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Cataract Options: LASIK Plus Intraocular

As the pilot population ages, one medical condition afflicts everyone and a second afflicts many. Presbyopia-the inability of the eye to accommodate for close-in focus-is a curse of middle age, setting in for most people between the ages of 40 and 50. The second condition-cataracts-afflicts most of the population, but not everyone requires treatment for it. In our October 2008 issue, we covered the leading choices for pilots facing cataract surgery. Generally, the FAA has no problem with cataract surgery, although the procedure must be reported. Longtime reader, eye surgeon and AME Dr. Steven Siepser wrote us recently to note that our October article overlooked some options for pilots facing cataract procedures. "The fourth option for cataract surgery," he writes, "is the use of an accommodating intraocular lens combined with laser vision correction for unencumbered maximum visual performance." Laser vision correction isn't a treatment for cataracts, but it does reshape and change the focusing power of the cornea, usually resulting in improved vision without glasses. As with cataract surgery, the procedure passes FAA muster, requiring a report to the FAA to explain the outcome. Barring any complications, it has no impact on medical issuance. The most common form of laser correction is laser in-situ keratomileusis or LASIK. The surgeon uses a microkeratome to lift a thin flap of corneal tissue, then an excimer laser is used to reshape the underlying corneal tissue. Cataract patients can also be candidates for laser correction, according to Siepser.

Aviation Consumer Staff
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As the pilot population ages, one medical condition afflicts everyone and a second afflicts many. Presbyopia-the inability of the eye to accommodate for close-in focus-is a curse of middle age, setting in for most people between the ages of 40 and 50. The second condition-cataracts-afflicts most of the population, but not everyone requires treatment for it. In our October 2008 issue, we covered the leading choices for pilots facing cataract surgery. Generally, the FAA has no problem with cataract surgery, although the procedure must be reported.

Longtime reader, eye surgeon and AME Dr. Steven Siepser wrote us recently to note that our October article overlooked some options for pilots facing cataract procedures. “The fourth option for cataract surgery,” he writes, “is the use of an accommodating intraocular lens combined with laser vision correction for unencumbered maximum visual performance.”

Laser vision correction isn’t a treatment for cataracts, but it does reshape and change the focusing power of the cornea, usually resulting in improved vision without glasses. As with cataract surgery, the procedure passes FAA muster, requiring a report to the FAA to explain the outcome. Barring any complications, it has no impact on medical issuance.

The most common form of laser correction is laser in-situ keratomileusis or LASIK. The surgeon uses a microkeratome to lift a thin flap of corneal tissue, then an excimer laser is used to reshape the underlying corneal tissue. Cataract patients can also be candidates for laser correction, according to Siepser.

Accommodation

Cataract treatments involving an artificial lens date to the 1940s, but these so-called intraocular lenses were rigid plastic, mono-focal devices giving a patient good focus at one distance only, usually distant. About a decade ago, multi-focal IOLs appeared. These lenses are able to distribute light over a range of optical zones to provide near, intermediate and distant vision, thus making patients far less dependent on glasses. However, multi-focal lenses produce more than one image on the retina, requiring a period of training and acclimatizing as the brain sorts through which image is the correct one. In 2003, Bausch & Lomb introduced a new kind of IOL which Siepser tells us is ideally suited for pilots. A second

Aviation Consumer Staff