Eye Exam Before AME? Vision Concerns & Medical Certification

The question of whether to undergo a comprehensive eye exam with an ophthalmologist or optometrist before seeing an Aviation Medical Examiner (AME) for a flight medical certificate is a common one among pilots and prospective pilots. While not always required, a proactive eye exam can be a prudent step, particularly if you have any existing vision concerns or anticipate potential issues.

FAA Vision Standards and the Medical Exam

The Federal Aviation Administration (FAA) has specific vision standards that pilots must meet, varying by medical class. For third-class medical certificates, the standard is 20/40 or better for both near and distant vision. However, the FAA exam conducted by an AME is a relatively basic assessment. It checks visual acuity, color vision, and field of vision. It doesn’t delve into the comprehensive evaluation of overall eye health that a dedicated eye exam provides.

As of January 1, 2025, the FAA implemented a change requiring a one-time color vision deficiency screening using approved computer-based tests for pilot exams. The results of this computer-based test should be uploaded as “Eye-Color Vision Test Results.” If an AME doesn’t have access to an approved computer-based test, they can issue a third-class medical certification with limitation #104, which restricts flight to day visual flight rules (VFR) only. Deferrals are not permitted in this situation.

Why Consider a Pre-Exam with an Eye Doctor?

An ophthalmologist or optometrist can perform a much more thorough evaluation than the AME’s basic exam. This includes tests for intraocular pressure, glaucoma, and other potential conditions that might not be detected during a standard FAA exam. Early detection of these conditions is crucial, as many eye diseases develop gradually and can cause significant vision loss before noticeable symptoms appear.

Dr. Quay Snyder, MSPH, president/CEO of Aviation Medicine Advisory Service, emphasizes that The evaluation by an eye doctor is much more complete than the FAA exam, and it can detect many diseases early, before more severe and permanent consequences develop. This thoroughness is particularly important given that the FAA considers evaluations from both qualified ophthalmologists and optometrists acceptable, without requiring a special referral.

Specific Scenarios and FAA Considerations

The need for a pre-exam depends on your individual circumstances. Here’s a breakdown of common scenarios:

• Returning Pilots with a History of Passing FAA-Approved Tests: For pilots who have previously passed an FAA-approved color vision test, a computer-based color vision screening test is generally not required.
• Returning Pilots with a Statement of Demonstrated Ability (SODA) or Letter of Evidence (LOE): Pilots holding a third-class SODA or LOE who wish to maintain their third-class certificate do not need a computer test. However, if they wish to upgrade to a first or second-class certificate, they will need to undergo an acceptable computer-based color vision screening test. If they fail, a third-class certificate with limitation #104 will be issued, and an appeal to the Federal Air Surgeon would be necessary for an upgrade. Pilots holding a first or second-class LOE or SODA do not need a computer test and can be issued the appropriate medical certificate if otherwise qualified.
• First-Time Applicants: First-time applicants can attempt any of the FAA-approved tests. If unable to pass any of them, the AME will mark Item 52 as “Fail” and annotate Item 59 with the details of the failed tests.

Glaucoma and FAA Medical Certification

The FAA routinely grants special issuance medical certificates to pilots with intraocular hypertension or glaucoma that is controlled and stable. However, this requires the completion of an annual Ophthalmological Evaluation for Glaucoma (FAA Form 8500-14) from a treating or evaluating ophthalmologist. If considerable disturbance in night vision is documented, the FAA may limit the medical certificate to NOT VALID FOR NIGHT FLYING.

Field of Vision Testing

The FAA requires a normal field of vision for all medical classes. The standard technique for assessing this involves a 50-inch square black matte surface with a white fixation point, and a white test object moved from the periphery towards the center. Alternative techniques, such as a standard perimeter or direct confrontation, can be used, but any significant deviations from normal require evaluation by an eye specialist.

What if You Fail the FAA Vision Exam?

If you fail the color vision test and are seeking a third-class medical certificate, the AME can issue a certificate with limitation #104, restricting flight to day VFR. If you desire a higher class of medical certificate, you’ll need to appeal to the Federal Air Surgeon. If you fail other aspects of the vision exam, the AME will document the failure and you may need to seek further evaluation and treatment to meet FAA standards.

The Bottom Line

While not always mandatory, a comprehensive eye exam from an ophthalmologist or optometrist before your AME exam is a wise investment in your aviation career and overall health. It allows for early detection and management of potential vision problems, increasing your chances of obtaining and maintaining a medical certificate. Prioritizing your vision, as Dr. Snyder advises, is essential for a long and safe career as a pilot. Most eye conditions can be cleared by the FAA after treatment is complete, so never forgo evaluations or treatment in an attempt to avoid declaring something on an FAA medical application.