Can you get a FAA medical with Glaucoma? If your condition is stable and within acceptable limits for aviation safety and you have your documentation in order in advance of your appointment with an Aviation Medical Examiner (“AME”), you should be able to obtain FAA medical with Glaucoma. In that, Glaucoma is a CACI condition. CACI stands for “Conditions AMEs Can Issue.” A CACI condition authorizes your AME to utilize his or her discretion and issue to you an airman medical certificate despite your having a CACI-eligible medical condition, so long as you can produce documentation that supports the status of your condition is within CACI limitations.
As you may know from our other articles, just because you might meet criteria to be issued a FAA medical certificate by your AME, doesn’t mean that you will necessarily be issued a medical by your AME. Nothing should be left to chance when presenting for examination with your AME. Instead, you must take extra efforts before your examination with your AME to ensure that your documentation establishes unequivocally for your AME and ultimately for the FAA that you are within CACI limitations and that you are eligible for FAA medical certification. Individuals who fall outside the CACI criteria face their application for airman medical certification being deferred and possibly being placed on a special issuance authorization, or worse, being denied.
CACI Criteria for Glaucoma
As with most CACI conditions, the FAA requires that you provide a detailed clinical progress note to your AME prior to or at the time of your FAA medical examination. Therein, the FAA requires that your treating ophthalmologist explicitly identify that your Glaucoma is stable and that no changes to your course of treatment are recommend or foreseen in the immediate future. The treating ophthalmologist must also note that your condition developed at age 40 or later. If you have early onset Glaucoma, before the age of 40, the FAA will not find your Glaucoma to be CACI qualified.
Your ophthalmologist must also make a specific finding that you have the following type of Glaucoma:
- Open Angle Glaucoma (which is being monitored and is stable)
- Ocular Hypertension (which is being monitored and is stable)
- Glaucoma Suspected (which is being monitored and is stable) or
- Previous history of Narrow Angle/Angle Closure Glaucoma (which has been treated with surgery or laser)
The FAA will not accept your Glaucoma as CACI qualified if you have the following:
- Normal Tension Glaucoma
- Secondary Glaucoma due to inflammation or
- Significant Eye Pathology (such as Neovascular Glaucoma due to proliferative Diabetic Retinopathy or Ischemic Central Vein Occlusion or Uveitic Glaucoma)
If you have one of the acceptable forms of Glaucoma, your treating ophthalmologist must also document that you have never had nerve damage or trabeculectomy (filtration surgery). The FAA will require that your interocular be 23 mm Hg or less in both eyes. Further, there must be documentation establishing that there is no evidence of defects or unreliable visual fields.
CACI Eligible Medications
The FAA will only allow Glaucoma to be CACI qualified if you are either taking no medication or you are taking one of the following types of medications:
- Prostaglandin Analogs (Xalatan, Lumigan, Travatan or Travatan Z)
- Carbonic Anhydrase Inhibitors (Trusopt and Azopt)
- Beta Blockers (Timoptic, etc) or
- Alpha Agonists (Alphagan)
The FAA will not accept your Glaucoma as CACI qualified if you are being medicated with the following:
- Combination of eye drops (the FAA will not accept your using multiple eye drops to treat your Glaucoma)
- Pilocarpine or other Miotics
- Cycloplegics or
- Oral medications
Your treating ophthalmologist must document that you are not experiencing any side effects from your use of medication. The key is to demonstrate to the FAA that your treatment is effective and does not pose any risk to aviation safety.
Documentation Required for CACI Qualified Glaucoma
In order to be successful with obtaining your FAA medical with Glaucoma, you should present to your AME with a detailed clinical progress report from your treating ophthalmologist. This detailed clinical progress report should encompass the information represented above. In addition to the detailed clinical progress report, you should also produce a legible, executed copy of the FAA Form 8500-14. While both the detailed clinical progress report and the 8500-14 are not technically required, having both will allow you to reassure your AME that you are CACI qualified. In addition to these two documents, you should produce a legible copy of your most recent visual field test report(s). The FAA will accept the following visual field tests when you are trying to get a FAA medical with Glaucoma:
- Humphrey 24-2 or 30-2 (either SITA or full threshold) or
- Octopus (either TOP or full threshold)
*Additional testing may be acceptable with FAA approval
The FAA will not accept confrontation or screen visual field testing.
Not CACI Qualified Glaucoma
If you fall outside the limitations of CACI qualified Glaucoma, you will likely require a special issuance authorization to obtain your FAA medical. You will still need to provide the FAA with the documentation listed above, even if your Glaucoma falls outside the CACI limitations. Nevertheless, in order to best argue your eligibility for a special issuance authorization, you should consider emphasizing, if appropriate clinically and correct, that your Glaucoma is capable of being appropriately monitored, that your condition is stable, that you are not utilizing any aeromedically disqualifying medications, that you are not at risk for subtle incapacitation, and that your vision would not be jeopardizing aviation safety.
Tips For Obtaining Your FAA Medical with Glaucoma
- Always remember to report your complete medical history on your application for airman medical certification, FAA Form 8550-8/MedXPress. With respect to your history of Glaucoma, always report affirmatively at question 18d., which asks about your lifetime history of any “eye or vision trouble except glasses.” While “trouble” is an ambiguous term, you should report any ocular diagnoses at question 18d. If you have not previously reported your Glaucoma at question 18d., you should consider requesting an amendment to your FAA Form 8500-8/MedXPress.
- Ensure that you obtain your required Glaucoma documentation in sufficient time before your FAA medical examination with your AME. If you don’t have the appropriate documentation at the time of your FAA examination, your application may end up being deferred. A deferral of your FAA medical examination can result in a significant period without your medical certificate. Your documentation must not be older than 90 days at the time of FAA medical examination.
- Your documentation should be presented by an ophthalmologist rather than an optometrist.
- If you fall outside of the CACI limitations for Glaucoma due to being unstable, you should consult with your treating ophthalmologist to consider appropriate clinical options for gaining stability before applying for a FAA medical with Glaucoma. Doing so may prevent the need for deferral or denial.
- It is always a good idea to make sure that the evidence you are presenting to your AME and ultimately to the FAA is considered within the appropriate regulatory criteria required to establish FAA medical certification. For this reason, you should consider the FAA’s requirements for visual acuity, as they are stated in the Federal Aviation Regulations at 14 C.F.R. §§67.103, 67.203, and 67.303.
Why involve a FAA attorney with your FAA medical and Glaucoma?
As you can tell from the above regulations, the medical certification process is more so a legal process than a medical process. Ensuring that your doctor is developing the proper documentation regarding your Glaucoma, as needed, can be a difficult task. To that end, everything that is submitted to the FAA (i.e. records, statements, evaluations, etc.) goes into your airman medical file. This file is what the FAA then utilizes to evaluate whether you are eligible to hold a medical certificate, despite your Glaucoma. If you are later denied and wish to appeal that denial, your airman medical file becomes “Exhibit A” before the NTSB or upon reconsideration by the Federal Air Surgeon. So, a FAA attorney can evaluate your records, prepare a plan for best presentation of your case to the AME or FAA, and best argue your medical eligibility to the Federal Air Surgeon, with an eye for potential, future appeal. Furthermore, if your medical documentation is as strong as possible upon initial submission, in doing so, hopefully, you will avoid unnecessary delay. Also, if you have failed to report your Glaucoma on your FAA medical application, a FAA medical attorney can give you counsel on how to rectify your omission.
If you are concerned about your FAA medical and Glaucoma, call the FAA attorneys at The Ison Law Firm. We are happy to evaluate your case and discuss with you a plan for presenting your case to your AME or the FAA. Aviation law is all we do. Nothing else.
We’re pilots representing pilots The Ison Law Firm Aviation Lawyers offers FAA enforcement defense and medical certification representation worldwide!
The Ison Law Firm Aviation Lawyers
Phone: Toll-Free 855-322-1215
Office Hours: Mon – Thu, 9:00 AM to 5:00 PM
Fri, 9:00 AM to 12:00 PM
Disclaimer: Messages left for attorneys after these business hours will be addressed the following business day, during business hours.
