ACS Ophthalmology sets sights on flying mission

Lt. Col. Jonathan Ellis (center), Ophthalmology Branch manager of the Aeromedical Consultation Service, Dr. Steven Wright (right), optometrist and Scott Humphrey, cornea imaging technician, demonstrate their Pentacam cornea topography device used in pilot screenings and waiver recommendation cases. The device measures the entire cornea with precision, without contact in only a few seconds. (U.S. Air Force photo/John Harrington)

Lt. Col. Jonathan Ellis (center), Ophthalmology Branch manager of the Aeromedical Consultation Service, Dr. Steven Wright (right), optometrist and Scott Humphrey, cornea imaging technician, demonstrate their Pentacam cornea topography device used in pilot screenings and waiver recommendation cases. The device measures the entire cornea with precision, without contact in only a few seconds. (U.S. Air Force photo/John Harrington)

Dino Tsuchiyama (left), Aeromedical Consultation Service Ophthalmology Branch electro-diagnostic technician, attaches electrodes to Lt. Col. Christopher Cannon in order to measure how well the retinas in Cannon’s eyes react to light. Ophthalmological electrophysiology studies the electrical activity of the eyes. (U.S. Air Force photo/John Harrington)

Dino Tsuchiyama (left), Aeromedical Consultation Service Ophthalmology Branch electro-diagnostic technician, attaches electrodes to Lt. Col. Christopher Cannon in order to measure how well the retinas in Cannon’s eyes react to light. Ophthalmological electrophysiology studies the electrical activity of the eyes. (U.S. Air Force photo/John Harrington)

Dino Tsuchiyama (left), Aeromedical Consultation Service Ophthalmology Branch electro-diagnostic technician, attaches electrodes to Lt. Col. Christopher Cannon in order to measure how well the retinas in Cannon’s eyes react to light. Ophthalmological electrophysiology studies the electrical activity of the eyes. (U.S. Air Force photo/John Harrington)

Dino Tsuchiyama (left), Aeromedical Consultation Service Ophthalmology Branch electro-diagnostic technician, attaches electrodes to Lt. Col. Christopher Cannon in order to measure how well the retinas in Cannon’s eyes react to light. Ophthalmological electrophysiology studies the electrical activity of the eyes. (U.S. Air Force photo/John Harrington)

Dino Tsuchiyama (left), Aeromedical Consultation Service Ophthalmology Branch electro-diagnostic technician, attaches electrodes from Lt. Col. Christopher Cannon to a multifocal electroretinogram machine. The machine measures electrical activity in the retina when the eye is exposed to a light source. (U.S. Air Force photo/John Harrington)

Dino Tsuchiyama (left), Aeromedical Consultation Service Ophthalmology Branch electro-diagnostic technician, attaches electrodes from Lt. Col. Christopher Cannon to a multifocal electroretinogram machine. The machine measures electrical activity in the retina when the eye is exposed to a light source. (U.S. Air Force photo/John Harrington)

Dino Tsuchiyama, Aeromedical Consultation Service Ophthalmology Branch electro-diagnostic technician, confirms settings on a multifocal electroretinogram machine before conducting a test on Lt. Col. Christopher Cannon (image on screen). The test helps determine the health of the retina, if there is damage to the optic nerve and the overall health of the eye. (U.S. Air Force photo/John Harrington)

Dino Tsuchiyama, Aeromedical Consultation Service Ophthalmology Branch electro-diagnostic technician, confirms settings on a multifocal electroretinogram machine before conducting a test on Lt. Col. Christopher Cannon (image on screen). The test helps determine the health of the retina, if there is damage to the optic nerve and the overall health of the eye. (U.S. Air Force photo/John Harrington)

EDITORS NOTE:  This is the fourth part of a four-part series on the Aeromedical Consultation Service at Wright-Patterson. A link to all of the stories, and the Air Force Waiver Guide, appears below. 


WRIGHT-PATTERSON AIR FORCE BASE, Ohio –
 For many who have had an eye exam, the puff of the glaucoma test is as familiar as a darkened room, letter chart and deciding, “Which one looks better, one or two?” 


But, for the staff at the Aeromedical Consultation Service Ophthalmology Branch, the end result of their work has nothing to do with selecting a nice frame or lens coating – the branch performs half of the Air Force’s pilot selection physicals, makes waiver recommendations for more than 200 air crew annually and gathers data on aviators to support recommendations for flight standards to the Air Force Medical Standards Agency.

“For that initial physical, eyeballs are far and away the biggest problem we have,” said Dr. Steven Wright, ACS optometrist. “Because when you’re young, theoretically, your heart is still good, your blood pressure is still good and your cholesterol is good. But, your eyes are fair game when you’re 22.”

ACS is part of the United States Air Force School of Aerospace Medicine, itself a part of the 711th Human Performance Wing. A staff of three ophthalmologists, two optometrists, four general technicians, one cornea imaging technician and one electrophysiologist test visual acuity, color vision and depth perception while scanning the front, back and inside of the eye. In addition, an optical fabricator, database administrator, administrative assistant and refractive surgery program manager provide the branch exceptional support, according to Wright.

It’s a very thorough examination but with a very different purpose than the one most are familiar with.

“When you go to your eye doctor, they’re concerned [with how you see] today and what they need to do to fix it,” Wright said. “We’re concerned about where are you going to be in 10 years? It’s very expensive to train a pilot to go into battle. If we lose years of service, then that’s money down the drain.”

Ophthalmology staff looks for any conditions that may impact the person’s vision within the next decade, the minimum timeframe the Air Force requires pilots to fly, according to Wright. And while the ability to see clearly is important, it’s no longer the days of requiring 20/20 uncorrected.

Prior to 1975, pilots needed 20/20 uncorrected vision, according to Wright. In 1980, the 20/20 requirement changed to 20/50 uncorrected for Air Force Academy candidates. In 1996, it changed to 20/70 uncorrected across the Air Force. Today, there is no acuity standard. Eyesight can be corrected up to -3.00 diopters with glasses or contacts and refractive surgery is allowed. In fact, over 40 percent of pilots today wear corrective lenses.

“If you can see the ‘E’ on an eye chart, you’re probably qualified to be a pilot,” Wright said. “You just have to correct to normal vision with lenses.”

The reasoning for the change is simply the result of an evolving mission.

“Nowadays, it’s more about multitasking,” Wright said. “It’s more about running a computer because the days of ‘whoever sees the other one first, shoots first, kills first’ are over. You don’t even see the guy you’re shooting anymore.”

That doesn’t mean vision isn’t important though, just that the focus has shifted to a different aspect of eyesight, according to Wright. While older aircraft utilized simple, analog flight instruments, the inside of today’s cutting-edge aircraft more resemble a video game, with digital displays and bright colors. Green and red works great to help a pilot distinguish friend from foe or good from bad, but for those with red-green color deficiencies – not color blindness, but seeing colors a little differently than normal -- the pilot may waste valuable seconds trying to determine the truth or even miss the difference entirely.

“While you’re flying, you have visual cues,” said Lt. Col. Jonathan Ellis, ACS Ophthalmology branch chief and ophthalmologist. “So, if you have poor vision, altered color vision or poor depth perception, or if you’re missing part of your visual field, you may miss a cue that you need. That could lead to a mishap, which, you could lose your life or the lives of other people on the plane or potentially millions of dollars to the Air Force for losing the aircraft.”

The ACS must balance supporting the mission by ensuring the Air Force has the pilots it needs to fly with protecting lives and equipment with ensuring safety of flight. Currently the acceptable level of risk is one percent, according to Ellis. That means that an air crew member must have a less than one percent chance of suffering immediate incapacitation in order to fly. With older ophthalmological equipment that couldn’t measure the eye with much precision, this used to limit the Air Force’s pool of pilots.

“What we historically did was if we found any abnormality in your cornea when you were coming in, you were disqualified,” Wright said. “Now that we’ve had decades and decades of being able to image the cornea and we have far better technology today than we ever have before, we’re now saying, ‘Do we really need to disqualify all these people with this condition?’ Now, if you have keratoconus (a bulging cornea), you’re going to get disqualified. But, if you have what we think could be a precursor to keratoconus, then what we do is set boundaries as far as how much irregularity we let in. Then we let those people in that group meet that new standard and we watch them over time. “

This focus on updating standards doesn’t apply only to pilots either.

“In addition to their regular review of complex ophthalmology cases from our command, Lt. Col. Ellis and Maj. Michael Parsons from ACS Ophthalmology recently accompanied me to Francis E. Warren Air Force Base, Wyoming, for a visit to a Missile Alert Facility,” said Chief of Aerospace Medicine Col. Christopher Hudson, Office of the Command Surgeon at the Air Force Global Strike Command in Barksdale AFB, Louisiana, who is responsible for 6,000 aircrew members and missileers assigned to eight AFGSC bases in the continental U.S.

“They performed a comprehensive assessment of vision requirements for missileers and provided recommendations to update vision standards,” Hudson said. “These changes will allow us to increase the pool of missileer candidates and streamline medical examinations, saving time for both missileers and medics.”

While the ACS does not make policy, it normally takes the lead in recommending policy to those that do, according to Wright. If the group performs well, then the new standard could possibly stay. And, if people develop disqualifying conditions over time, then Wright said the standards could be tailored to ensure the one percent rate of acceptable risk.

“First and foremost our job is to get disqualified air crew members back flying,” Wright said. “We do that by seeing them in person. We do that through case reviews. But, ultimately our goal is to try to put people back flying when we can justify it from a medical perspective that they’re safe to fly.”

Due to AFGSC bases being located in predominantly remote and rural locations with missileers manning missile sites 24 hours a day, 7 days a week, 365 days a year for the past 50 years, the support provided by ACS is particularly appreciated.

“Specialty medical care is often not available in the local area,” Hudson said. “The ACS provides timely, expert medical recommendations to ensure our aircrew and missileers can perform their critical duties safely and effectively. The ACS is the world's premier Aerospace Medicine authority and a tremendous resource to our nation.”

Whether it’s screening new aviators, getting flyers back in the cockpit or tracking groups of medical conditions to more precisely define aeromedical standards, sometimes it’s the simple things that motivate the professionals at ACS Ophthalmology.

“I’m kind of an airplane geek even though I don’t fly,” Wright said. “I just think it’s kind of fun when you go to an air show and you see the guy from the F-22. It’s like ‘Oh, yeah. I did his physical 10 years ago.’ It’s kind of cool.”