1 st class medical and exophoria

[tecu]

Hello everybody,

Two weeks ago I went to get my medical exam for a 1 class medical certificate (I am a student pilot and wanted to make sure that I am healthy to fly professionally) I passed most of the exam except one of the visón test ( the test was when they aske “wich musical note number does the red line cross through”) the rest of the examination I have favorable results like 20/20 vision corrected and the ability to distinguish colors. The AME doctor then came in and told me that I have something called heterophoria and he gave me the 8500-7 form to take to my eye doctor to complete an eye evaluation. I took it to my eye doctor, got the eye evaluation, the eye doctor filled it out and faxed to the AME. (My eye doctor told me that everything is normal and also wrote on the form that I don’t have any symptoms of diplopia) The AME told that he has to deferr it to the FAA because according to the 8500-7 form filled out by my eye doctor I have 8 BI of exo at a distance of 16 inches with correction. The AME told me that I will be getting g a letter from the FAA. The AME told me not to get discourage because it is denied but just deferred

My questions are:

1) what can I expect to be next?
2) Will I ever be able to fly proffesionaly?

I have 26 hrs log to get my private license but I stopped because of this.

Thanks!

 

[Cherokee_Cruiser]

You sound like me but 14-15-ish years ago. I was a similar story but I already had a 1st class medical and Private pilot license and then in the late teenage years I had trouble on a routine doc visit with the eye machine for the musical note/red line test. So I went to the eye doctor and filled out the 8500-7 form and submit that to the FAA.

1. The next step is most likely same as me, they'll ask you to do a Medical Flight Test (MFT). You basically go up with a FSDO examiner in a Cessna or whatever you fly and basically just shoot a couple touch n goes to show that you can fly okay. Once you pass that and based on your description of what you have, your flying isn't affected and you will pass it, then you will get a SODA - Statement of Demonstrated Ability. My SODA was issued on the basis of the MFT. Mine lists "diplopia on lateral gaze" on the SODA. Just make sure your SODA is valid for a 1st class medical (which it should automatically be if you applied for a 1st class). Since my condition was benign and not worsening, the SODA is basically good for life - and my gut feeling is yours will be too.

2. Once you get a SODA for your condition, you can professionally fly. I had no issues in any airline interviews I did. When you fly you carry your 1st class medical and SODA with it too. That's it.


The only caveat is I don't know how the MFT would work for you since you are a student pilot and can't take passengers until you get your PPL. I wouldn't worry too much though. Unless you have one of those ~17-18 disqualifying conditions on the main medical application (eg, suicidal, insulin injected diabetes shots, etc), you should be able to get a SODA or waiver for eye conditions.


There are pilots with one deaf ear. One kidney. All sorts of stuff out there that may shock you, but all it takes is a SODA or a waiver to go along with your 1st class medical.


Keep us posted, I'd be curious what you hear next. It should be steps to get a SODA or a waiver. As for me, as I grew older the condition kinda corrected it self. I don't know it was some eye muscle imbalance thing, maybe fatigue/being tired made it worse. But today approaching mid 30s I still have the SODA (it's good for life) but I don't have the diplopia on lateral gaze anymore.

 

[FlightSurgeon]

Hi Tecu,

I think you will end up fine, it's just a matter of how many steps you have to take to get to the certificate (ideally as few as possible). I would ask the AME to supply you with the name of your Regional Flight Surgeon and call him/her, ask what to expect next. If possible plead your case for the RFS to review your file rather than forwarding to Oklahoma City. A few points:

-Heterophoria requirements only apply to 1st and 2nd class medicals. 3rd class has no such requirement, so at the very least you could ask the RFS to issue a 3rd so you can complete your training.

-You should point out to the RFS if able that even exceeding the threshold for a 1st class (6 prism diopters) that the AME is still directed not to withhold the medical certificate as outlined below:

Guide for Aviation Medical Examiners

Referencing the FARs, the applicable section is Part 67.103(f):

(f) Bifoveal fixation and vergence-phoria relationship sufficient to prevent a break in fusion under conditions that may reasonably be expected to occur in performing airman duties. Tests for the factors named in this paragraph are not required except for persons found to have more than 1 prism diopter of hyperphoria, 6 prism diopters of esophoria, or 6 prism diopters of exophoria. If any of these values are exceeded, the Federal Air Surgeon may require the person to be examined by a qualified eye specialist to determine if there is bifoveal fixation and an adequate vergence-phoria relationship. However, if otherwise eligible, the person is issued a medical certificate pending the results of the examination.

What was your phoria at distance? I would assume less than 6 prism diopters of exophoria? If that is the case the you have a situation where your eyes don't converge as strong as the average person, typically also known as convergence insufficiency. It can cause a sensation of double vision when reading/close up only, and may cause a person to close one eye when reading. I would think that given the eye doctor documented on the 8500-7 that you have no diplopia you have already satisfied the FAR requiring bifoveal fixation. 8 prism diopters of exophoria at 16 inches, while indicative of a reduced vergence/phoria relationship, is not excessive and should easily be judged as "adequate".

Aaron R Florkowski, MD
FAA Designated AME
www.kansascityame.com

 

[tecu]

You sound like me but 14-15-ish years ago. I was a similar story but I already had a 1st class medical and Private pilot license and then in the late teenage years I had trouble on a routine doc visit with the eye machine for the musical note/red line test. So I went to the eye doctor and filled out the 8500-7 form and submit that to the FAA.

1. The next step is most likely same as me, they'll ask you to do a Medical Flight Test (MFT). You basically go up with a FSDO examiner in a Cessna or whatever you fly and basically just shoot a couple touch n goes to show that you can fly okay. Once you pass that and based on your description of what you have, your flying isn't affected and you will pass it, then you will get a SODA - Statement of Demonstrated Ability. My SODA was issued on the basis of the MFT. Mine lists "diplopia on lateral gaze" on the SODA. Just make sure your SODA is valid for a 1st class medical (which it should automatically be if you applied for a 1st class). Since my condition was benign and not worsening, the SODA is basically good for life - and my gut feeling is yours will be too.

2. Once you get a SODA for your condition, you can professionally fly. I had no issues in any airline interviews I did. When you fly you carry your 1st class medical and SODA with it too. That's it.


The only caveat is I don't know how the MFT would work for you since you are a student pilot and can't take passengers until you get your PPL. I wouldn't worry too much though. Unless you have one of those ~17-18 disqualifying conditions on the main medical application (eg, suicidal, insulin injected diabetes shots, etc), you should be able to get a SODA or waiver for eye conditions.


There are pilots with one deaf ear. One kidney. All sorts of stuff out there that may shock you, but all it takes is a SODA or a waiver to go along with your 1st class medical.


Keep us posted, I'd be curious what you hear next. It should be steps to get a SODA or a waiver. As for me, as I grew older the condition kinda corrected it self. I don't know it was some eye muscle imbalance thing, maybe fatigue/being tired made it worse. But today approaching mid 30s I still have the SODA (it's good for life) but I don't have the diplopia on lateral gaze anymore.

@Cherokee_Cruiser thanks so much for sharing your own experience with me. It has given me hope. I will definitely keep you posted when I get any updates

 

[tecu]

Hi Tecu,

I think you will end up fine, it's just a matter of how many steps you have to take to get to the certificate (ideally as few as possible). I would ask the AME to supply you with the name of your Regional Flight Surgeon and call him/her, ask what to expect next. If possible plead your case for the RFS to review your file rather than forwarding to Oklahoma City. A few points:

-Heterophoria requirements only apply to 1st and 2nd class medicals. 3rd class has no such requirement, so at the very least you could ask the RFS to issue a 3rd so you can complete your training.

-You should point out to the RFS if able that even exceeding the threshold for a 1st class (6 prism diopters) that the AME is still directed not to withhold the medical certificate as outlined below:

Guide for Aviation Medical Examiners

Referencing the FARs, the applicable section is Part 67.103(f):

(f) Bifoveal fixation and vergence-phoria relationship sufficient to prevent a break in fusion under conditions that may reasonably be expected to occur in performing airman duties. Tests for the factors named in this paragraph are not required except for persons found to have more than 1 prism diopter of hyperphoria, 6 prism diopters of esophoria, or 6 prism diopters of exophoria. If any of these values are exceeded, the Federal Air Surgeon may require the person to be examined by a qualified eye specialist to determine if there is bifoveal fixation and an adequate vergence-phoria relationship. However, if otherwise eligible, the person is issued a medical certificate pending the results of the examination.

What was your phoria at distance? I would assume less than 6 prism diopters of exophoria? If that is the case the you have a situation where your eyes don't converge as strong as the average person, typically also known as convergence insufficiency. It can cause a sensation of double vision when reading/close up only, and may cause a person to close one eye when reading. I would think that given the eye doctor documented on the 8500-7 that you have no diplopia you have already satisfied the FAR requiring bifoveal fixation. 8 prism diopters of exophoria at 16 inches, while indicative of a reduced vergence/phoria relationship, is not excessive and should easily be judged as "adequate".

Aaron R Florkowski, MD
FAA Designated AME
www.kansascityame.com

@aflorkowski Thanks so much for sharing your knowldge. To answer your questions about my phoria at distance, it was (without correction 1.5 BI and with correction 2 BI both at a distance of 20 ft) I called the Regional Flight Surgeon offfice to speak with the person the AME told me to, and that person was not there at the moment I called. I receptionist took my info and number and hopefully I am able to talk to them soo ln and use the printers that you shared. Once again thanks so much and I will also keep you posted.

 

[FlightSurgeon]

If you were 2 BI in each eye that is a total of 4 PD of exophoria at distance with correction (which is less than 6). I would believe that you meet criteria for a 1st class, as I am not aware of a near phoria requirement. FWIW, that level of exophoria at distance is very normal, actually more normal than having no phoria at all. I will be interested in what follows, please keep us updated!

Aaron R Florkowski, MD
FAA Designated AME
www.kansascityame.com

 

[Cherokee_Cruiser]

Oh nice, I didn't realize we had an AME here ever since Dr. Forred retired. Nice to see you Dr. Florkowski!


Quick question, if one has a SODA for a condition he had as late teenager, but now in the mid 30s that condition no longer exists, is there a way to "un do" a SODA?

 

[FlightSurgeon]

Oh nice, I didn't realize we had an AME here ever since Dr. Forred retired. Nice to see you Dr. Florkowski!


Quick question, if one has a SODA for a condition he had as late teenager, but now in the mid 30s that condition no longer exists, is there a way to "un do" a SODA?

Thanks! I'm not aware of a process for undoing a SODA. Why do you feel that you would need to? They aren't punitive in a any way.