August 2014- The most commonly performed operation worldwide is cataract surgery. By the time you reach the age 65, you most likely have the beginnings of cataracts in one or both eyes and early onset is possible at a much younger age.
The good news is that for most people, cataracts typically grow at a slow rate and the problem is easily remedied with a 15-minute operation. There’s a cost involved, however, and the cost can be substantial.
For many, dealing with cataracts can be postponed for years—but for pilots, the problem is not so easily ignored.
FAR 67 requirements
The vision requirements in FAR 67 are very specific and some things will disqualify you from issuance of a medical certificate, or at least require a special issuance.
If you have cataract surgery, you can be back in the air relatively quickly after being released by your surgeon. Requirements to do so include complete records of the surgery, a statement from the surgeon that you are completely healed and there are no adverse effects from the surgery, and a current FAA Form 8500-7 “Report of Eye Evaluation” attesting that you have no vision problems that would prevent issuance of a medical certificate.
It sounds formidable but it isn’t all that bad. Best of all, when you present the documentation to your AME, he or she can issue you a brand-new medical certificate then and there, provided something else isn’t wrong with you.
FAR 67.103 and 67.203 list distant vision requirements (among other things) for those pilots that hold a first- or second-class medical certificate. In both cases, the requirement is vision that’s 20/20 or better, either uncorrected or corrected, in each eye separately.
To be issued a third-class medical certificate, FAR 67.303 requires 20/40 distant vision or better, either uncorrected or corrected, in each eye separately.
Unfortunately, cataracts cause distant vision to degrade—slowly at first, but eventually reaching a severity that makes visual acuity impossible at 20/20, and given some time, even at 20/40.
What is a cataract?
A cataract is a cloudiness of a lens that is positioned between the cornea and the retina of the eye. As we age, cloudiness appears and then becomes greater and greater until colors fade, vision becomes blurry and glare from oncoming lights becomes blinding, making driving at night difficult and often dangerous. If untreated, a person can be rendered legally blind from cataracts.
As the condition worsens, external corrective measures like eyeglasses or contact lenses are ineffective. When that happens, it becomes impossible to pass the vision portion of a FAA medical examination.
To eliminate a cataract, the cloudy lens is removed surgically and a new lens is inserted into the eye. Insurance typically only pays for a lens that corrects for distant vision problems, though, so if you have astigmatism issues or difficulty with near or intermediate vision, you will have to cover that cost out of your own pocket.
Insurance and cataracts
Most private insurance plans will not cover cataract surgery until your distance vision degrades to 20/50. It is sometimes possible for a surgeon to request and receive a waiver from the insurer by showing that without surgery a cataract sufferer will incur significant lifestyle challenges or face unemployment.
It’s also possible for the surgeon to provide documentation that glare is degrading the person’s night vision to 20/50 or more even though basic vision is still better than 20/50. In that case, most private insurers will grant a waiver.
Medicare and cataracts
With Medicare, the 20/50 distant vision rule also applies, however, there is no procedure for requesting a waiver. In essence, a surgeon is taking a huge risk if he or she performs cataract surgery on someone who has distant vision better than 20/50 since an audit of the doctor by Medicare officials will likely result in a substantial fine and sanctions.
If, on the other hand, glare degrades the person’s night distant vision to 20/50 or worse, and the doctor has properly documented that the requisite tests for glare were done and confirmed the condition, chances are he or she will feel comfortable performing the operation.
Given that the alternatives are to either quit flying or pay the cost of surgery out-of-pocket, it would be prudent to seek a physician who feels your glare problem is severe enough to allow him to do the operation.
Waivers for vision better than 20/50, and glare waivers
The majority of private insurance companies will look favorably on a waiver request when an insured’s livelihood is involved, but for private pilots with nonqualifying cataracts (daytime distant vision better than 20/50), it isn’t so simple. An insurer often considers flying to simply be a hobby, regardless of how much flying means to a pilot.
All pilots can explore playing the “glare card,” though, if the surgeon is so inclined. Proving that night vision is 20/50 or worse due to glare will frequently result in private insurance coverage for at least a portion of the cost of the surgery.
For pilots with Medicare coverage—which is the coverage the great majority of pilots with cataracts are going to have—there is a greater challenge. Be sure to discuss this with a potential surgeon if he or she seems leery of repairing your basic distant vision because it isn’t 20/50 or worse.
Also go over the FAA documentation requirements before scheduling the surgery and make certain that the surgeon is willing to complete the paperwork, which is a requirement for keeping you in the air. Your AME can advise you about what the surgeon needs to provide before you go for your eye evaluation as well as supply you with an FAA 8500-7 form.
John Loughmiller is a 4,600-hour commercial pilot and CFII MEI-A. He lives in Kentucky with Donna, his wife of 40 years, and often commits random acts of aviation. Send questions or comments to editor@piperflyer.org.
RESOURCES
FAA Form 8500-7, Report of Eye Evaluation
faa.gov/documentLibrary/media/Form/FAA%20Form%208500-7.pdf
