Vision testing checks for visual acuity, color vision, and eye muscle balance. Visual acuity is the ability to see both near and distant objects clearly. FAA Class I medical standards require that pilots have distant vision that is 20/20 in each eye, or that is correctable to 20/20. A pilot whose uncorrected vision is worse than 20/100 also must have an ophthalmologist or an eye doctor check refraction (the eye's ability to focus).
If you encounter a problem with the FAA concerning eye muscle balance, you are unlikely to pass muster with a major airline, the reason being that the FAA will either reject you for Class I certification or issue a waiver. The waiver will tell any potential airline employer that you have a fairly serious problem with eye muscle balance.
Eye muscle problems may not be permanently disqualifying. Many eye muscle weaknesses or imbalances can be corrected through exercise programs. Ophthalmologists have a machine specifically designed for eye muscle strengthening. The procedure is painless and completely legal, but is very time-consuming. You may find yourself spending a couple of hours a week for up to a year in the ophthalmologist's office and following through with supplemental exercises at home.
While an ophthalmologist may have room for a 20-foot eye lane (generally the most accurate way to test acuity, according to Dr. Reinhart), most FAA examiners use a machine that simulates that distance using a series of mirrors. However it is done, the objective is to learn whether the pilot can see 20/20 with or without glasses.
The color vision test is given to make sure a pilot can detect red and green lights - such as VASI and approach lights - at night. To test color vision, doctors use flip cards with different-colored dots; pilots are asked what numbers the dots form. "They can miss up to four plates" out of 15, Dr. Reinhart states. "Most people pass."
For those with a military background, an option is the Farnsworth Lantern Test (Falant), which the FAA will accept. If you have flown for the military, your records already will contain the fact that you have passed the Farnsworth Lantern Test; simply make sure that you have a copy of your medical records. Unfortunately, the Falant is not widely available outside the military.
To issue a Class I certificate, the examiner also must determine that the applicant does not have glaucoma. To do this, the doctor generally will use a tonometer (to measure interocular pressure). A word of caution: The crude screening for glaucoma that involves simply touching the eyeball with the fingertip, although occasionally used by a physician who does not have ready access to a tonometer, is not adequate to indicate whether or not you have glaucoma. For your protection, you should make certain your vision is properly checked.
The FAA will usually certify a pilot with glaucoma treated with eye drops, but left untreated, glaucoma can deteriorate vision so that a pilot can no longer meet visual acuity standards.
For the hearing test, the FAA again accepts two options. The examiner can administer the whispered voice test. First Class standards dictate that the pilot must be able to hear with either ear what the doctor whispers at a distance of 20 feet. The other FAA-accepted method is to test hearing with an audiometer, which measures actual hearing loss in decibels at various frequencies. "The FAA is only interested in the three communication ranges - the 500-, 1000-, and 2000-cycles-per-second ranges," Dr. Reinhart said. "For a First Class, the FAA will accept a rather significant loss - 40 db in the 500 range, 35 in the 1000 and 2000 ranges." While many pilots prefer to "get by" with the easier whispered voice exam, AMEs stress the importance of learning about high-frequency hearing loss (often caused by exposure to loud noise) in time to prevent loss in the lower communication ranges. Furthermore, as Dr. Reinhart noted, the whispered exam "does you a disservice." Only an audiogram can determine with accuracy whether you have suffered any hearing loss and in what frequency range this may have occurred. Many senior AMEs have audiometers and will perform this test if the applicant requests it.
Blood pressure and pulse are checked to detect such conditions as high blood pressure, coronary artery disease, and heart irregularities. A doctor can glean a variety of useful information from these readings-not only the pressure and pulse rate, but how these change with time and exercise.
A pilot's blood pressure can rise when the examiner takes it simply because of the stress of having so much at stake, Dr. Reinhart pointed out. However, he added, "The FAA has given the applicant every benefit of the doubt." Not only do the standards specify reclining blood pressure, but the acceptable cutoff rates, even for a Class I, Reinhart says, "are higher than most doctors would accept" without treatment.
"A single high reading does not mean you are doomed," according to Dr. Jackson. "The FAA is interested in the overall pattern of blood pressure over time." Most doctors recheck a high reading later in the exam, perhaps after the pilot lies down and relaxes a bit. If blood pressure remains high, the FAA manual recommends rechecking the readings morning and evening for three days.
At age 35, and annually starting at age 40, the FAA requires pilots to undergo a resting electrocardiogram (EKG). While this test yields a variety of information, the intent behind the FAA standards is to make sure a pilot has not had a heart attack. It is possible to have a mild heart attack without being aware of the incident.
Kidney disorders fall into two main groups: Those produced by generalized disease of the body, such as systemic lupus erythematosis (which involves the kidney), and those in which a local abnormality involves primarily the kidney, such as occurs in spongy kidneys (a congenital abnormality). There are many kidney disorders, and only a doctor is qualified to tell you whether or not you suffer from one. The information derived from urine tests is combined with other data (including other types of testing, a person's dietary habits, and any exercise regimen) to produce a diagnosis.In his book, The Pilot's Medical Manual for Certification & Health Maintenance (available through FAPA), Dr. Reinhart writes of the urinalysis: "This is the test that is probably the easiest to mess up and the simplest to protect. Even in a fasting state, you should drink plenty of water; don't go to the exam dehydrated. Playing a hard tennis game the night before can also create an abnormal urinalysis, so go to the exam in a rested state. Some individuals 'spill protein' in their urine, yet this tendency may not be significant. Again, this is a matter you should have learned about before reporting for your company physical; you should have a note from your physician explaining your condition if, indeed, it is a harmless one.
"An individual's urine can tell the evaluating physician a great deal. If it is normal, many health problems can be ruled out. If there is an abnormality, further testing is necessary to determine if there is a risky disorder." Dr. Reinhart said you can "save yourself a lot of grief by taking along a doctor's explanation of any abnormal readings to either an FAA physician (for your Class I certificate) or an airline physician (for pre-employment screening).
How long the entire Class I medical exam takes depends on the efficiency of the doctor's office and the thoroughness of the doctor. "At a minimum, the whole process would take a half-hour," Dr. Jackson said. If there are complicating factors, or an EKG needs to be done, "it might take an hour."
Pilots generally know at the end of the exam whether they have passed. In some cases, they will need to wait a day or two for further test results.
(Caution: Occasionally a doctor decides an FAA-requested test is not needed and does not include it. The FAA will not issue the First Class ticket until it receives that test, and several months can be wasted this way. So you should check on what tests are requested by the FAA and insist on having them done.)
