Ophthalmology: Ophthalmology and Naval Aviation Flashcards
Types of Cataracts
- Nuclear Sclerotic
- Cortical
- Posterior Subcapsular
Symptoms of cataracts
Decreased VA
Both with bright light and issues with glare during nightime
Nuclear Sclerotic Cataracts
Yellow-brown nucleus from aging
Cortical Cataracts
Whitish clefts or spokes
From aging or trauma
Posterior Subcapsular
Central posterior frothy plaque with night-time glare and halo complaints
Treatment for Cataracts
Surgical with IOL (intra-ocular lens)
True/False
All patients with cataracts require a waiver
True
If vision is 20/20 BCVA or better and pt has a negative glare test, they can continue flying without surgery requirement (may need Ophtho follow-up every 6 months due to risk of progression)
Pilot with cataract and BCVA less than 20/20…
…disqualified from flying until successful surgical removal
Note: waiver to SG 1 may be considered after surgery, provided VA returns to 20/20, is within refraction limits, and Glare test is negative (normal)
True/False
Post-surgery waivers for lens implant (during cataract surgery) are usually given to patients with multi-focal lenses
False
NO multi-focal lenses in order to be considered
Three classes of photopigment found in retinal cone cells
- Red
- Green
- Blue
Genes that specify the ____ and _____ sensitive photo-pigments are located on the X chromosome
Red and Green
Remember: ordering Red and Green chile in New Mexico is called “Xmas”
The gene that specifies the _____ photo-pigment is located on chromosome 7
Blue
Protanopia
Red Defect
First described
Deuteranopia
Green Defect
Second described
Tritanopia
Blue Defect
Third described
All 3 photo-pigments intact, but one has reduced sensitivity
Anomolous Trichromatism
MOST COMMON
- Red = protanomaly*
- Green = deuteranomaly*
- Blue = tritanomaly*
True/False
Monochromatism (one functioning photo-pigment) is rare
True
Roughly 0.003%
Dichromatism
Two functioning photo-pigments
- Red defect = protanopia*
- Green defect = deuteranopia*
- Blue defect = tritanopia*
Red-Green Color Deficiency
Protan and Deutan defects
True/False
Women have a higher prevalence of red-green color deficiency
False
- Prevalence in men = 8%*
- Prevalence in women = 0.40%*
PIP passing requirements
12 of 14 correct (testing for color vision)
Remember: 8% of males fail PIP
Note: PIP stands for pseudoisochromatic plates
How many seconds per slide while conducting a PIP
3 seconds
How many males fail a FALANT
approx. 5%
* Only allowed for aviators who have been “grand-fathered” in*
* FALANT stands for Farnsworth Lantern*
Pass for FALANT
First run 9/9 = pass
- Need 16/18 to pass “second run” (tests two and three if < 8/9 on the first)*
- Note: 2 seconds to view each presentation as opposed to PIP which is 3 seconds per slide*
Computerized Color Testing
Rabin Cone Contrast Test (CCT) - USAF aviation standard
Waggoner Computerized Color Vision Test (WCCVT) - world wide civilian use
Uncorrected VA varies with class
SG1 20/?
SG1 20/100
Pass for CCT
55+ in each eye
Note: monocular testing
Pass for WCCVT
“Mild” or “Normal” (computer generated)
Note: binocular testing
Hardest color vision test to pass
PIP
FALANT is easier (5% fail compared to 8%)
FALANT is ___% sensitive for CVD
35% (allows mild to pass)
Computer tests are 99% sensitive/specific
Ways applicants “cheat” color vision testing
- X-chrome contact lens
- Tinted glasses
- Wrong lighting
- Wrong test distance
- Memorizing test
Uncorrected VA varies with class:
SG1 = 20/?
SG1 20/100
Uncorrected VA varies with class:
SG2 = 20/?
SG2 20/200
Uncorrected VA varies with class:
SG3 20/?
SG3 20/400
True/False
Rotary Wing Aircrew must have 20/100 uncorrected VA (same as SG1)
True
True/False
Amblyopia is typically waived for applicants
False
Pathologic vision loss is also NOT waived for any class (i.e., optic neuritis, retinopathy, etc.)
“Goodlite” for SNA (uncorrected)
20/40-0
Goodlite (BCVA) for SNA and Aviators
20/20-0
“Goodlite” for SNFO, Aircrew, etc.
20/20-3
Stereo Vision is required for…
SG1, SNFS, Helo aircrew
NO waivers considered for aviators in actual control of aircraft
“Pass” for stereo vision:
AFVT
Verhoeff
Randot
AFVT = line “D” (25 arcsec)
Verhoeff = 8/8
Randot = 40 arcsec
Waiver requests for defective stereo vision must include a complete exam with _________ from waiver guide filled out entirely.
ocular motility worksheet
Risk factors for retinal detachment
- Myopia > -8.00 D
- Age
- Head Trauma
- Diabetes
- Lattice Degeneration of peripheral retina
Symptoms of Retinal Detachment
- Curtain of blur
- Flashing lights
- Floaters
- VA loss
- Macular detachment
- Peripheral Field Loss
Retinal Detachment Waivers can be requested ____ to ____ weeks following laser treatment
4-6 weeks
Note: 3 month wait for intraocular surgery
Central Serous Retinopathy
Symptoms of CSR
Sudden, painless decrease in central vision or metamorphopsia (distorted vision)
- Note: usually found in males with type A personalities (think aviators/surgeons)*
- Idiopathic, associated with recent steroid use*
Disposition for CSR
CD (waiver considered for designated personnel)
- Must remain down until complete VA recovery (spontaneous recovery usually within several weeks)*
- Repeated attacks can lead to permanent vision loss (focal laser ablation of leaks is considered for chronic/recurrent CSR)*
Waiver Requirements for CSR
Normal Amsler Grid
Asymptomatic vision
Baseline BCVA of 20/20
AMS and copy of last aviation duty exam
Copies of all eye care notes
Limits for phorias Class I
6 Esophoria
6 Exophoria
1.5 Hyperphoria
Note: no waivers for SNA applicants outside limits
Class II/III limits for phorias
NOHOSH or NOTOSP
True/False
History of eye muscle surgery at ANY age is CD for any aviation billet that requires stereopsis with NO waivers considered for Class 1 applicants
True
Note: waivers considered for Class II and III (Helo/SAR = NO waivers)
Pterygium (extends to the cornea)
less than 1mm is NCD (waivers considered for greater than 1 mm if asymptomatic with VA 20/20)
Pinguecula
- Benign growth (plural = pingueculae) similar to a callus except on the conjunctiva*
- Note: pinguecula can become pterygiums*
“Surfer’s eye” or “Farmer’s Eye”
aka Pterygium
People who spend long hours in the sun or in dusty/dry conditions are at increased risk
Possible risk of pterygium surgery
Astigmatism (refractive error causing blurry or distorted vision)
Treatment for allergic conjunctivitis
Prescription ophthalmic antihistamines and mast cell stabilizers
OTC or prescription vasoconstrictors/decongestants/corticosteroids are NOT approved
High IOP without any vision loss or nerve cupping
Ocular HTN
Optic nerve disease characterized by a pattern of VF loss and optic atrophy associated with cupping of the optic nerve
Glaucoma
True/False
Laser treatment to angle/iris is acceptable for Glaucoma waiver
True
Note: open angle glaucoma requiring incisional surgery will NOT be considered
True/False
Narrow angle glaucoma will be considered for waiver after surgical OR laser treatment
True
Unlike open angle glaucoma where incisional surgery is CD without a possible waiver
General Waiver considerations for Glaucoma
Minimal visual field loss (without miotic pressure drops)
Acceptable drops = prostaglandins, B-blockers (must be asymptomatic), and carbonic anhydrase inhibitors
Keratoconus
Progressive corneal ectasia (thinning/bulging)
- Findings:*
- increase in myopia and astigmatism*
- cone seen on red reflex with dilated pupil*
- “Fleisher ring” (iron line at cone base)*
Fleischer Ring (seen in Keratoconus)
True/False
Keratoconus is CD in applicants and designated personnel
True
CD for applicants, but “case-by-case” for designated personnel
- Class I aviators require corneal cross-linking treatment at DOD center*
- Class II-IV may have procedure performed at civilian center*
Retinal Vascular Occulsion
Iris Synechiae (iris-lens adhesion)
Seen in Anterior Uveitis: pt with pain and photophobia, ciliary flush, anterior chamber cells and flare-WBCs/protein
Etiology of Anterior Uveitis
- Trauma
- Systemic Inflammatory Disease (Reiter’s, Sarcoid, Ankylosing Spondylitis, RA)
- Systemic Infection (Syphilis/TB)
- Idiopathic (50% - initial, 30% recurrent)
Waiver Guidelines for Anterior Uveitis
3 month wait after off meds (only for single idiopathic or infectious)
Recurrent, severy, posterior, or systemic inflammation elsewhere makes waiver unlikely (typically requires PEB for continued Naval Service)
