AINsight: Recent FAA Medical Updates and Controversies

 - February 10, 2023, 12:41 PM
(Image: Image by arjun saini from Pixabay)

All pilots who require any type of vision correction to meet FAA standards will notice new wording on their next FAA medical certificate. While there used to be seven vision restriction choices the AME could place on a pilot’s medical certificate—such as “must wear corrective lenses” or “must have available glasses for near vision”—there is now only one such choice.

The FAA made this change to simplify things for both pilots and AMEs alike, although at first glance this new limitation can be a bit confusing to read.

Please keep in mind that this only applies to visual acuity limitations and does not apply to separate vision restrictions. These include letters of eligibility or waivers (Statements of Demonstrated Ability) for color vision deficiencies or other types of conditions requiring specific FAA approval such as amblyopia (lazy eye) or true one-eye monovision.

This new change reflects only those limitations for run-of-the-mill use of corrective lenses for distant, near, and, when applicable, intermediate vision. The only limitation choice is now “must use corrective lens(es) to meet vision standards at all required distances.”

On the face of it, the wording initially seems a bit odd. It gives the impression that the pilot must use some corrective lens (or lenses) for “all” distances. That is not the case, however. In its guidance to AMEs to use this new restriction, the FAA states that it must be placed “when corrective lenses are required to meet any [emphasis mine] of the visual acuity standards.”

For example, if a pilot needs to have only reading glasses in their possession to meet the near-vision requirements, the new restriction will be placed on their medical certificate but the spirit is still the same—have reading glasses with you. If a pilot wears unifocal contact lenses, unifocal glasses, bifocals, trifocals, or progressive lenses to meet any or all of the visual acuity requirements, the limitation placed on their medical certificate will be the same newer restriction noted above.

Nothing will change in regard to which corrective lens the pilot actually uses, just in the wording on their medical certificate. 

On a separate note, while not in great favor with the FAA, there is some acceptance of the newer multifocal contact lenses, which theoretically provide correction for both distant and near vision. There is a one-time “tap dance” (read eye evaluation data submission) to permit this, but the multifocal contacts are indeed approvable on a case-by-case basis.

While most of the admittedly-few pilots in my practice who are using these lenses seem to love them—as they report that they can see at distance quite well, without needing separate reading glasses for near vision—it is sometimes difficult to get their visual acuity to measure within FAA standards at all required distances at their FAA exams. Nonetheless, if they pass and the required eye evaluation data is favorable, the pilot gets their medical certificate.

All that said, the best news here is that the pilot’s subjective experiences with multifocal contacts seem to surpass their objective data. Pilots report that they see quite well at all distances with their multifocal contacts. Good for them.

I tried several brands of multifocal contact lenses myself and found that I could see no distance well at all. My personal experience with these lenses was a clear failure, although I have successfully worn unifocal contacts for more than 50 years but need to also keep reading glasses with me.

For those who have successful outcomes with multifocal contact lenses, the FAA permits their use in pilots.

Cardiovascular Concerns

In an upcoming blog, I intend to discuss more thoroughly an issue that is gaining traction in social medial circles and aviation-related chat rooms and is something that is asked about by many of the pilots visiting my office. But I’ll touch on it now.

This subject relates to concerns that the FAA is overlooking cardiovascular concerns that are reportedly a result of the Covid vaccines. Usually, pilots are concerned that the FAA is making too big a deal of medical conditions, but this situation is exactly the opposite.

Nobody asked for this darned Covid virus to show up and we’ve been dealing with its ramifications for more than three full years now. There are several cardiovascular risks from the virus itself and these can be quite severe. Fortunately, they are also pretty rare.

I have covered these in detail in prior blogs, as I have some of the then-known potential vaccine risks (these risks are rare but do exist).

More recently, there have been yet new concerns related specifically to the use of the Covid vaccines as they pertain to the pilot’s electrocardiograms (ECG). There are risks and benefits to everything we do in medicine, and that includes choices to take, or not take, a vaccine.

The main concern being discussed recently is whether a slight change in a certain timing interval on a pilot’s ECG is something to be concerned about, whether it is a result of a Covid vaccine, and whether the FAA is sweeping this under the proverbial rug.

One thing I can assure pilots is that the FAA is not trying to hide from concerning new adverse vaccine reactions that could lead to a multitude of incapacitating events in pilots while in flight. That would not do anybody any good. However, the FAA has not done an adequate job of discussing the concerns as of yet.

In light of the recent concerns, here’s some of the information that the FAA put out to AMEs internally. In stating its overall support of the Covid vaccines, it notes, “The FAA has no evidence of aircraft accidents or incapacitations caused by pilots suffering medical complications associated with Covid-19 vaccines.”

OK, good enough so far, but tell me more! The remainder of the guidance continues, “When making changes to medical requirements and guidance, the FAA follows standard processes based on data and science. New scientific evidence enabled the FAA to safely raise the tolerance used to screen for a certain heart condition.”

A certain heart condition. The best the FAA could do is state to AMEs—the folks trained to become physicians and to be the aeromedical liaison between pilots and the FAA—that science was used to determine that “a certain heart condition” was properly evaluated.

I find this nebulous statement given to AMEs by the FAA to be uninformative and disappointing, especially considering the amount of social media attention and published concerns that this topic is receiving.  

That said, the cardiac interval is something that has been under scrutiny in both basic cardiology literature and FAA medicine for the more than 30 years that I have been an AME. There’s nothing new there.

Even so, I hope for more complete information from the FAA on a subject that has become a true hotbed in the airline and business jet cockpits—and unfortunately in the AME’s office, too. I am presently asked about this situation several times daily by pilots in my office, while at the same time also receiving numerous email inquiries.

While no pilot wants to receive the dreaded “nastygram” that their ECG has come into question, sometimes that does happen. In those cases, a one-time cardiology evaluation is required to ensure that the changes noted on the pilot’s ECG are not pathological in nature and do not pose concerning risks to aviation safety.

In this circumstance, however, part of the concern is that an ECG finding that might have been evaluated in the past is now simply acceptable to the FAA without further analysis. Again, the FAA has clearly stated that they have researched the situation with its cardiology consultants and that no significant risks are being stifled.

I am not trying to downplay any aviation medicine risk factor. When cardiac intervals reach concerning levels (for some conditions, too short of an interval is as bad, if not worse, than one that is too long) there are indeed risks for worsening cardiac outcomes. These cases definitely need evaluation and sometimes must be followed on an ongoing basis, typically annually.

There are way too many additional nuances to this entire discussion to continue with today. I am using this introduction as the “tease” to a future blog that will be entirely devoted to these concerns.

While I could write endlessly on the medical aspects of the specific ECG finding in question, I am hopeful that the FAA will shed some additional light on the subject in the meantime. At that time, I will discuss the ECG changes themselves more specifically and what the inherent risks are relating to these changes.

The question will remain, however, as to whether the Covid vaccines are, or are not, truly impacting such conditions more than the virus itself would. After following Covid carefully for three years, it is my impression that the vaccines are, for the most part, doing way more good than they are harm.

We must be objective in our evaluations and discussions, however, as any vaccine can pose some risk, too. There is still plenty of data to gather and research to be done, as everything involving Covid evolves in a continuous and ongoing manner. This will be a long-term and challenging epidemiological research project.

I think it will be years before the statistical research on many Covid-related topics provide answers that will be satisfactory to many people, including pilots, who have understandable concerns at the present time. I am doing my best to review all of the data that I can accumulate on an unbiased and comprehensive level.

While my initial impression is that the now-acceptable slight increase in the ECG interval in question—which the FAA has added to the list of “normal variants” that don’t require an evaluation if the pilot is asymptomatic—does not pose a significant new aeromedical risk, I will continue to evaluate the situation objectively.

I further remain hopeful that the FAA will soon publish a bit more information on its research and discussions with its cardiologists. Stay tuned.

Dr. Robert Sancetta is a former DC-10 captain with 11,000 flight hours. He has worked as a Senior AME since 1993 and is appointed as AME consultant to the FAA Federal Air Surgeon.

The opinions expressed in this column are those of the author and not necessarily endorsed by AIN Media Group.