Doctor offers tips for aging pilot eyes

October 23, 2013

Despite pilots experiencing vision disorders as they age, they can work with the FAA to ensure that they can keep flying, said Dr. Ingrid Zimmer-Galler, associate professor of ophthalmology at Baltimore’s Wilmer Eye Institute/Johns Hopkins Medical Institutions, during a session at AOPA Aviation Summit.

Advancements in treatment for eye diseases, including glaucoma, cataracts, macular degeneration, and retinal detachment, can help pilots achieve nearly 20/20 vision, helping them pass their next flight physical, said Zimmer-Galler.

Just as the average age of the U.S. aircraft fleet is increasing, pilots are aging as well, said Zimmer-Galler. “Half of pilots are 50 years old or older, and we have almost 6,000 pilots who are 80 years and older,” she said. “On one hand, it’s wonderful that pilots are flying longer. But on the other hand it fits with the trend that the pilot population is aging.”

Eyes are one of the first things that see the effects of age, said Zimmer-Galler. “One third of those 65 and older will have eye problems. One of the main ones is presbyopia, a condition where the eye loses its ability to focus on close objects,” she said. “It’s when your lens loses flexibility.”

When people are young, the eye lens can focus seamlessly,” said Zimmer-Galler. “But the lens begins losing its flexibility in the early 40s and that continues into the 60s,” she said. “The lens becomes flatter and more round. The best way to correct it is with reading glasses, bi- or trifocals, contact lenses, or refraction surgery.”

A common eye disease is cataracts, which are when the lens of the eye becomes yellow and cloudy. “Cataracts blocks and refracts light into shapes so there’s no clear image. By age 65, people will begin to experience some the effects of cataracts,” said Zimmer-Galler. “If it starts to affect your vision, then you need to think about cataract surgery. Many times, changing glasses will help, but the symptoms only get worse.”

The surgery has become the most common surgical procedure in the United States, said Zimmer-Galler. “The FAA has allowed standard cataract surgery for decades,” she said.

Another eye disease experienced by pilots is macular degeneration, said Zimmer-Galler. “It happens in the center of the retina, causing blurred vision in the center of vision. You don’t go totally blind. You keep your peripheral vision,” she said. “Age and genetics are the two biggest factors for those with the disease. One out of three people will get macular degeneration.”

There are wet and dry versions of the disease, said Zimmer-Galler. “Most people have the dry form, and with 90 percent of them, it does not lead to severe losses of vision and pilots are still able to fly,” she said. “But 10 percent of people get wet macular degeneration, which causes a severe loss of vision.”

But the good news is there are treatments available for wet macular degeneration if it’s caught early, said Zimmer-Galler. “If caught early, you can stabilize your vision at a good level,” she said. “But if you don’t catch it until you start getting vision loss, only one third of the time does your vision come back after treatment.” The disease is treated with antiangiogenics injections.

Finally, pilots can get glaucoma, when pressure on the eye is too high, causing damage to the optic nerve, said Zimmer-Galler. “The optic nerve has 1.5 million nerve fibers, and as you age, they go away. You are down to one million fibers by age 70,” she said. “But with glaucoma, you lose those fibers at a quicker rate. Risk factors are age, and African-Americans have a higher risk of getting the disease.”

With glaucoma, the change is subtle, as you gradually lose side vision, said Zimmer-Galler. “It’s important that you have regular eye screenings so you can catch the disease early so it can be treated,” she said. Treatments include medication and surgery.