New refractive surgery procedures in ophthalmology and the influence on Pilot's fitness for flying.
During the last years more and more procedures came up to render people with refractive errors possible to see without contact lenses or glasses. The different procedures for hyperopia, myopia and astigmatism are performed in increasing numbers in hospitals, laser-centres and in private practise. Modern radial keratotomy was introduced in the late 70 by the Russian Fjodorov. Because of the many complications this procedure was replaced by other procedures. Photorefractive keratectomy (PRK) was introduced in 1985, using an excimer laser to vaporize corneal tissue. Because of the side effects as pain and glare and the limited indication area Laser in situ keratomileusis (LASIK) was developed. In this procedure a corneal lamella is cut in, flapped back and the excimer laser vaporize the corneal tissue. These two procedures are mostly applied nowadays. But there are also new techniques that are still in an experimental state. One of that is the implementation of an intrastromal corneal ring that can reduce myopia up to 4 diopters. During the laser thermo keratoplasty 8 to 16 laser applications are performed in the periphery of the cornea to reduce hyperopia up to + 5 diopters. Another refractive surgery procedure is the phakic intraocular lens implantation for high myopia and +3 to +10 diopters hyperopia and the clear lens extraction with intraocular lens implantation for high hyperopia. The Joint Aviation Authority Requirements allow a hyperopia and myopia for commercial pilots of 3 diopters. Some pilot candidates with higher refractive errors undergo refractive surgery. But there are also pilots who are customers of the refractive operating ophthalmologists to get rid of the crutch glasses. This paper gives an overview about the refractive procedures that are performed nowadays on pilots and pilot candidates and gives information about the relevant indications and complications of refractive procedures in the aviation environment.
Stern
C
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Institute of Aerospace Medicine, German Aerospace Center DLR, Linder Höhe, D-51146 Cologne, Germany. Claudia.Stern@dlr.de
D000328:Adult; D000337:Aerospace Medicine / Q000592:standards*; D000401:Aircraft; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D008875:Middle Aged; D009216:Myopia / Q000601:surgery*; D017410:Practice Guidelines as Topic