Keratoconus and Fitness to Fly

BACKGROUND: Of the body senses, vision is the most important for safe flight. Keratoconus causes progressive blurring and distortion of vision, which threatens the career of a civilian or military aviator. The goal of this retrospective study was to describe a series of keratoconus cases in a pilot population and to discuss decisions about their flight waivers.METHODS: To assess the impact of keratoconus on flying careers, we reviewed the records of all aviators with keratoconus examined in an Aeromedical Center over the past 5 yr.RESULTS: The files of 19 pilots [13 line pilots and 6 military pilots (3 fighter pilots)] were collected and analyzed. Of the 19 patients, 2 did not obtain flight fitness waivers. Among the 17 who received waivers, correction for defective distant vision (glasses or contact lenses) was imposed on 5 aviators.DISCUSSION: Keratoconus is a medical condition with aeromedical significance that should be detected by aeromedical examiners. A flight license can only be considered if the disease is stable and with satisfactory visual quality. Double pass aberrometry may be helpful to determine flight fitness. This study shows that keratoconus is not always a disability for aviators. Most of them are able to continue their flying careers safely. However, it must be analyzed on a case-by-case basis.Delbarre M, Crepy P, Froussart-Maille F.