Technological changes and medical experience has brought forward a proliferation in the availability and options in eye surgery directed at improving visual acuity. Civil Aviation Medicine Branch has monitored the progress and has adapted the medical guidelines regarding certification for flight to reflect the growing body of knowledge and experience in this important area.

Which Procedure is recommended by Transport Canada (TC)?

TC's position in this regard is that refractive surgery is an elective procedure, i.e. a voluntary personal decision entered in to after careful consideration of the risks and benefits and discussions between the pilot and his/her attending physicians.

While there are many techniques available, some earlier methods are dropping out of favour while others are evolving rapidly both in technical precision and popularity. The list includes clear lens extraction, Radial Keratotomy (RK), Astigmatic Keratotomy (AK), Automated Lamellar Keratoplasty (ALK), Photorefractive Keratectomy (PRK), Laser-assisted in-situ Keratomileusis (LASIK), Laser Thermokeratoplasty (LTK) and Intrastromal Corneal Rings (ICR). The details of these procedures are beyond the scope of this document, further information is available from the Ophthalmology specialists community.

Which Surgical Centre does TC recommend?

TC’s Medical Advisors cannot direct prospective candidates to a specific service provider. There are many providers available, using a variety of techniques and having a wide range of experience and success. The watch word --- "Caveat emptor" BUYER BEWARE.

Why does TC have concerns about this procedure?

While the advances in this area of surgery have been impressive and the outcomes have improved in terms of fewer complications and shorter period of incapacitation, there are still issues that have a serious potential for affecting safety in flight. The most important risks from an aviation standpoint are loss of best corrected visual acuity, undercorrection, or overcorrection, fluctuation in vision at different times of the day, glare, "halo" or "starburst" effect due to corneal haze, loss of contrast sensitivity, loss of low contrast visual acuity and regression or return towards pre-operative refractive levels.

It is therefore, quite important that these concerns are adequately addressed in the post-operative period before a return to active operational flying is permitted.

How long does one have to wait before returning to flying?

Requirements for Medical Certification Following Refractive Surgery

What documents do I need to submit in order to reinstate my license after undergoing this procedure?

The PRK and LASIK (36kb) form and the RK (36kb) form need to be completed, either by the attending ophthalmologist or your optometrist, and should include the information concerning the pre-operative conditions, the date of the surgery, the type of procedure, the size of the ablation zone (area of surgery), the three month visual acuity situation and any comments concerning side-effects, such as haze, glare night vision problems, etc.

Note:

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Will I need any other reports?

TC/CAM is currently requesting a follow-up report at one year post-surgery in the same format as the original reports. This will enable CAM to compile statistics to assist in establishing guidelines for the future.

Who needs to know when this surgery has been done?

You need to inform the eye centre that you are a pilot/air traffic controller. They have an obligation to report your situation to TC Civil Aviation Medicine. You should inform your Civil Aviation Medical Examiner as he needs to up-date your file and ensure that you are aware of your obligations with respect to grounding yourself. While there is no requirement to inform the CAM office directly, you might want to consider it if you are in a career situation where return to authorized flying activities is a priority. This could alert CAM and help to expedite the re-cetification when the reports are ready.

Failure to inform TC/CAM about this surgical procedure could lead to Enforcement action should the circumstances come to light in the future. "Miraculous" improvements in visual acuity found at renewal medical examinations with your CAME will be vigorously pursued.

Non-disclosure to other aviation employers will undoubtedly result in a similar dim view of the situation. The majority of carriers will accept these procedures if Transport Canada has approved the medical certification. The exception to this rule is the Canadian Forces, where a history of refractive surgery is disqualifying for flying training or activity. (The military does corneal contour mapping, so any previous surgery is immediately obvious.)

What about "touch-ups"? Does that put the clock back to square 1?

Generally speaking, a touch -up is done to tweak up the visual acuity and doesn’t increase the occurrence of side effects. In these cases we would need a report at one month post-op to confirm the visual acuity and lack of side effects.

What about the restrictions printed on my current Medical Certificate referring to glasses or contact lenses?

After completing surgery that results in visual acuity which permit flying without corrective lenses, you will be issued with a new Medical Certificate.