Eye exam
11 min read

Before starting a discussion on the government’s pilot health issue du jour, cataracts, I want to tell you something about third class medical reform because there is a connection.

You might think that getting rid of the third class medical is something relatively new but it is not. The discussion had been going on for at least 70 years when it was resolved.

To illustrate this I offer a couple of passages from the old book Civil Aviation Medicine in the Bureaucracy, by Heber A. Holbrook, who was once the executive officer of the FAA’s Office of Aviation Medicine. The following passages are related to the rapidly declining private flying activity in 1946 and 1947.

“Private flying again turned to look suspiciously at federal regulator red tape as the cause of its woes. And once again the ‘medical dog’ was handy to whip as put by one observer of the scene.

The Non-Scheduled Flying Advisory Committee of the CAA told CAA Administrator T. P. Wright that only one physical examination should be required for student or private pilot licensure, a change that would eliminate the requirement for the two-year periodic repeat physical examination.”

You can imagine the heated debate that followed and in the end it seems the decision to retain the medical requirement was based on the fact that aviation had gone to hell in a handbasket all on its own, not because of any perceived red-tape threat, and that future development would be just fine with the medical requirements that existed.

Medical X

It’s been a goal for decades.

Now it might all be changing with less emphasis on red tape and more on education. At least we hope that will be the case.

In more recent times the health Nazis, as some call them, have launched crusades about things like blood pressure, sleep apnea, and now cataracts. They were threatening new rules but in its latest, on cataracts, the NTSB is apparently bowing to the demise of the medical and urging education. Undoubtedly such admonishments will continue and probably multiply as the third class medical goes away.

Despite the requirement for a medical, we have been self-certifying all along once leaving the AME’s office. Do I feel well enough to fly? You bet. Have at it.

To me, vision was always the toughest question. How you feel is obvious, vision is not, and the slow deterioration in what you see as you age is as insidious as it is certain. This can simply be the result of aging, or it can be related to cataracts or other conditions. The better you can see, the better, but how much is enough?

One thing is pretty certain about cataracts. If you are young, you probably don’t have them. If you are old, you might because the condition is part of the aging process for a lot of folks. For a clinical definition, Google it. For practical purposes cataracts result in things like cloudy vision, blurred vision, sensitivity to glare, and lights becoming starbursts.

The NTSB picked an interesting accident to highlight the subject. The pilot pranged a 172 on a night arrival three weeks after he had to have the help of a fellow pilot in a car to find his way off the runway and to the taxiway and his hangar.

The pilot had vision that was corrected to 20/20 but he had been diagnosed with cataracts. I thought it unusual that the NTSB picked this accident as an example because the pilot was 72 years old, had mild to moderate coronary artery disease, gout, high cholesterol, high blood pressure and major depression that was in complete remission. He was or had been taking the appropriate medication for all those things. According to his most recent medical certification examination he was 72 inches tall and weighed 251 pounds. The pilot had checked NO to all the questions about ailments and medications in section 18 of the medical application.

I mention all that because it strikes me that any number of things other than cataracts could have been causing problems. I’ll add that this is the first probable cause finding that I recall mentioning vision problems.

I did go back through NTSB accident reports and while cataracts were not often mentioned as a causal factor, in recent times they were mentioned more often in the narrative of an accident.

Eye exam

How much can you really see?

When cataracts are mentioned, there are also usually mentions of other things. Naturally, most of the pilots were old but most also had a list of medications and ailments that made me wonder if I would want to take all of that flying. The fact that I learned of this from accident reports lends a least a little credibility to my thoughts. It also illustrates why the NTSB might have chosen the accident mentioned for illustration. It could have been the one with the least other factors.

This made me think back to my last third-class exam and a remark that the AME made as he was signing the certificate: You know, Richard, neither one of us can see worth a @#$& but I guess we are still okay to fly.

My journey out of the world of perfect vision started on October 11, 1975.

I was 41 and had taken my 11-year old son to Harlingen, Texas, to the annual Confederate Air Force fly-in. It was a grand affair, we saw a lot of interesting things, got sunburned, and because I hadn’t made a hotel reservation we had to flee after the air show was over, in search of pillows. Something else must have been going on in the area because there was nothing available in Corpus Christi so we hopped on up to Houston.

Before I could find us a hotel room, though, I had to manage an approach to the big airport at Houston in the dark. What’s this? I couldn’t make out some of the numbers on the chart. So, with our son reading off what I needed to know, we arrived.

The next day I got fitted for my first pair of glasses.

As time ran I learned many times that vision correction always involves some compromise. I went through half glasses, bifocals, trifocals and Varilux lenses while trying to put a little youth back into my vision. The use of each had special requirements.

As I got older, I also learned a lot about what is called accommodation. Simply put, that is how well your vision handles the transition from looking at things up close to those far away. Or, how well you focus.

The aviation connection for me was most noticeable after a long flight that was in clouds, meaning I had been fixating on something close up, the instrument panel, for a long time before looking out front to land once in visual conditions.

I never had any trouble landing, but when a controller would tell me to turn left on taxiway echo, for example, I would invariable have to ask him if that was the next left.

That visual limitation reached a peak on the ramp at Wilmington, North Carolina, after several hours of cloud flying. We were meeting another couple, they landed right behind us, we parked, and they parked and were walking over as I unloaded our stuff. This was someone I had known for years and saw fairly frequently but I wasn’t sure he was Earl Tillman until he was within 10 or 15 feet.

172 on final approach

If you’ve been staring at the panel for two hours, how quickly can you focus on the runway?

I don’t go to doctors much but because of flying I did get my eyes checked by an ophthalmologist at least once a year and more often when needed, as after this encounter.

My vision had been corrected to 20/20 but in about nine months it had dropped to 20/70. Not only was there trouble with accommodation, I was literally flying blind. New glasses fixed that. No reason was offered for the change but I suspect that was when cataracts first started developing. Perhaps the most interesting thing about this is that I had compensated for the drop in visual acuity without knowing it was happening until it came time to see Earl on the ramp at ILM.

Glare had started to bother in the sense that it made the instrument panel more difficult to see when it was bright outside. This was especially noticeable on a sunny but hazy day. From this I learned why so many senior pilots wear baseball caps, especially of the long-billed variety. After I turned about 65 I always had a couple handy for every flight. Block the windshield with the bill and the panel brightens up.

I did recognize early-on that deteriorating vision was more a problem at night. I did stay night current until about six years before I stopped flying but I had done little night flying in the few years before that.

I checked my logbook and found my last night flying other than local had an interesting twist, especially given that as I sit writing this it is 09:26 on 9/11/2016 or 15 years and 40 minutes after the first airplane was flown into the World Trade Center and our world changed.

That last night leg was on 12/12/2001, three months and one day after the attack. I was returning from New Orleans with Tom Benenson of the FLYING staff. The National Business Aviation Association annual convention had been scheduled for soon after the attack, it was cancelled, and Tom and I were returning from a truncated version of the gathering that had been hastily arranged for the later date.

The weather was IFR and we were non-stop from New Orleans to Hagerstown, Maryland, my home base. It got dark an hour or so out and as I was descending and pondering the arrival, I though the 1,900 overcast and six miles visibility would be no hill for a stepper. The GPS approach to runway 9 would give me distance to the touchdown zone all the way in and, because this was before VNAV, I could to use my old brain to create a safe descent profile.

All this worked well but I still had a feeling that I was flying in an eerie place, with less visibility than was reported. Maybe my cataracts had reached the point where they were playing tricks with lights and this was enhanced by the slight obstruction to visibility.

After that, my night flying was limited to one more outing to do the required takeoffs and landings for night currency. I don’t recall why I went to the trouble to do that.

Instrument approach G1000

Do glass cockpits mean pilots are spending more time looking inside these days?

After I retired my P210, I flew for about another year, in a Skylane and a Columbia 400 (now Cessna TTx), both with Garmin G1000 glass cockpits. They were both nice airplanes and I did enjoy flying with the new equipment. I had no vision problems doing this because my vision at light airplane instrument panel distances remains pretty good to this day. I don’t wear glasses at all for computer work, reading, or watching TV up close.

I actually wonder if vision considerations have changed for flying. When age starts making a difference, near vision is usually the first to deteriorate. Many a pilot has gone to the drugstore for half glasses to use on charts and the instrument panel. Now that would be the iPad or panel because charts are electronic. I think pilots of today spend a lot more time using near than far vision simply because there is more stuff to look at inside the airplane. For me, as age was running its course, my near vision improved even though far vision got worse. Cataracts probably influenced that.

Distance vision was always prized for seeing other traffic. The farther away you see them, the easier they are to miss, and we all know that small airplanes are hard to see at any distance. Now, though, many pilots look for other traffic on the instrument panel. Yes, looking outside for other traffic is still important but there is less luck involved when using electronics for seeing and avoiding other traffic.

If a pilot doesn’t have to get his vision checked by an AME, he’ll still need to pass a vision test for a driver’s license, at least until those self-driving cars become available. More important is for the pilot to be honest with himself about being able to see well enough to fly.

When it comes to impairment, vision is low on the list of pilot health problems that lead to flying problems but I think it is big on the list of things pilots need to think about as they get older.

The last research I did on pilot incapacitation/impairment suggested that about ten-percent of the fatal accidents included this in the NTSB finding of probable cause. Drugs, prescription, over-the-counter, and otherwise, are involved in half of these. That was with the third class medical requirement and I think it is 100-percent safe to say that the number will not increase as a result of the coming changes in medical requirements.

In closing, I have an observation to make. A while back I was well-roasted by a certain vocal and politically correct segment of the population for making fun of the fact that the keypad used to access the T-hangar area with my car included braille on the keys. Was airport management sending me a message?

Richard Collins
7 replies
  1. Hunter Heath
    Hunter Heath says:

    Richard, that’s a journey most pilots will take if they live long enough. In addition to cataracts, aging vision may be impaired by deterioration of the clear gel that fills the eye (vitreous collapse, with “floaters” or retinal detachment); macular degeneration that impairs central vision; glaucoma that can cause blindness in various areas of the visual fields; and difficulties fusing images from the two eyes (double vision). There are numerous other vision-reducing conditions. Especially important with diabetes mellitus no longer an absolute barrier to certification is diabetic retinopathy. Whether or not medical certification is required, my advice to older pilots is to develop a relationship with a good ophthalmologist and to have a careful examination every few years, or whenever there is any change of vision.

  2. Duane
    Duane says:

    The quality of vision obviously tends to deteriorate with age, although if maintaining good vision is important, it’s not terribly difficult for those who can afford to fly to also afford to do the visual maintenance and repairs necessary over time – including vision exams, treatment for glaucoma, cataracts, etc., as well as various forms of surgery available to correct vision problems including near-sightedness and far-sightedness.

    Vision is of course only one part of seeing. Maintaining a good scan both inside and outside the cockpit is a skill that is extremely important to piloting. No matter how good your vision is, it’s very difficult to spot traffic while practicing “see and avoid” due to various factors, and as Dick says, the more technology in the panel or on your lapboard, the less we tend to look outside.

    It seems that there is one fairly obvious partial solution that has been in use for a very long time in warplanes and even to a small degree in higher end automobiles – the head up display. It’s really not all that difficult to produce a HUD for use in private light aircraft, technically speaking. It just hasn’t been much in demand. The biggest trick is in connecting the necessary flight data inputs to a HUD, including not only basic six-pack data but also nav data and traffic data … as we evolve more and more into the world of electronic flight data and away from the old mechanical and electro-mechanical six packs, the data sources for HUD become readily available.

    One of the design features that seems useful is for aircraft designers and avionics designers is to design and build in a common open architecture flight data portal. Such a portal would allows data sharing across multiple and even redundant platforms, both panel-mounted and portable. Garmin has already marketed such a device, but the FAA’s disdain for portable, non-certified avionics data sources has been a hurdle. With the new Part 23 reforms plus FAA’s new willingness to allow non-TSA glass panel products in certified light aircraft, perhaps we are near to establishing a universal flight data portal architecture that would easily accommodate redundant data sources and support widespread use of HUD.

  3. Kenny Phillips
    Kenny Phillips says:

    One other insidious aspect of cataracts is the reduction in visual contrast. I remember walking into a friend’s house, looking at the TV his elderly father was watching, and commenting that perhaps Pop should get his cataracts fixed. The TV looked like an old-time black & white set with the contrast turned all the way up. The color was virtually gone. But it was good enough for him to watch Matlock. His kids took him to the doctor, and the cataracts were fixed, and the old man was likely a safer driver than previously (yep, he was still driving, looking through his fogged-up lenses!)

  4. Steve S
    Steve S says:

    Cataracts can really be an issue. I had them, didn’t know it and went back to my opthomologist for new glasses a few time. When I switched to a more competent opthomologist, he saw the cataracts in a heart beat.

    Before the cataract surgery, I was a 757 Captain and couldn’t see the copilot’s instruments… God forbid I let the copilot fly ….. After the surgery it was like someone turned on the lights, dramatic difference.

    I now pass the physical with 20/20 uncorrected.

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