Air Force Flying Physical

Medical Examination Standards

Eye, Flying Classes I, IA, II, and III.

Lids/Adnexa.

Any condition of the eyelids which impairs normal eyelid function or comfort or poten tially threatens visual performance.

Epithora, nasolacrimal duct obstruction.

Ptosis, any, except benign etiologies which are not progressive and do not interfere with vision in any field of gaze or direction.

Dacryocystitis, acute or chronic.

Dacryostenosis

Conjunctiva.

Conjunctivitis, chronic, seasonal.

Trachoma, unless healed without scarring.

Xerophthalmia.

Pterygium which encroaches on the cornea more than 1mm or interferes with vision, or is progressive, or causes refractive problems

Cornea.

Keratitis, chronic or acute, including history of.

Corneal ulcer of any kind, including history of recurrent corneal ulcers or recurrent cor neal erosions.

Vascularization or opacification of the cornea, from any cause, when it is progressive, interferes with vision or causes refractive problems.

History of traumatic corneal laceration unless it does not interfere with vision, nor is likely to progress.

Corneal dystrophy of any type, including keratoconus of any degree.

NOTE:UPT Applicants who demonstrate a topographical pattern suggestive of keratoconus, referred to as TPSK, but who do not have any other clinical signs of keratoconus, may be eligible for waiver. However, these members must have been processed through EFS-Medical for eligibility. Test results from outside agen cies, or civilian sources do not qualify. Members identified with TPSK may be waivered into the ACS TPSK Study/Management Group, only after evaluation by the ACS. Members identified with TPSK will be informed that their participation in this study group is mandatory for consideration of waiverability into UFT and continued flying. Reevaluation periodically at the ACS will be required for waiver renewal.

History of radial keratotomy (RIK) or any other surgical or laser procedure, such as pho torefractive keratectomy (PRIK) and laser in situ keratomileusis (LASIK) accomplished to modify the refractive power of the cornea or for any other reason, such as phototherapeutic keratectomy (PTK), are not waiverable.

Orthokeratology, active or a history of within six months of application to UFT. A7.6.3.8. Lamellar or penetrating keratoplasty (corneal transplant).

lJveal Tract. Acute, chronic or recurrent inflammation of the uveal tract (iris, ciliary body, or choroid), except for healed traumatic iritis.

Retina/Vitreous.

Retinal detachment and history of same.

Degenerations and dystrophies of the retina including retinoschisis and all types of cen tral and peripheral pigmentary degenerations.

Degenerations and dystrophies of the macula, macular cysts, and holes.

Retinitis, chorioretinitis, or other inflammatory conditions of the retina, unless single episode which has healed, is expected not to recur, and does not impair central or peripheral vision.

Angiomatoses, phakomatoses, retinal cysts and other conditions which impair or may impair vision.

Hemorrhages, exudates or other retinal vascular disturbances.

Vitreous opacities or disturbances which may cause loss of visual acuity. A7.6.6. Optic Nerve.

Congenito-hereditary conditions that interfere or may interfere with central or periph eral vision.

Optic neuritis, of any kind, including retrobulbar neuritis, papillitis, neuroretinitis, or a documented history of same.

Optic atrophy (primary or secondary) or optic pallor.

Optic nerve cupping greater than 0.4 or an asymmetry between the cups of greater than
0.2.

Optic neuropathy.

Lens.

Aphakia, unilateral or bilateral.

Dislocation of a lens, partial or complete.

Opacities or irregularities of the lens which interfere with vision or are considered to be progresstve.

Pseudophakia (intraocular lens implant).

Posterior capsular opacification.

Other Defects and Disorders.

Asthenopia, if severe.

Exophthalmos, unilateral or bilateral.

Nystagmus of any type, except on versional end points.

Diplopia in any field of gaze, either constant or intermittent, including history of

Visual field defects, any type, including hemianopsia.

Abnormal pupils or loss of normal pupillary reflexes, with the exception of physiologi cal anisocorta.

Retained intraocular foreign body.

Absence of an eye.

Anophthalmos or microphthalmus.

Any traumatic, organic, or congenital disorder of the eye or adnexa, not specified above, which threatens to intermittently or permanently impair visual function.

Migraine or its variants, to include acephalgic migraine (See paragraph A7.23.). A7.6.8.12. History of any ocular surgery to include lasers of any type.

VISION & REFRACTIVE ERROR STANDARDS.

Vision Limits for Each Eye					Refraction Limits
Flying Class	Distant Vision		Near Vision		Any Meridian	Astig- matism	Ani- sometro- pia	Contact Lenses Notes5,6,7,1 3
	Uncorr	Cor- rected	Un- corr	Corrected
I Notes 2, 10, 12,13	20/70	20/20	20/20	-	+2.00 -1.50	1.50	2.00	Note 1
IA Note 2, 10, 12,13	20/200	20/20	20/40	20/20	+3.00 -2.75	2.00	2.50	Note 1
II (Pilot) Note 1,13	20/400	20/20 Note 3,11	-	20/20 Notes:3,9	+3.50 -4.00	2.00	2.50 Note 4
II (other than pilot) and III Note 1,13	20/400	20/20 Note 3,12	-	20/20 Notes: 3, 9	+5.50 -5.50 Note 8	3.00	3.50 Note 4

Notes:

1. Use of hard, rigid, or gas permeable (hard) contact lenses within 3 months before the examination or soft contact lenses 1 month before examination is prohibited. Document SF 88 appropriately to ensure this requirement has been met.

2. These medical standards apply for USAFA, AFROTC cadets at the time of AF commissioning physi cal, AF active duty members, civilian applicants for flying training, and applicants from the Reserve and Guard components during the initial flying physical.

3. Individuals found on routine examination to be 20/20 in one eye and 20/25 in the other but correctable to 20/20 in each eye may continue flying until the appropriate corrective lenses arrive. These lenses must be ordered by the most expeditious means. Be advised that this policy should only be used if the con dition does not cause acute change in stereopsis performance (i.e., failure of depth perception screening tests).

4. Anisometropias greater than Flying Class II or III standards may be considered for waiver if the OVI (or VTA) stereopsis is normal and the aviator has no asthenopic symptoms due to poor fusional control, or diplopia.

5. Complex refractive errors that can be corrected only by contact lenses are disqualifying.

6. All aircrew members are prohibited from using contact lenses for treatment of medical conditions unless they have been specifically prescribed and issued or approved by the ACS.

7. Optional wear of contact lenses for aircrew members is outlined in Attachment 17.

8. Waivers may only be considered after the individual has a normal ophthalmological examination to include a dilated fundus exam and possesses plastic lens spectacles which correct them to 20/20 in each eye and meets the USAF standards for approved commercially obtained spectacles for aircrew duties (see attachment 17.7).

9. Actively flying personnel should be corrected to 20/20 at the nearest cockpit working distance.

10. The Air Force Chief of Staff retains Exception To Policy (ETP) authority for vision and refractive limits for UFT applicants.

11. Flying Class II aviators should be refracted to their best corrected visual acuity. Use of spectacles to correct to better than 20/20 is at the discretion of the crewmember.

12. For qualification purposes, cycloplegic refraction readings should be recorded for that required to read the 20/20 line in each eye. However, continue refraction to best visual acuity and report the best achievable corrected visual acuity as a clinical baseline. (Thus, acuity and refractive error numbers may not correlate). Cycloplegic refractions that cannot achieve the 20/20 line will need clinical evaluation or re-evaluation.

13. Crewmembers who wear corrective spectacles or contact lenses must carry a spare set of clear pre scription spectacles on their person while performing aircrew duties, see AFI 11-206, paragraph 6.3.3. Additionally, only 15 percent (N-iS) transmittance neutral density gray spectacle lenses are approved for flying duty, see AFR 167-3, para 2-4d. Consult other guidance, such as AFMOA or MAJCOM policy let ters pertaining to aircrew spectacles.

Heterophoria and Heterotropia.

Flying Class III except InFlight Refuelers:

Esophoria greater than 15 prism diopters.

Exophoria greater than 8 prism diopters.

Hyperphoria greater than 2 prism diopters.

Heterotropia greater than 15 prism diopters.

Esophoria greater than 10 prism diopters.

Exophoria greater than 6 prism diopters.

Hyperphoria greater than 1.5 prism diopters.

Heterotropia, including microtropias.

Point of convergence (PC) greater than 100mm.

History of extraocular muscle surgery is cause for complete evaluation of ocular motil ity by a competent eye care professional to look for residual heterophorias, heterotropias (includ ing microtropias), and motor sensory problems.

NOTE:The evaluation must include all of the motility tests listed in A7. 11. Further processing of such cases will proceed in accordance with A7. 11. as well.

Near Point of Accommodation.

Flying Classes II and III. No standards.

Flying Classes I and IA. Near point of accommodation less than minimum for age specified in attachment 11.

Color Vision, Classes I, IA, II and III. Color vision testing must be performed monocularly under an approved and standardized illummant (i.e., Illuminant C). Five or more incorrect responses in either eye (including failure to make responses in the allowed time interval) in reading the 14 test plates versions of one of the following Pseudoisochromatic Plate (PIP) sets is considered a failure: Dvorine, the original version of the AO (excludes Richmond PIP version), or Ishihara (record responses as correct! total).

NOTE:No other PIP versions, such as the Richmond PIP, or Beck Engraving versions, or other tests for color vtsion are authorized for qualification purposes. Also note that the Farnsworth Lantern (FALANT) has been dropped as an USAF qualifying test.

Flying Class I/IAIII/III: Must possess normal color vision as demonstrated by passing the approved PIP.

Flying Class Il-Flight Surgeon Applicants: Same as above.

NOTE:FS applicants with mild color vision defects may be considered for a FCIIA waiver. FCIIA waiver authority is delegated to HQ AETC/SG. Controversial cases will be referred to AFMOA/SGOA.

Depth Perception/Stereopsis.

Flying Class III (other than Inflight Refuelers and individuals required to perform scanner duties). No standard.

Flying Class I, IA, Il-Flight Surgeon Applicant and Ill-Inflight Refueler Applicants and individuals required to perform scanner duties. Failure of the Vision Test Apparatus (VTA-DP) or its newer replacement, the Optec Vision Tester (OVT), screening depth perception test with uncorrected refractive errors should be retested with refraction correction in place, regardless of level of unaided visual acuity. Failure even with correction is disqualifying, but may be considered for waiver consid eration by higher waiver authorities, only after completion of a full evaluation by an ophthalmologist or optometrist, to include all of the following: ductions, versions, cover test and alternate cover test in primary and 6 cardinal positions of gaze, AO Vectograph Stereopsis Test at 6 meters (4 line version), AO Suppression Test at 6 meters, Randot or Titmus Stereopsis Test, Red Lens Test, and 4 Diopter Base out Prism Test at 6 meters. These tests are designed to identify and characterize motility/align ment disorders, especially microtropias and monofixation syndrome. The results of these tests done locally are considered to be preliminary, but will be used by waiver authorities to determine whether a candidate should be permanently disqualified without any waiver consideration, to identify if there are potentially correctable causes, and to determine whether further evaluation is required.

NOTE: A prospective Undergraduate Flying Training (UFT) Microtropia Study/Management Group is estab lished at the ACS with minimally defective stereopsis secondary to monofixation syndrome or microstra bismus that are considered appropriate for waiver consideration. Potential Study Group members must meet the criteria established by the ACS to be eligible for this Study/Management Group. All potential candidates must be evaluated at the ACS Ophthalmology Branch if recommended and approved by HQ AETC/SGPS. AETC/SGPS is the waiver authority.

Flying Class II and Ill-Inflight Refuelers and individuals required to perform scanner duties. A new failure of the VTA-DP or OVT requires evaluation by an ophthalmologist or optometrist to determine the cause of the failure and to rule out correctable causes, i.e., refractive error and am sometropia. If any new failure still is unable to pass the VTA or OVT with proper optical correction, then all of the motility tests listed above under Flying Class I in A7. 11. must be accomplished as a pre requisite for any further waiver consideration.

A7. 11.4. If the aviator has previously failed the VTA or OVT, and has previously been evaluated, and has either, normal motility or a stable previously known waivered motility disorder, and can pass another stereopsis test, such as the Verhoeff, Titmus, Randot, or Howard Dolman, no further work-up or waiver is required. However, such cases should already have been granted an initial waiver for this consideration. If not, a waiver is required.

NOTE: If the local flight surgeon feels that the degree of depth perception may not be compatible with the present aircraft or duties of assignment, further work-up and waiver will be required. Consultation at the ACS is indicated for any rated aircrew member with defective, questionable or change in stereopsis or depth per ception or a significant change in the level of stereopsis performance.

Field of Vision.

Flying Classes I, IA, II and III.

Contraction of the normal visual field in either eye to within 30 degrees of fixation lfl any meridian.

Central scotoma, whether active or inactive, including transitory migraine related or any other central scotoma which is due to active pathological process.

Night Vision, Flying Classes I, TA, II, and III. Unsatisfactory night vision as determined by history for initial flying. In trained aviators, this history is confirmed by the appropriate electrophysiolog ical tests requested by the Aeromedical Consultation Service ophthalmologists. Dark field and empty field myopia due to accommodation are normal physiologic responses.

Red Lens Test.

Flying Classes II and III (except Inflight Refuelers). No standards.

Flying Classes I and IA and Inflight Refuelers and individuals required to perform scanner duties. Any diplopia or suppression during the Red Lens Test which develops within 20 inches of the center of the screen (30 degrees) is considered a failure. Complete evaluation of ocular motility/align ment by a qualified ophthalmologist or optometrist is required as a prerequisite for higher waiver authorities to determine if ACS evaluation is required.

Intraocular Pressure, Flying Classes I, IA, II, and III.

Glaucoma. As evidenced by intraocular pressures of 30 mmllg or greater, or the secondary changes in the optic disc or visual field associated with glaucoma. Trained aircrew with glaucoma require consultation (review or evaluation) with the ACS prior to waiver consideration.

NOTE: Pigmentary dispersion syndrome (PDS) is not medically disqualifying for flying (includes Initial Flying Classes) unless associated with elevated intraocular pressures above 22 mmHg. PDS with elevated TOP, referred to as Pigmentary Glaucoma Suspect, (PGS) requires local ophthalmology evaluation. A con firmed diagnosis of Pigmentary Glaucoma Suspect (PGS) is disqualifying for all initial Flying Classes. Trained aircrew with PGS require consultation (review or evaluation) with the ACS prior to waiver con sideration.

Ocular hypertension (Preglaucoma). Two or more determinations of 22 nimHg or greater but less than 30 mmllg, or 4 mmHg or more difference between the two eyes. (See paragraph 16.4.).

NOTE: Abnormal pressures obtained by a noncontact (air puff) tonometer or Schiotz must be verified by applanation.

Information derived from Air Force Instruction 48-23, Current as of Dec 2000.

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