Pilot Eye Exams: What Every Pilot Needs to Know

• Pilots must pass a general eye exam every year and a comprehensive eye exam by an ophthalmologist (eye specialist doctor) every 5 years until age 40. After that, the comprehensive exam is required every 2 years, or more often if an ophthalmologist finds a condition that calls for additional testing.
• Retinal diseases, such as macular edema (swelling of the retina) and age-related macular degeneration, must be evaluated to make sure vision remains at a level that does not affect flight safety. In some cases, a pilot may need to stop flying temporarily and complete treatment before returning to flight duties.
• Lens-based vision correction surgery is an option for pilots who cannot have corneal surgery due to certain limitations. This involves implanting an additional lens (ICL). For senior pilots who also have cataracts, artificial lens implant surgery may be considered to treat the cataract and correct vision at the same time.

Flying an aircraft is a demanding and complex job. Pilots are responsible for the lives of many passengers and crew members, and their work depends on knowledge, skill, experience and precise decision-making to keep errors to a minimum. For this reason, becoming a pilot requires passing a selection process that looks at personality, knowledge and ability, as well as sound physical and mental health. Pilots must also undergo regular health check-ups at set intervals.

Aviation medicine is a specialized branch of preventive medicine. Part of this field overlaps with occupational medicine, focusing on evaluating and caring for the health of pilots and flight crew, both physically and psychologically, to ensure the highest level of safety during flight. Another part overlaps with emergency medicine, covering the air transport of patients and injured people.

Compared with many other professions, flying involves greater risk, pressure and responsibility. This makes both physical and mental health especially important. Health check-ups for issuing the medical certificate that accompanies a pilot’s license are carried out under the Civil Aviation Authority of Thailand (CAAT) medical certification standards of 2022. These check-ups may only be performed by an Aviation Medical Examiner (AME) or Senior Aviation Medical Examiner registered with the Civil Aviation Authority of Thailand.

A pilot health check-up includes the following

1. Height, weight, blood pressure and pulse measurement
2. Blood and urine tests
3. Electrocardiogram (EKG, a test of the heart’s electrical activity)
4. Hearing test
5. Chest X-ray
6. Dental exam
7. Comprehensive eye exam, which includes:
   • Near and distance vision testing, with or without glasses
   • Measurement of refraction (how the eye focuses light) and corneal curvature
   • Eye pressure measurement
   • Color vision testing
   • Computerized visual field testing
   • Eye exam by an ophthalmologist experienced in aviation medicine
8. Physical exam by an Aviation Medical Examiner registered with the Civil Aviation Authority of Thailand

1. Do not eat or drink for 8 to 12 hours before the check-up.
2. Stop taking all supplements not prescribed by a doctor for 2 to 3 weeks beforehand.
3. Get at least 8 hours of sleep before the check-up
4. If you wear glasses, bring your prescription or the glasses you currently use for flying so your vision can be measured.
5. If you have had vision correction surgery, bring a medical certificate showing your vision prescription before surgery.
6. If you have a chronic condition or are currently ill, inform the doctor and bring your medications with you.

Good eyesight is essential for pilots, because vision is their main sense for perceiving their surroundings. Pilots must see clearly at a distance to recognize terrain and judge distances during takeoff and landing. They must also see clearly up close to read charts, data, and values on the cockpit display screens. Most vision problems in pilots are caused by refractive errors (problems with how the eye focuses light), including nearsightedness (myopia), farsightedness (hyperopia), astigmatism, and age-related presbyopia (difficulty focusing on close objects). These problems may cause a pilot to fall short of the required medical standards.

Vision

1. Refractive errors caused by abnormal focusing of light in the eye (nearsightedness, farsightedness, astigmatism, and presbyopia).
2. Eye muscle disorders. Pilots must not have strabismus (misaligned eyes) or eye muscle problems that cause double vision.
3. Color vision deficiency. Pilots must be able to distinguish colors safely. Modern aircraft have many color-coded displays that use color to classify information. Colors are also used as signals outside the aircraft, such as runway lights and light signals, especially the Precision Approach Path Indicator (PAPI) lights that help pilots judge their landing approach.
4. Night vision problems, especially glare, halos (rings of light around bright sources), and reduced contrast sensitivity. These problems most often occur in people who have had vision correction surgery.
5. Visual field defects, which may be caused by eye diseases such as glaucoma or other retinal diseases. They can also be caused by conditions in the brain, such as a pituitary tumor pressing on the optic nerve.

Eye diseases requiring evaluation

1. Pinguecula and pterygium (growths on the white of the eye) are caused by degeneration of the conjunctiva (the thin membrane covering the eye). Key risk factors are age and exposure to UV rays in sunlight, which puts pilots at higher risk than people who work in offices. Pinguecula and pterygium usually do not affect vision but may cause eye irritation. Pilots should wear sunglasses that block sun and wind and use artificial tears during flights.
2. Cataracts are the clouding of the eye’s natural lens due to degeneration. Like pinguecula and pterygium, key risk factors are age and UV exposure from sunlight. However, cataracts usually affect vision, making it worse. If a pilot does not meet the required standards, artificial lens implant surgery is needed before returning to flight duties.
3. Glaucoma is damage to the nerve cells of the eye, which shows up as thinning of the optic nerve head. Key risk factors are age, genetics and abnormally high eye pressure. Pilots with early-stage glaucoma but whose visual field is still at an acceptable level may be able to continue flying, provided they undergo special evaluations at intervals set by their ophthalmologist.
4. Other retinal diseases, such as macular edema (swelling of the retina) and age-related macular degeneration, must be evaluated to confirm that vision remains at a level that does not affect flight safety. In some cases, a pilot may need to stop flying temporarily and complete treatment before returning to flight duties.

1. Pinguecula and pterygium (growths on the white of the eye) are caused by degeneration of the conjunctiva (the thin membrane covering the eye). Key risk factors are age and exposure to UV rays in sunlight, which puts pilots at higher risk than people who work in offices. Pinguecula and pterygium usually do not affect vision but may cause eye irritation. Pilots should wear sunglasses that block sun and wind and use artificial tears during flights.
2. Cataracts are the clouding of the eye’s natural lens due to degeneration. Like pinguecula and pterygium, key risk factors are age and UV exposure from sunlight. However, cataracts usually affect vision, making it worse. If a pilot does not meet the required standards, artificial lens implant surgery is needed before returning to flight duties.
3. Glaucoma is damage to the nerve cells of the eye, which shows up as thinning of the optic nerve head. Key risk factors are age, genetics and abnormally high eye pressure. Pilots with early-stage glaucoma but whose visual field is still at an acceptable level may be able to continue flying, provided they undergo special evaluations at intervals set by their ophthalmologist.
4. Other retinal diseases, such as macular edema (swelling of the retina) and age-related macular degeneration, must be evaluated to confirm that vision remains at a level that does not affect flight safety. In some cases, a pilot may need to stop flying temporarily and complete treatment before returning to flight duties.

Pilots must pass a general eye exam every year as part of the physical exam for renewing their medical certificate. They must also pass a comprehensive eye exam by an ophthalmologist every 5 years until age 40, and every 2 years after that. More frequent special testing may be required if an ophthalmologist finds any disease or abnormality that calls for it. In these cases, the Aviation Medical Examiner will note a limitation on the medical certificate requiring special eye exams at appropriate intervals.

Refractive errors such as nearsightedness, farsightedness, astigmatism, and age-related presbyopia can be corrected with vision aids, including eyeglasses and contact lenses, allowing pilots to see normally and fly safely. For pilots who prefer not to wear vision aids, vision correction surgery is another option to restore normal vision and improve clarity. Today, vision correction surgery technology has advanced significantly and offers high precision and safety. As a result, civil aviation authorities around the world accept that pilots who have had vision correction surgery can return to flying, just like pilots with normal vision.

1. Corneal vision correction surgery
   This surgery uses a laser to reshape the curvature of the cornea (the clear front surface of the eye). Currently accepted procedures include PRK, LASIK, and ReLEx SMILE. These procedures deliver precise results, have few complications, and allow vision to recover quickly. However, vision may not be fully stable during the first 3 months, so pilots must stop flying for at least 3 months after surgery.
2. Lens-based vision correction surgery
   Some pilots have limitations that prevent corneal surgery, such as a cornea that is too thin, abnormal corneal curvature, or corneal disease. For these pilots, the vision correction option is lens-based surgery, which involves implanting an additional lens (implantable contact lens, or ICL). For senior pilots who also have cataracts, artificial lens implant surgery may be considered to treat the cataract and correct vision at the same time.

For more details about vision correction surgery and considerations for pilots, read our special article Modern-Day Refractive Surgery, what should pilots know?

Wg.Cdr. Taechit Mirasena, M.D. is a doctor specializing in preventive medicine (aviation medicine) and ophthalmology. He holds a Certificate of Aviation Medicine (Germany) and is an Aviation Medical Examiner for the Civil Aviation Authority of Thailand.
Samitivej Srinakarin Hospital is classified as an Aeromedical Center (AMC). This is a hospital or medical facility with Aviation Medical Examiners or Senior Aviation Medical Examiners appointed by the Director General of the Civil Aviation Authority of Thailand to conduct examinations for issuing or renewing medical certificates of all classes.

Frequently asked questions

How often do pilots need an eye exam?
Pilots need a general eye exam every year as part of renewing their medical certificate. A comprehensive eye exam by an ophthalmologist is required every 5 years until age 40, then every 2 years. More frequent testing may be required if an ophthalmologist finds a disease or abnormality.
What eye tests are included in a pilot health check-up?
The comprehensive eye exam includes near and distance vision testing, refraction and corneal curvature measurement, eye pressure measurement, color vision testing, computerized visual field testing, and an exam by an ophthalmologist experienced in aviation medicine.
Can pilots fly after LASIK or other vision correction surgery?
Yes. Civil aviation authorities around the world accept that pilots who have had vision correction surgery can return to flying. After corneal laser surgery such as PRK, LASIK, or ReLEx SMILE, pilots must stop flying for at least 3 months because vision may not be fully stable during that time.
What if a pilot cannot have corneal laser surgery?
Pilots whose cornea is too thin, has abnormal curvature or is affected by disease may have lens-based surgery with an implantable contact lens (ICL). Senior pilots who also have cataracts may consider artificial lens implant surgery to treat the cataract and correct vision at the same time.
Can a pilot with glaucoma or cataracts keep flying?
Pilots with early-stage glaucoma and an acceptable visual field may continue flying with special evaluations at intervals set by their ophthalmologist. Pilots with cataracts that cause them to fall short of the required standards need artificial lens implant surgery before they can return to flying.
How should I prepare for a pilot health check-up?
Fast for 8 to 12 hours, stop non-prescribed supplements for 2 to 3 weeks, and sleep at least 8 hours. Bring your current flying glasses or prescription, a pre-surgery vision certificate if you have had vision correction surgery, and any medications you take.