Refractive Surgery For Aviation Personnel: How To Correct Refractive Errors Without Compromising Flight Aptitude?"

The professionals in the air transport industry have strict visual requirements when performing their duties. Although refractive surgery procedures are becoming safer and more efficient, it is important to be aware of the ophthalmological standards for flight aptitude before performing any intervention in this particular population. The purpose of our study is to analyze the refractive and functional results of refractive surgery among flight crew as well as its impact on aeronautical expertise.

The Aircrew Medical Expertise Center in Rabat-Morocco

This is a 12-year retrospective study of 112 eyes of 55 patients who underwent refractive surgery to correct myopia and/or myopic astigmatism. Patients are members of the Moroccan military and civilian airflow, which is subject to regular medical assessments according to well-regulated legal standards at the Aircrew Medical Expertise Center. Preoperative evaluation criteria included refractive errors and corneal astigmatism assessed by corneal topography. Postoperatively, we analyzed the refractive and functional outcomes, persistent adverse effects that could compromise flight safety (glare, impaired night vision and reduced contrast sensitivity), as well as the impact of surgery on aviation qualifications.

The most common procedures were Lasik in situ keratomileusis (55%), Photorefractive keratectomy (21%) and phakic implants (18%). Postoperative outcomes were considered as good if visual acuity (with or without correction) was at least 20/30 for each eye in the civilian flight crew, which corresponds to the minimum visual acuity required in Moroccan civil aviation. For military pilots, a corrected visual acuity of 20/20 for each eye was necessary for the operative results to be considered as good. All pilots need to go through a waiver procedure to maintain their flight fitness, subject to the normalcy of their contrast sensitivity and glare resistance. We observed 84% of good results against 16% of poor operative outcomes.

Our study highlights the multifaceted role of the ophthalmologist when performing refractive surgery for flight crew members. In addition to serving as a skilled surgeon, the ophthalmologist must also act as an advisor and an expert in aviation safety to ensure optimal outcomes for this particular population. In fact, visual function is a paramount safety factor in aviation. Hence, any ophthalmic intervention needs a meticulous ophthalmological assessment in compliance with prevailing standards.