Eye Disqualifier for Pilot: Esophoria

[aerospace09mom]

My mid actually called me to ask if this site would weigh in on a
question about a medical condition and going pilot. My mid is an
aerospace engineering major and is now half way through his Second Class year .
Although he has PERFECT - 20/15 eyesight, the Academy has informed him
that he has a "vision condition" called esophoria and that the Navy will
not allow him to become a pilot.

He can go NFO - which to me makes no sense based upon the reason they
will not let him fly. His one eye microscopically crosses when his eye is
dilated. They say that in the jarring that he would receive flying, it
could cause the disorder to become constant. How would the jarring decreas from the back seat (NFO) of a jet? (My question, not his.) His sponsor
dad was career Navy, a pilot, grad from USNA and has the same condition.
He now is a pilot with a major overnight shipping company and has to pass eye exams every year - and this condition has never caused a problem in either his Naval or private careers.

We had him go to a private ophthalmologist while at home who said that
testing him with his eyes dilated is not the correct way for that exam
to be done. Our doctor has written a letter for my son to use, should he
need to - a last resort sort of thing.

What my son wants to know is are there any parents out there with this
condition that fly or flew for the military or who have sons or
daughters who graduated from the Academy with this condition and fly. Are there any doctors out there that know about this condition and have informaton, advice or insight on what he might want to know or ask the doctor(s) who will see him at Bethesda? He has NOT been seen by an ophthalmologist at the Academy.

Are there any corrections for esophoria that would make it okay for the
Navy for him to fly? He was told at Medical at the Academy that Pensicola does not allow any waivers for this condition.

Thank you so much for your help and resources.

 

[kp2001]

Here is the waiver guide information regarding esophoria:

12.6 EXCESSIVE PHORIAS
AEROMEDICAL CONCERNS: Excessive phorias are frequently associated with defective stereopsis and/or diplopia, a devastating state if this occurs during a critical phase of flight.

WAIVER: CD for Class I aviators. No waivers are considered.

INFORMATION REQUIRED:
1. Evaluation by an eye professional or an ophthalmologically proficient flight surgeon is necessary.
2. The consult should address any history of diploplia or previous eye surgery, and include all the studies requested on the accompanying ocular motility worksheet.
ICD-9 CODES:
378.4 Excessive Phorias
378.41 Esophoria
378.42 Exophoria
378.43 Hyperphoria

I would be interested to hear a tape recording of why he was told that esophoria was disqualifying. I know it doesn't exist, but I would doubt that the reason he quoted you isn't quite exactly what was said. An esophoria will not become "permanent" due to any jarring or other activity. What can happen however is as your eye muscles become fatigued (long flight, stress, etc) it could cause a person to loose their stereovision. Loosing stereovision is less of a problem for the backseater than it is the pilot who needs to be able to discriminate distance.

The key here is for him to find out if he truly has the disorder or not. I'm assuming he is already set to see the guys at Bethesda for a second opinion. They will perform most of the same tests again that he had performed already, but hopefully with a different outcome this time.

At this point the best thing to do would be to hope that the doc's at Bethesda have a different exam result than the optometrist at the Academy did. I wouldn't give up hope yet, but if they come to the same result it would be very difficult for him to get a pilot slot as NAMI does not offer waivers for this condition.

 

[CC_Candidate]

where did you get that "waiver information" from kp2001? I've been trying to look for "waiver information" on knee dislocations...

 

[kp2001]

where did you get that "waiver information" from kp2001? I've been trying to look for "waiver information" on knee dislocations...

It is super top secret, double probation stuff

Actually it can be found on the NAMI/NOMI webpage and is what all Naval Flight Surgeons reference when dealing with aeromedical issues. The direct link is:

http://www.nomi.med.navy.mil/NAMI/WaiverGuideTopics/index.htm

This is only for Navy Flight. Although it may be similar to Air Force I am not sure and this is definately not the waiver guide for admittance/acceptance to ROTC or service academies.

 

[CC_Candidate]

just curious...I am applying to the Naval and Air Force Academies and just wanted some idea of what they could be looking at. There shouldn't be too much of a difference...right?

 

[kp2001]

just curious...I am applying to the Naval and Air Force Academies and just wanted some idea of what they could be looking at. There shouldn't be too much of a difference...right?

This is only for Naval aviation, I'm sure the air force one is similar, but this is definately not for the academies.

 

[VMINROTChopeful]

My mid actually called me to ask if this site would weigh in on a
question about a medical condition and going pilot. My mid is an
aerospace engineering major and is now half way through his Second Class year .
Although he has PERFECT - 20/15 eyesight, the Academy has informed him
that he has a "vision condition" called esophoria and that the Navy will
not allow him to become a pilot.

He can go NFO - which to me makes no sense based upon the reason they
will not let him fly. His one eye microscopically crosses when his eye is
dilated. They say that in the jarring that he would receive flying, it
could cause the disorder to become constant. How would the jarring decreas from the back seat (NFO) of a jet? (My question, not his.) His sponsor
dad was career Navy, a pilot, grad from USNA and has the same condition.
He now is a pilot with a major overnight shipping company and has to pass eye exams every year - and this condition has never caused a problem in either his Naval or private careers.

We had him go to a private ophthalmologist while at home who said that
testing him with his eyes dilated is not the correct way for that exam
to be done. Our doctor has written a letter for my son to use, should he
need to - a last resort sort of thing.

What my son wants to know is are there any parents out there with this
condition that fly or flew for the military or who have sons or
daughters who graduated from the Academy with this condition and fly. Are there any doctors out there that know about this condition and have informaton, advice or insight on what he might want to know or ask the doctor(s) who will see him at Bethesda? He has NOT been seen by an ophthalmologist at the Academy.

Are there any corrections for esophoria that would make it okay for the
Navy for him to fly? He was told at Medical at the Academy that Pensicola does not allow any waivers for this condition.

Thank you so much for your help and resources.

your son might want to do a search on the airwarriors.com forum. they have suggestions over there for esophoria. this was mentioned over there as something that has fixed mild esophoria:
http://www.bernell.com/product/2105/27

(i know nothing of esophoria, but i can use the search function so i did

 

[aerospace09mom]

help kp2001

this is aerospace09mom's son. i just was qualified by an ophthalmologist at Walter Reed Army Medical Center yesterday. however, i spoke with my flight surgeon today and he will not accept the values as the values taken here at the Naval Academy for my esophoria conflict with what the ophthalmologist said. he wants a "consensus" on the values before he makes his decision. I wanted to explain to him right then the difference between OPTOMETRISTS at the academy medical center and an OPHTHALMOLOGIST, but i didn't want to assume he didn't know the difference. Do you have any advice? I gave him the ophthalmologist's contact information and the flight surgeon said he is going to get in touch with the doctor at Walter Reed and try and connect him with the optometrists to try and come to some understanding for the differing numbers. he also ordered me to go back to the optometry department at Navy to discuss the disparity, whatever that's supposed to mean. anyways, I'd appreciate whatever advice you have to give. i've contacted the ophthalmologist and left a message explaining the new situation. i hope he'll be able to straighten things out.

thanks

 

[kp2001]

I think you're doing all the right things. I think the concern the flight surgeon has is that he now has two differing sets of information for a disqualifying condition. He probably will simply want someone to be "the authority" on the subject or want you retested by the optomotrist to see if they get new numbers that correlate with the ophthalmologist.

You were smart to be reserved and not be "sassy" with the flight surgeon. He knows what the difference between an optom and an ophtho are and remember he's pretty much got a final say in whether you are pilot qualified or not, so get him on your side. He is simply trying to follow the guidelines and is trying to get the various opinions to come together to one, unified, consensus statement. There really is no difference between an optomotrist and an ophthalmologist when it comes to this condition. They are both equally qualified to do the tests and make the diagnosis. Remember an optomotrist still did four years of post graduate work to get his degree. An ophthalmologist has done four years and then an additional three to be able to do eye surgery (An over simplification, but the point is the same).

 

[RetNavyHM]

I agree with what KP2001 says, and can add my 2 cents in here, since I was the corpsman at USNA who had to forward the information to NAMI in Pensacola for the final approval to get the medical qualification. I was also the first person who Mr. Koppy (the aviation medical god who has been at NAMI for longer than I care to think about) would call and berate for submitting information that didn't match up.

You need to get that tie breaker. It is possible for a reading to be a little off, enough to put you out of standards by mistake. If it does not occur on 2 other occasions, it was a mistake. There is a reason they call it "practicing" medicine.

KP2001, I don't know if Mr. Koppy is still at NAMI, if he is look out!! He loves nothing better than showing a bunch of young doctors whats what. In a kind and respectful way of course!!

Of course there was no respect when it came to the young corpsman....

Great guy though!

 

[kp2001]

KP2001, I don't know if Mr. Koppy is still at NAMI, if he is look out!! He loves nothing better than showing a bunch of young doctors whats what. In a kind and respectful way of course!!

Of course there was no respect when it came to the young corpsman....

Great guy though!

Not to hijack, but haha. I'm not sure if he's still there or not. I guess I'll find out in September when I head down to my flight surgery class.