Fly Well

Is it a bird? Is it a plane?

February 1, 2012

Sackier Who didn’t love Superman and his alter ego, Clark Kent? Flying was my favorite superpower, followed by X-ray vision, depicted by laser beams shooting out of Superman’s eyes. If you cannot see Lois Lane in peril from a hundred yards without spectacles and want to explore options, pop into an alley, pull your undies over your trousers, and zoom off to see an ophthalmic surgeon to consider laser eye correction. With advertisements proclaiming, “Perfect vision or your cash back.” I thought it time to shed light on the therapy.

The human eye is marvelous; light penetrates the windshield (cornea) at the pupil, an opening in the iris, which changes shape rapidly adjusting for lighting conditions. Inside, the lens thickness varies depending on how light needs to be bent (refracted), further focusing images. An inverted picture is projected on the retina, thence to the brain via the optic nerve where it is flipped right-way up allowing you to see that tall building you need to leap over. Our eyes have other cool equipment—lids offering protection from debris, windshield washers, and muscles providing mobility.

Problems seeing distant taxiway signs imply nearsightedness (myopia)—the eye is too long for its optical system. Others cannot see close up (hyperopia), while corneal warping (astigmatism) causes distortions in the horizontal and/or vertical planes—the kind you see, not fly. All can be addressed with eyeglasses or contact lenses. Overnight “training lenses” (orthokeratology) improve sight but are not comfortable or acceptable for all patients.

If you pursue activities such as flying, skiing, scuba diving, or others requiring good sight, eyeglasses or contact lenses may not suit you. If avoiding outer lenses appeals, consider laser refractive surgery.

Find a good eye surgical practice, talk to others, and research web assets such as the FDA and consumer-scoring sites. Ascertain your doctor’s experience and results, but do not be pressured into going ahead. Some centers engage ophthalmologists to evaluate your suitability. If you wear contact lenses, switch to glasses for several weeks before examination to prevent lens-induced corneal shaping interfering with accurate surgical planning. Assessment includes measuring degree of correction required, building a 3-D map of your cornea, and measuring its thickness; if too thin, surgery is not safe. Pupil size is noted and if too large, surgery may not be recommended as halos around bright lights or double vision may ensue.

Various infections, autoimmune diseases, diabetes, chronic dry eye, or prior surgery may disqualify you, as does participation in high-impact sports. Operation should be deferred during menopause or until eye growth is complete (over age 18). Insurance rarely covers this surgery; although expensive, in this economy prices have dropped.

Performed as an outpatient with oral sedatives and local anesthetic drops, surgery is painless, although pressure and dimmed vision occur from application of instruments and while staring at a light facilitating laser positioning. LASIK (laser-assisted in situ keratomileusis) is most commonly performed. First, a corneal flap is lifted, having been cut with blade or laser, rather like a trap door, exposing the internal corneal layer. Laser pulses—programmed from preoperative evaluation—reshape tissue, changing refraction characteristics. A clicking sound is heard during laser firing; some say they detect a singed-hair aroma. The flap is replaced and the patient discharged wearing an eye patch and with eye drops prescribed. Other rarely used options include radial or photorefractive keratotomy (RK or PRK), where corneal slits are cut or a technique used where laser induces shape change. Many have both eyes treated at the same time; others choose treatment one eye at a time. Recovery is swift with analgesics relieving discomfort and irritation. Avoid eye rubbing, which can have negative consequences.

No therapy is risk-free, so ensure you are fully informed. Perfect uncorrected vision may not result, requiring eyeglasses postoperatively and, if formerly myopic, you may find near vision deteriorates necessitating reading glasses; eventually, visual keenness may regress. Quality and acuity must be considered, and some will develop dry eye, requiring treatment. With age, accommodation failure develops (presbyopia), impairing near vision. Monovision correction by contact lens or laser involves one eye set up for reading, the other for distance. However, depth perception and image quality suffer. If considering laser monovision correction consider a contact lens trial period first.

Gary Crump, AOPA’s director of medical certification, stated, “All FDA-approved refractive procedures are FAA allowable. Postoperatively, self-ground until recovered and visual acuity stabilizes, meeting standards for the class of medical privileges being exercised. The FAA requests, but does not require, Form 8500-7 Eye Evaluation completed by the treating eye doctor, submitted after vision has stabilized. Alternatively, present it to the AME during your next FAA physical allowing office issuance, assuming no other issues.”

Do your homework, put your glasses on, and read the fine print. For some people, quality of life is enhanced.

I appreciate the advice I received from Dr. John Corboy.

Email the author at jonathan.sackier@aopa.org.

Jonathan Sackier