Laser pointers and aviation safety.

Laser pointers have been used by teachers and lecturers for years to highlight key areas on charts and screens during visual presentations. When used in a responsible manner, laser pointers are not considered to be hazardous. However, as the availability of such devices has increased, so have reports of their misuse. The Food and Drug Administration (FDA) issued a warning in December 1997 on the possibility of eye injury to children from handheld laser pointers. In October 1998, the American Academy of Ophthalmology upgraded an earlier caution to a warning, stating that laser pointers can be hazardous and should be kept away from children, after two reports of eye injuries involving young girls (age 11 and 13 yr). Of particular concern was the promotion of laser products as children's toys, such as those that can project cartoon figures and line drawings. Additionally, there have been reports involving the misuse of laser pointers (e.g., arrests made after police interpreted the red beam to be a laser-sighted weapon, spectators aiming laser lights at athletes during sporting events, cars illuminated on highways, and numerous incidents involving the illumination of aircraft). This technical note discusses physiological effects of exposure from a laser pointer, the regulation and classification of commercial laser products, and how the misuse of these pointers is a possible threat to aviation safety.

Monovision contact lens use in the aviation environment: a report of a contact lens-related aircraft accident.

BACKGROUND: The use of contact lenses to satisfy the distance visual acuity requirements for obtaining a civil airman medical certificate has been permitted since 1976. According to the Federal Aviation Administrations Guide for Aviation Medical Examiners, the use of monovision contact lenses is not considered acceptable for aviation duties. METHODS: A report is presented using information from a National Transportation Safety Board (NTSB) aircraft report (NTSB/AAR-97/03) of a nonfatal accident on a scheduled airline flight. Past studies on the use of contact lenses in the aviation environment are reviewed. RESULTS: On October 19, 1996, a McDonnell Douglas MD-88 aircraft, Delta Airlines Flight 554, was substantially damaged in an undershoot approach while landing at LaGuardia Airport, Flushing, New York. The approach, with less than favorable weather conditions, was over water to Runway 13 and the flight crew transitioned to visual references just above the decision height. During continued descent, the plane struck an approach light structure and the end of the runway deck, shearing off the main landing gear and sliding 2,700 feet down the runway. CONCLUSIONS: The NTSB determined that the probable cause of this accident was the inability of the pilot to overcome his misperception of the airplane's position relative to the runway, due to the use of monovision contact lenses. The adverse effects of wearing contact lenses in the aviation environment are discussed.

Motorist vision policy.

BACKGROUND: The primary purpose of public policy requiring vision testing for driver license renewal is to identify individuals with functional vision impairments and, when necessary, to restrict their driving. This is based on the presumption that poor vision is causally related to poor driving and traffic crashes. METHODS: The AOA Environmental and Occupational Vision Committee performed a synthesis of relevant empirical literature on policy-based research and developed potential options for enhancing traffic safety. RESULTS: Presently, some states require vision testing for driver's license renewal and some do not. Regional and nationwide studies report that vision-related license renewal policies are associated with enhanced traffic safety. However, contemporary vision screening tests may be of limited value in identifying individuals with functional vision impairments. CONCLUSION: The most cost-effective and valid method for identifying, treating and counseling visually impaired drivers is to require a comprehensive eye examination as a condition for driver license renewal for those with a high prevalence or high probability of vision impairment.

Clinical application of the new civil airman vision standards and certification procedures.

INTRODUCTION: The final rule revising the civil airman medical standards became effective September 16, 1996. The purpose of this study was to review changes in the vision standards and procedures and how they relate to the clinical optometrist. METHODS: Revision of Airman Medical Standards and Certification Procedures and Duration of Medical Certificates; Final Rule, (14 CFR, Parts 61 and 67) and the Guide for Aviation Medical Examiners, published by the Federal Aviation Administration's Office of Aviation Medicine, were reviewed, and those parts pertaining to the clinical optometrist were summarized. DISCUSSION: The uncorrected distance visual acuity standards for first- and second-class airmen have been deleted. New equivalent near-vision standards were established for all classes of airmen. A major change--for pilots > or = 50 years of age--was the addition of an intermediate vision requirement of 20/40 or better at 32 inches for both first- and second-class medical certificate holders. Although the third-class medical certificate is still valid for 24 months after the date of examination for those > or = 40 years of age, the certificate is now valid for 36 months for those < 40 years of age. CONCLUSION: The new vision standards primarily affect the elderly pilot. Ophthalmic considerations in the application of the new vision standards are reviewed.

Vision impairment and corrective considerations of civil airmen.

BACKGROUND: Civil aviation is a major commercial and technological industry in the United States. The Federal Aviation Administration (FAA) is responsible for the regulation and promotion of aviation safety in the National Airspace System. To guide FAA policy changes and educational programs for aviation personnel about vision impairment and the use of corrective ophthalmic devices, the demographics of the civil airman population were reviewed. METHODS: Demographic data from 1971-1991 were extracted from FAA publications and databases. RESULTS: Approximately 48 percent of the civil airman population is equal to or older than 40 years of age (average age = 39.8 years). Many of these aviators are becoming presbyopic and will need corrective devices for near and intermediate vision. In fact, there has been approximately a 12 percent increase in the number of aviators with near vision restrictions during the past decade. Ophthalmic considerations for prescribing and dispensing eyewear for civil aviators are discussed. CONCLUSIONS: The correction of near and intermediate vision conditions for older pilots will be a major challenge for eye care practitioners in the next decade. Knowledge of the unique vision and environmental requirements of the civilian airman can assist clinicians in suggesting alternative vision corrective devices better suited for a particular aviation activity.

Aphakia and artificial lens implants in the civil airman population.

The Federal Aviation Administration allows civilian airmen with aphakia to fly with waivered certificates. This study analyzes, in the civil airman population, the distribution of aphakia and intraocular lens (I.O.L.) implant by type (unilateral, bilateral), class of airman medical certificate, and gender, for a 4-year period (1982-85). Medical records were individually evaluated for all certified airmen who were carrying FAA-specific codes for the pathology categories during the study period. The prevalence of both aphakia and I.O.L. increased most for bilateral type and second-class certificate holders. During the study period, the prevalence of aphakia increased most for males and I.O.L. increased most for females. The incidence declined in both pathology categories during the later years of the study period. Implications for aeromedical certification of the increasing prevalence of aphakia and I.O.L. in the civil airman population are discussed. The modification of surgical procedures for cataract extraction and evolution of I.O.L. devices strongly suggests continued specialized aeromedical certification and clinical research review.

The prevalence and aeromedical certification considerations of contact lens use by civilian pilots.

Federal Aviation Regulations permit the routine use of contact lenses by civilian pilots to satisfy the distant visual acuity requirements for obtaining medical certificates. Specific information identifying the prevalence of contact lenses in the civil airman population is required to guide future medical certification decisions, policy changes, and education safety programs to aviation personnel. A descriptive, retrospective epidemiologic study was performed of active airmen by 5-year intervals for a 20-year period (1967-1987) using FAA data-bases and publications. The percentage of airmen who use contact lenses quadrupled during the study period. When stratified by class of medical certificate and age, the prevalence rates for airmen with first-class medical certificates and older airmen showed the largest increases. A summary is provided of aeromedical certification factors that an optometrist and/or ophthalmologist should consider while fitting an airman with contact lenses. The increasing use of contact lenses indicates a need for ongoing review of adverse changes and safety consequences for pilots. Key words: vision; contact lens; epidemiology; medical certification.

Effect of simulated altitude on the visual fields of glaucoma patients and the elderly.

We investigated whether mild hypoxia, such as may be encountered in civilian aircraft, causes temporary visual field defects in elderly persons or temporarily increases pre-existing defects in persons with glaucoma. The central 24-2 program on the Humphrey automated perimeter was used to test visual fields in 3 groups of subjects: 6 with glaucoma; 12 age-matched controls, all of whom were over 44 years of age; and 6 normal subjects under 36 years of age. Visual fields were tested at ground level and at simulated 3000 m (10,000 ft) in an alternating sequence. A repeated measures design of multiple analysis of variance was used to analyze the data. Altitude was found to have no effect on the visual fields of subjects with glaucoma, age-matched normals, or younger subjects. We found no evidence to suggest a change in the present Federal Aviation Administration (FAA) standards, which allow a special certificate to be issued to persons with glaucoma who wish to obtain medical clearance to operate civilian aircraft, nor have we found any evidence that should discourage glaucoma patients from flying as passengers.

Functional model of an eye protection program: guide for the clinical optometrist.

An eye protection program is needed in occupational medicine policies. Typical eye injuries and eye accidents, as they relate to occupational accidents, justify the management advocating such a program. A recommended model for a functional eye protection program is provided and defined.