LASIK Eye Surgery for Pilots: Go or No Go?

by Paul Engstrom, Aviation Writer

Imagine throwing away your eyeglasses or contact lenses because now you can see air traffic and hazards aloft and on the ground, read instruments, maps and charts, and perform other important visual tasks in the cockpit perfectly well without any eye gear.

Also, imagine feeling totally confident you'll ace the vision test "sans glasses" the next time your medical certificate comes up for renewal.

It's all possible, thanks to an increasingly popular surgical technique called LASIK.

However, just as you carefully weigh such factors as the weather, the condition of your plane and your own physical and mental state before takeoff, you should carefully weigh 'going under the knife' to improve your vision for the sake of flight unencumbered by corrective lenses.

The elective procedure does entail risks, isn't exactly cheap and rarely qualifies for health insurance coverage.

LASIK, or laser-assisted in-situ keratomileusis, has been on the scene for about 10 years. Using a tiny scalpel, the surgeon partially cuts through the top one-third of the cornea just above the pupil, folds the corneal flap back, vaporizes tissue underneath with a programmed excimer laser, then replaces the flap, which heals without sutures. This restores proper curvature to the eyeball so images are focused squarely on the retina.

Another laser procedure "PRK, or photorefractive keratectomy, which evolved from a technique in the 1980s called radial keratotomy" removes tissue only from the surface of the cornea. But its reshaping effect is similar to that of LASIK.

PRK is used primarily to correct near-sightedness, whereas LASIK can correct that condition as well as far-sightedness and astigmatism, an irregularly shaped cornea.

Typically, patients can return to work a few days after LASIK and their vision stabilizes within three months. The cost: about $1,200 to $2,500 per eye.

Advertisements suggest that the procedure is effective, convenient, painless and quick. And, true, the vast majority of patients have a successful outcome.

But Kim Broadwell, a physician and commercial pilot who lives in Rochester, N.Y., cites "the dark side of LASIK" that could have big consequences for aviators, namely:

• The risk of infection (in one to five of 10,000 corrected eyes).
  
• Complications (in about one of 100 eyes) that can lead to corneal scarring, which reduces sharpness of vision.
  
• Dry eyes that require lots of eye drops.
  
• Poor vision in dim light.
  
• Glare and halos around lights at night.
  
• Unknown long-term effects, if any. Van B. Nakagawara, an ophthalmologist, and his fellow vision researchers at the Federal Aviation Administration's Civil Aerospace Medical Institute in Oklahoma City, Okla., warn of other potential snags, including:
  Under- or overcorrection of the eye in surgery, which may entail a second operation or corrective lenses.
  
• A worsening of near-sightedness.
  
• Less ability to detect contrasts.
  
• Mild eye irritation, sensitivity to bright light and teary eyes for a few days after surgery.
  

The good news is that the FAA  doesn't require a waiver on your medical certificate if you undergo LASIK. You simply must meet the visual acuity standards for the class of certificate you want.

In addition, according to Nakagawara, 'an eye specialist must verify that surgical healing is complete, visual acuity is stable and no significant glare intolerance is present.'

Broadwell and other experts advise that you seriously consider the consequences if something goes wrong. In other words, does the small risk that LASIK could end your flying days really outweigh the inconvenience of wearing glasses or contact lenses?

They also suggest that:

• You learn as much as you can about the procedure. Maybe you're not a good candidate for LASIK.
  
• Make sure your pilot-oriented expectations are in line with what the surgeon can deliver.
  
• Consider other options, such as implanted intracorneal rings.
  
• Find a surgeon who has lots of experience performing LASIK, as that will boost the likelihood of success.
  

When he isn't flying, Paul Engstrom writes and edits from Sebastopol, Calif.

The information contained herein is meant for informational purposes only. Neither IFA, nor Paul Engstrom assume any responsibility or liability for events that occur due to actions you or others on your behalf take based on the information given in this article. You are proceeding at your own risk. It is strongly advised that you seek the opinion and advice of a qualified aviation medical examiner and appropriate medical physician for any medical needs you may have.