follow-up is undertaken by an eye specialist.
(3)Applicants with hypermetropia exceeding +5.0 dioptres may be assessed as fit subject to a satisfactory ophthalmological evaluation provided there are adequate fusional reserves, normal intraocular pressures and anterior angles and no significant pathology has been demonstrated. Corrected visual acuity in each eye shall be 6/6 or better.
(4)Applicants with a large refractive error shall use contact lenses or high-index spectacle lenses.
(e)Convergence Applicants with convergence outside the normal range may be assessed as fit provided it does not interfere with near vision (30–50 cm) or intermediate vision (100 cm) with or without correction.
(f)Substandard vision
(1)Applicants with reduced central vision in one eye may be assessed as fit for a revalidation or renewal of a medical certificate if the binocular visual field is normal and the underlying pathology is acceptable according to ophthalmological evaluation. Testing should include functional testing in the appropriate working environment.
(2)Applicants with acquired substandard vision in one eye (monocularity, functional monocular vision including eye muscle imbalance) may be assessed as fit for revalidation or renewal if the ophthalmological examination confirms that:
(i)the better eye achieves distant visual acuity of 1.0 (6/6), corrected or uncorrected;
(ii)the better eye achieves intermediate and near visual acuity of 0.7 (6/9), corrected or uncorrected;
(iii)there is no significant ocular pathology;
(iv)a functional test in the working environment is satisfactory; and
(v)in the case of acute loss of vision in one eye, a period of adaptation time has passed from the known point of visual loss, during which the applicant is assessed as unfit.
(3)An applicant with a monocular visual field defect may be assessed as fit if the binocular visual fields are normal.
(g)Keratoconus 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.
(h)Heterophoria Applicants with heterophoria (imbalance of the ocular muscles) exceeding when measured with optimal correction, if prescribed:
(1)at six metres:
2.0 prism dioptres in hyperphoria,
10.0 prism dioptres in esophoria,
8.0 prism dioptres in exophoria and
(2)at 33 centimetres:
1.0 prism dioptre in hyperphoria,
8.0 prism dioptres in esophoria,
12.0 prism dioptres in exophoria may be assessed as fit provided that orthoptic evaluation demonstrates that the fusional reserves are sufficient to prevent asthenopia and diplopia. The Netherlands Optical Society (TNO) testing or equivalent should be carried out to demonstrate fusion.
(i)Eye surgery
(1)After refractive surgery or surgery of the cornea including cross linking, a fit assessment may be considered, provided:
(i)satisfactory stability of refraction has been achieved (less than 0.75 dioptres variation diurnally);
(ii)examination of the eye shows no post-operative complications;
(iii)glare sensitivity is normal;
(iv)mesopic contrast sensitivity is not impaired;
(v)evaluation is undertaken by an ophthalmologist.
(2)Cataract surgery Following intraocular lens surgery, including cataract surgery, a fit assessment may be considered once recovery is complete and the visual requirements are met with or without correction. Intraocular lenses should be monofocal and should not impair colour vision.
(3)Retinal surgery/retinal laser therapy
(i)After successful retinal surgery, applicants may be assessed as fit once the recovery is complete. Annual ophthalmological follow-up may be necessary. Longer periods may be acceptable after two years on recommendation of the ophthalmologist.
(ii)After successful retinal laser therapy, applicants may be assessed as fit provided an ophthalmological evaluation shows stability.
(4)Glaucoma surgery A fit assessment may be considered six months after successful glaucoma surgery, or earlier if recovery is complete. Six-monthly ophthalmological examinations to follow up secondary complications caused by the glaucoma may be necessary.
(5)Extraocular muscle surgery A fit assessment may be considered not less than six months after surgery and after a satisfactory ophthalmological evaluation.
(j)Visual correction Spectacles should permit the licence holder to meet the visual requirements at all distances.