Developed in collaboration with CASA Medical.
This guidance should be used for pilots or controllers with:
Glaucoma is a heterogeneous group of diseases characterised by elevated intraocular pressure (IOP), cupping of the optic nerve head (disc) and visual field loss. It is the most frequent cause of irreversible blindness worldwide. The main aviation risks are acute glaucoma which can incapacitate suddenly and insidious onset visual field loss which reduces situation awareness.
Open angle glaucoma is a slow process that is characterised by a gradual blockage of the eye’s drainage system and leads to gradual loss of vision. The cause is unknown. It is managed by treatment.
Narrow angle glaucoma and narrow angle of the anterior chamber glaucoma occurs as the angle formed between the cornea and the iris gradually decreases with age as the crystalline lens thickens. The condition will generally be identified in a presbyopic applicant undergoing routine optometrist examination for the purpose of near vision prescription. The existence of a narrow angle puts the applicant at risk of chronic glaucoma or acute angle closure, an incapacitating condition. Prophylactic office surgery by laser iridotomy or iridoplasty is generally effective. Cataract extraction is curative because the thin lens implant no longer puts pressure on the anterior chamber angle.
Secondary glaucoma can stem from a range of conditions such as ocular injury, inflammatory disorders (eg uveitis), central retinal vein thrombosis, medication (eg steroids) or diabetic retinopathy.
Risk factors for glaucoma are:
If intra-ocular pressure is ≤ 21 mmHg no further action is required unless previous clinical suspicion of intra-ocular hypertension or glaucoma. Once a diagnosis is made the treating specialist will determine the IOP target.
Periodic reviews are required following the diagnosis of glaucoma or ocular hypertension.
The aviation environment is unlikely to cause any significant increase in intraocular pressures .
If ALL the criteria in the table below are met, the pilot or controller meets the acceptable criteria for certification by the ME. Evidence supporting the ME’s decision (for example reports and results) must be available to CAA NZ.
| ME must confirm | Tick |
|---|---|
| No concurrent unacceptable ophthalmic diagnosis (e.g. neovascular glaucoma due to proliferative diabetic retinopathy or an ischemic central vein occlusion or uveitic glaucoma) | 
|
| Acceptable diagnosis: Open Angle being monitored and stable, Ocular Hypertension or Glaucoma Suspect being monitored and stable, or previous history of Narrow Angle/Angle Closure Glaucoma which has been treated with iridectomy/iridotomy (surgical or laser) and is currently stable. |
|
| Medications are acceptable (Prostaglandin analogs, Carbonic anhydrase inhibitor, Beta blockers, or Alpha agonist. Combination eye drops are acceptable.) |
|
| ;No symptoms (including no side effects of treatment) |
|
|
Visual fields:
|
|
| Normal contrast sensitivity if using Pilocarpine drops |
|
| Fully recovered from any surgery (3 months after surgery or 7 days after selective laser trabeculoplasty) |
|
| Stable optic nerve findings |
|
| Stable intraocular pressures |
|
| ME considers safe to certify |
|
An AMC referral to CAA NZ Aviation Medicine teams is required if a pilot’s pr controller’s condition does not meet all the above criteria and the applicant consents to their condition being considered under flexibility to the CAR 67 rules.
