Aeromedical Report
Questions about Medical Treatment and Flying

By Dr. Tom Yasuhara, M.D., M.P.H.
Air Line Pilot, April 2003, p. 5

I’ve heard about a new procedure for vision correction called conductive keratoplasty. Will the FAA allow pilots who have had this surgery to hold medical certificates?

The FAA requires that at least 6 hours elapse between the last dose of Viagra and the conduct of flight duties.

Approved by the FDA in April 2002, conductive keratoplasty (CK) is a procedure that uses radiofrequency energy to reshape the cornea in individuals who have farsightedness (hyperopia). Currently, CK is not approved by the FAA. The FAA typically does not approve procedures or medications within the first year of FDA approval.

The FAA’s final policy on CK will likely come after more clinical data are available. The procedure has not been studied in patients who are younger than 40 years old, and it is not used to treat nearsightedness (myopia), as are alternative procedures, such as LASIK or PRK.

For more information, we recommend discussing CK with a qualified ophthalmologist and reviewing the FDA website at

I’ve lost a significant amount of my hearing over the years, and my doctor thinks I might benefit from wearing a hearing aid. Will I be able to pass my FAA medical exam if I have a hearing aid?

Some forms of hearing loss, such as overexposure to noise or degeneration of the middle ear bones (otosclerosis), may be improved by hearing aids and then cleared through your FAA-designated aeromedical examiner (AME). Other conditions, like Meniere’s disease or tumors like acoustic neuromas, require an FAA waiver regardless of the degree of hearing loss they cause.

Your AME could issue you any class of medical certificate as long as you were able to meet the FAA hearing standard with the use of the hearing aid, and as long as the reason for your hearing loss did not involve an otherwise disqualifying problem.

If you needed a hearing aid to pass your FAA medical exam, your medical certificate would be annotated "must use hearing amplification." This would allow you to fly with a volume-adjustable headset or cockpit speaker instead of having to wear the hearing aid in flight.

For more information, go to

What flying restrictions, if any, would apply if I decided to seek a prescription for Viagra?

Viagra (sildenafil citrate) was approved by the FDA in 1998 as a treatment for erectile dysfunction. While it has proven to be a significant aid in the treatment of certain forms of male impotence, it should be used only as directed after an appropriate clinical evaluation by your attending physician. Several medical conditions increase the risk of side effects from Viagra, and some medications could result in adverse drug interactions.

Clinical studies have documented side effects for Viagra that include headache, gastrointestinal upset, and changes in color vision. As a result, the FAA requires that at least 6 hours elapse between the last dose of Viagra and the conduct of flight duties.

For additional details, we recommend reviewing the following websites: and

I’ve been diagnosed with a condition called central serous retinopathy. What effect is this likely to have on my flying career?

Central serous retinopathy is an eye condition that involves a collection of fluid in the portion of the retina that controls sharp, central vision. Perceived visual distortions can include blind spots, blurry vision, or straight lines appearing crooked. Usually only one eye is affected. The condition usually occurs in young men (ages 20-45) and is thought to be related to high-stress conditions. As a result, we receive many calls from pilots who are affected by central serous retinopathy.

In some cases, specific laser treatment may be appropriate, and in others, observation alone is the preferred approach. The condition lasts on average about 3–4 months, but recurrences are not unusual. The FAA requires that a pilot re-main grounded until documentation of complete resolution has been received and approved. A complete eye examination will need to be performed by the attending ophthalmologist. If a residual defect is present, the pilot may qualify for a special waiver (Statement of Demonstrated Ability).

We strongly recommend early contact with ALPA's Aeromedical Office.

If a pilot has a cardiac condition that requires the replacement of a heart valve, will the FAA ever consider issuing a medical certificate?

The FAA will allow pilots to fly after a single heart valve is replaced. The FAA does not certify pilots with multiple heart valve replacements except for a special case called the Ross procedure. Single mechanical valves or tissue valves are acceptable if replacement surgery is required.

The FAA will require a 6-month observation period following the surgery before the pilot can request a Special Issuance Authorization. The evaluation required at the end of the 6-month period includes a clinical status report, cardiovascular evaluation with standard ECG, doppler echocardiography, and a holter monitor.

Pilots with mechanical heart valves are at risk for forming blood clots. The standard treatment includes anticoagulation (blood thinning, most commonly with the medication called Coumadin). The degree of anticoagulation is monitored by a laboratory test called the INR. Pilots taking Coumadin for their mechanical heart valves need to have at least monthly reports of their INR, with at least 80 percent of those INRs falling between 2.5 and 3.5.

Note that the FAA views repair of a heart valve somewhat differently from its policy on complete replacement of the valve as discussed above.

The Aeromedical Office has ample experience in helping pilots regain their medical certificates following either form of surgery and would recommend that you call us as soon as such a procedure is recommended.

Dr. Tom Yasuhara, MD, MPH, is an associate aeromedical advisor with ALPA’s Aeromedical Office, which is located in Aurora, Colo.