AOPA Pilot Magazine - May 2013 - 26

FLY WELL

BY DR. JONATHAN M. SACKIER

A clear picture
Avoid flying in clouds caused by cataracts

DR. JONATHAN
SACKIER is a
surgeon and
private pilot
living in Virginia.
He is a resource
for the AOPA
Pilot Protection
Services plan.

26 | AOPA PILOT May 2013

IMAGINE A THUNDEROUS waterfall blocking a cave
entrance—clear water turned white by circumstance.
This is appropriate imagery for cataract (Latin cataracta, “to dash down”). And down is how aviators feel
when hearing “you have cataracts.”
Your eye is amazing—eyelids, lashes, and tears protect
against foreign objects, desiccating wind, and the sight
of annual inspection bills. Incoming light is focused by
the delicate cornea and penetrates the iris, which dictates how much enters this adjustable aperture. The
lens further focuses images; surrounding muscles allow
shape change, adjusting focus as necessary. Light strikes
the retina where specialized cells interpret images,
transmitting to your brain. The crystal-clear lens is constructed of specialized cells and if orientation, protein,
or water content changes, opacities develop, clouding
vision. Age most commonly instigates such changes, but
other factors contribute. Smoking, hypertension, and
diabetes affect the lens—yet another reason to avoid cigarettes and maintain a healthy diet and weight. Physical
or thermal eye trauma and using certain medications
may also be a factor, as is chronic exposure to sunlight;
pilots may be more susceptible to cataracts, so wear
decent sunglasses.
Earliest symptoms include sensing that sight is “not
quite right,” such as spectacle wearers constantly cleaning their glasses thinking dirt is impairing their vision.
Bright lights may become troublesome and colors might
take on a yellowish tinge. Areas of view may be fragmented; a section of the panel, for instance—and, for
reading, people may require more light. Regular eye
exams make sense and pilots should have this in advance
of their AME visit so any issues potentially impacting
flying privileges can be dealt with in an orderly manner. However, if symptoms appear suggesting cataracts,
have your eyes checked pronto. If both visual fields are
impacted, without surgery an airman will receive medical denial. If only one eye is affected, special issuance
certification may be possible.
There is evidence that diets rich in lutein (kale, spinach) and zeaxanthin (saffron, berries, peppers, corn)
and taking a statin drug may lower cataract risk.
There are no current medical cures; therapy is limited to surgery. First, a full assessment of eye anatomy
and function is made to plan the procedure. Under

local anesthesia (eyedrops and possible injection), perhaps with a little sedation to squash anxiety, the pupil
is dilated with drops. Under microscopic guidance, a
tiny cut is made into the eye, possibly by laser; the lens
capsule is entered; and a James Bond-like instrument
squishes the lens and then sucks it up—medicine’s fancy
word for that is phaecoemulsification. Next, an artificial
lens is slipped into the capsule and the operation is over,
usually within 45 minutes. Post-operative pain is easily
controlled with tablets, and eye drops prevent infection
and control swelling. An eye patch during sleep is recommended to prevent inadvertent rubbing. Although
some precautions are advised for a short while—avoiding windy days, shampoo, and make-up—vision will
soon improve. With the most commonly implanted unifocal lenses, most patients will require reading glasses,
although by the age cataracts appear (after age 50) the
majority would have been using them anyway. Some
will additionally require spectacles or contact lenses
to perfect distance vision. More expensive implantable
multifocal lenses may obviate the need for any further
eye correction. If one has cataracts in both eyes, surgery
may be performed on one side at a time for a number of
reasons. Although frustrating because of the resultant
unbalanced vision, the gap usually is only a few weeks.
All operations have potential complications and
although uncommon, you need to be aware of them and
ask good questions. Some are serious, such as retinal
detachment; and others, such as lens capsule thickening, may occur years later. With prompt attention these
can be addressed.
Once your vision stabilizes, you must meet the standards for the class of medical required and the surgeon
should complete FAA Eye Exam Form 8500-7 (www.
faa.gov/documentlibrary). This should be presented
to the AME at the next medical. If spectacles or contacts are required one has to achieve the necessary
standard for “corrected” vision. With multifocal lenses
(e.g. Crystalens), a mandatory three-month grounding
is imposed until clearance is obtained.
So while a haze around a loved one’s face may be
romantic, and piloting in IMC challenging, don’t cloud
the issue—fly well and get your peepers checked. AOPA
EMAIL jonathan.sackier@aopa.org

http://www.faa.gov/documentlibrary http://www.faa.gov/documentlibrary

AOPA Pilot Magazine - May 2013

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