Glaucoma in US Civil Aviation: 2005-2014

INTRODUCTION: Until recently, glaucoma requiring treatment was disqualifying for U.S. pilots and required an aeromedical special issuance waiver. Since 2013 Aerospace Medical Examiners (AMEs) have been authorized to evaluate third-class pilots with mild glaucoma using similar protocols and issue medical certificates without a waiver if these criteria specified in the AME Guide are met. METHODS: The FAA's medical database was searched for pilots with glaucoma between 2005 and 2014. The National Transportation Safety Board (NTSB) accident database was then searched to determine which pilots with glaucoma had aircraft accidents during that period. The odds of accidents in the glaucoma pilots were compared with the overall pilot accident odds. RESULTS: Of 5000 pilots being treated for glaucoma, 78 were involved in aircraft accidents; however, glaucoma was not cited as the probable cause or contributing factor in any of the accidents. A logistic regression model adjusted for age showed that glaucoma had a protective effect on accident odds. The crude accident rate for third-class pilots with glaucoma was estimated to be 7.2 per 100,000 flight hours, with a fatal accident rate of 1.8 per 100,000. Although these point estimates were slightly higher than the estimated general aviation accident rates, the differences were not statistically significant. DISCUSSION: These findings suggest that third-class pilots with glaucoma are not at significantly greater risk of an accident than the U.S. general aviation community. It also indicates that FAA certification protocols for certifying and following pilots with glaucoma provide an adequate level of flight safety.