Glaucoma The mere
presence of raised IOP is called ocular
hypertension, and it involves an increased
risk of developing glaucoma.
This latter diagnosis is
not ascertained by raised IOP alone, it
demands the occurrence of either disc
cupping or visual field defects.
Secondary glaucomas are
caused by conditions which interfere with
the normal passage of the aqueous in the
pupil or the chamber angle (e.g. anterior
The first objective signs
in the fundus are atrophy of nerve fibre
bundles and cupping of the optic disc.
Substantial axon atrophy is present when
visual field defects are first measurable.
The C/D ratio (a measure
of the diameter of the cup in relation to
that of the whole disc) and the rim area
(the area of the outer rim of the disc with
nerve fibres) is of help to record cup
If the disease process
goes on, the cup usually first reaches the
rim of the disc in either the lower or the
upper pole. In severe cases, no rim of nerve
fibres is seen at all, and the cup is deep
or undermines the disc edges.
With progression of the
disease, the scotomas increase in size and
coalesce. Visual field testing is essential
to prove functional impairment.
An increased IOP, i.e.
above about 22 mm or a difference between
the eyes of 6 mm Hg or more should cause a
suspicion of glaucoma.
The diagnosis glaucoma
does not per disqualify flying duties.
Aircrew with glaucoma should be free of
side-effects from the local drug therapy
given; the most important is the
accommodative reduction of the visual
examination of the visual function under the
guidance of AMA is obligatory.
Aircrew with glaucoma
controlled by non
miotic drugs or surgery may be considered
fit for flying duties only if the
results of automated perimetry in the
central 30º results conform to mild
glaucomatous loss in both eyes or moderate
glaucomatous loss in one eye, the other eye
being absolutely normal.
The criteria for
The criteria for
< -12 dB.
Fewer than 37
points depressed below the p< 5% level
and fewer than 20 points below the p <
deficit (0 dB) in the 5 central degrees.
hemi-field with sensitivity of < 15 dB
in the 5 central degrees.
Such aircrew will
undergo six monthly
reviews by eye specialist for
field defects will be
fit for P2 status only (Fit to fly as
Pilot-in-Command along with qualified