Optic Nerve Cupping

[BitStream89]

Hi guys,

I'm a 25 year old male that has optic nerve cupping. This does not have any impact upon my vision acuity. I am 20/20 with glasses/contact lenses. My prescription has stayed the same for the past 8 years and is mild. I've known about this for a few years and my opthalmologist has performed numerous field and pressure tests along with digital imaging of the nerve to rule out glaucoma. In other words i have no loss of field nor increased pressure in the eye. It is his belief that I was simply born with this shape to my nerves. Also the nerve has not changed or atrophied in the six years it has been monitored.

What are the chances I will run into a problem trying to get a 3rd class medical for private pilot training?

Any feedback would be appreciated. I've always wanted to be a pilot and while reading about the medical exam Ive become worried that may not be possible. This is the only physiological abnormality I have and I'm in perfect health otherwise .

Thanks for your help

 

[Clark1961]

I'm not an expert and we (POA) don't have an expert posting here.

Contact a Senior Aviation Medical Examiner to determine the information they need to issue the medical. You may have to pay a consulting fee if the AME's time is required or it may be a simple response like "get this form filled out and bring it to the exam."

I've had eye surgery for lens implants and had to have a form filled out by an ophthalmologist. No big deal.

I know a pilot with macular degeneration who was issued a third class (it had restriction) so the FAA rules aren't that tight.

 

[Henning]

What part of the country are you in? Perhaps we can get you referred to someone good. I have never heard of the condition, but from the sounds of it, it is likely not to cause too much of an issue, at least with a third class. Much of that depends on if a condition is degenerative, or able to produce sudden incapacitation. If it is a stable congenital anomaly that does not hinder performance, typically those things get certified with no, or minimal, hassle.

As was mentioned, a consultation with an AME may be in order before you start filling out any forms, so you know what you need to have for documentation at the exam.

 

[W. Stewart]

Hi guys,

I'm a 25 year old male that has optic nerve cupping. This does not have any impact upon my vision acuity. I am 20/20 with glasses/contact lenses. My prescription has stayed the same for the past 8 years and is mild. I've known about this for a few years and my opthalmologist has performed numerous field and pressure tests along with digital imaging of the nerve to rule out glaucoma. In other words i have no loss of field nor increased pressure in the eye. It is his belief that I was simply born with this shape to my nerves. Also the nerve has not changed or atrophied in the six years it has been monitored.

What are the chances I will run into a problem trying to get a 3rd class medical for private pilot training?

Any feedback would be appreciated. I've always wanted to be a pilot and while reading about the medical exam Ive become worried that may not be possible. This is the only physiological abnormality I have and I'm in perfect health otherwise .

Thanks for your help

You have a very good knowledge of this, it sounds like. You have "physiologic cupping". This is merely a variation in the way you were made, like having long arms or a large hat size. Probably the diameter of the optic discs themselves is large (large discs may have large cups, with absolutely normal nerve tissue in the "rim"). There are probably others in your family with large discs.

The odds of you having glaucoma at age 25 are approximately zero. There are many types of glaucoma, but excluding congenital glaucomas, traumatic glaucoma, or pigmentary glaucoma, glaucoma at age 25 is almost unheard of. As you age, you should worry about glaucoma more--it is definitely a disease that discriminates against the elderly.

You should be aware that you have large cups, as should your ophthalmologist, but I think that frequent fields at your age are a waste of money. Get a copy of your disc photographs, and possibly your OCT/HRT image to keep in your personal file at home, to compare with over time. If you wear contacts, you need to see your provider yearly, anyway, so that will give him/her opportunity to monitor your discs

I am not an AME, so I can't answer what you should take to your FAA physical, but I would take your most recent fields and a letter from your ophthalmologist. This should not be an issue, as YOU ARE NORMAL!

Wells
(ophthalmologist, fellowship trained in glaucoma)

 

[AggieMike88]

Well's has the eye doc items covered.

And I'll echo the others saying that a CONSULT with a senior AME who does FAA Certification as a main job rather than an add on, would be wise.

Make the appointment with the AME, make sure both doctor and especially staff know this is a CONSULT, do not fill out any forms, bring all of the documentation that Wells mentions, and then ask the AME to answer the question, "If this was a real exam, would you give me my 3rd class medical on the spot?"

This will give the AME the chance to physically examine you, compare your condition against the medical standards, review the eye doc reports you brought, and tell you if all is sufficient for issuance in the office. He he says you're lacking something, then find out what you need and ask if having that means you can be issued in the office.

FAA Medicals are a big "Know you can pass with 100% certainty before you make the appointment" sort of thing. Not knowing what applies to you and what documentation is needed creates too much risk of deferral, denial, and loss of flying privileges.

Once the AME says he can issue your certificate in the office, then and only then do you make the appointment for the real exam and fill out the FAA Paperwork (MedXpress.faa.gov)

 

[BitStream89]

Thanks everyone. So I've never been diagnosed with glaucoma or any other eye 'condition,' so if I was to leave this off the FAA form do you think the AME would be able to tell there was a congenital abnormality? I looked at the wording on the FAA website and it seems as though I'm only required to list a condition if I was diagnosed or if my vision is somehow affected. I'd rather skip the 'red tape' if legal to do so as I am honestly of perfect vision corrected to 20/20 with contacts. Thanks

 

[flyingron]

I'd leave it off. "You might have a condition but we haven't found evidence of the condition" is the same as "You don't have the condition.". Believe me I went through the mill on that one based on a idiot AME and the fact that the initial FAA reviewer couldn't read past the "initial tests showed a possibility of X but subsequent tests showed no evidence of X" which got me grounded for three months and on an SI until I convinced the idiots in Joklahoma city that I did not have X nor did I ever had it. They finally relented after much evidence aand a lot of shouting by an new AME and sent me a weasel document that let me out of the SI but warned me if I ever did get X to stop flying and let them know.

Having an 8500-7 (carefully worded to insist the cupping is inconsequential and NOT signs or precursors to glaucoma) in your back pocket wouldn't be a bad idea, but I'd not disclose it unless the someone forces the issue.

 

[DrPappy]

Thanks everyone. So I've never been diagnosed with glaucoma or any other eye 'condition,' so if I was to leave this off the FAA form do you think the AME would be able to tell there was a congenital abnormality? I looked at the wording on the FAA website and it seems as though I'm only required to list a condition if I was diagnosed or if my vision is somehow affected. I'd rather skip the 'red tape' if legal to do so as I am honestly of perfect vision corrected to 20/20 with contacts. Thanks

If you have not been diagnosed with glaucoma, then there is no reason to put this on your form. The only sticky point would be if your eye doctor put your diagnosis as a "glaucoma suspect." I would ask the eye doctor (or a technician there) if any diagnosis has ever been made of "365.xx" (assuming they are using ICD-9, which is just a way doctors classify diseases, though in the US we are soon to go to ICD-10). Sorry for TMI.

The "xx" is one of a range of numbers; for example 365.01 means "Glaucoma suspect, Open Angle with Borderline Findings." A glaucoma suspect has not been officially diagnosed with glaucoma, so personally I probably would not report that, but if you are paranoid you might want to check.

Large optic cups are not a congenital abnormality; instead they are just a variation of normal.

I'm also going to go out on a wire here, and no offense to any primary care physicians here, I have nothing but love. If your AME is a PCP, the likelihood of them even being able to SEE your optic nerves MUCH LESS make a diagnosis of glaucoma is probably less than lotto odds.

 

[bbchien]

The "leave it off" is terrible advice. Remember, FAA can see your diagnosis codes sicne the ACA of 2010 unprotected them. If you lie, and are found by them, you get pilot certificate discipline. If you are not on meds, there is nothing to do except send in the record of the exam. The AME should issue you straight.


First log in in 13 months. Though I'd leave what I can- but I see that all the same problems are still here at good ol' POA. User #5 signing off again.

 

[flyingron]

Optic nerve cupping is NOT a diagnosis. My ophto doesn't code it as anything other than comprehensive examination. I report the examination but there's no reason to report things that MIGHT be wrong.