stuckindayton

There's really a couple of things going on that I would have issue with. First, the only measurement of refraction is an autorefraction and that is, frankly, garbage. It's a computer estimate of your prescription and it's often way off. Furthermore, it's not the way we measure refractions for flight physicals. That is based on the doctor's exam, after your eyes are dilated and only to 20/20 (which will always yield a lower prescription) versus to your best vision. Maybe they did that as well, but it's not documented here. If they didn't do that, then you shouldn't be disqualified from FC I per AF policy. Second, how did they test your depth perception? By FC I policy, it must be done with your best correction in place and it must be with glasses. If you don't have glasses that are your best prescription and they didn't make any for you, then that didn't meet FC I policy. So are they going to DQ you from FC I despite not doing the proper tests? I don't know how that works at MEPS. I only saw patients who made it to Wright-Patt. I'd hope they weren't DQing people improperly without giving us the chance to do it right. I know we saw a lot of people who didn't meet refractive standards, but I don't know if they were DQing others and we never saw them. Unless there's more to the story, I'd address the fact that MEPS isn't doing to physical properly to DQ you from an FC I slot. I don't know, maybe that's how MEPS works. But, I was at USAFSAM for almost 20 years and that's not how we did things. Table 4 confuses everybody, myself included when it first came out. It was just an attempt to make PRK and LASIK less restrictive for everybody, but for various reasons they didn't want the limits to be the same for trained aircrew versus applicants, thus we have all sorts of inconsistencies. If you are sure that there's no more documentation, I can ask a few of the admin folks if they run into this and how they handle it. Seems silly to risk losing a C-130 slot over stupidity.

Well if your pre-op astigmatism is listed as 3.25 by your surgeon, then you would need a waiver to be FC I qualified, but that won't kick in until you get re-evaluated by the AF. Until then, it's just between you and a LASIK/PRK surgeon if that's the way you choose to go. Happy to help. Keeps my old brain going in these retirement days. Cheers, Steve

I'll agree, this is confusing. The pre-op limits of +3.00/-8.00 and 3.00 D of astigmatism were the old limits for everybody- trained aircrew and aircrew applicants. They had been the limits for decades and the AF decided it was time to raise the limits to reflect improvements in technology. So the limits of +3.00/-8.00 and 3.00 D are the limits of what does NOT require a waiver if the outcome is good. Above that, as you see in Table 4 is the "no shit" limits for what the AF will consider for waiver. There are some weird reasons when the hyperopia and astigmatism limits are different for trained versus untrained, but I honestly don't remember them anymore. If you are a civilian applicant, you fall under untrained. Thus, you are allowed to go to those limits. If you are above -8.00/+3.00 and 3 D of astigmatism then you would need a waiver. As long as the procedure is relatively successful you should be fine. The depth perception issue would have to be completely re-evaluated after PRK or LASIK. Note that there is also a 6 month wait time between PRK/LASIK and getting re-evaluated. It's one year for hyperopic (plus) treatments, but I don't think they'd consider your treatment hyperopic since you'd mostly be correcting the astigmatism which is myopic astigmatism. Does that make any sense?

Wait, are you currently aircrew for the AF? That creates an odd situation for PRK/LASIK. The limit is 6.00 D pre-op for aircrew applicants, but 3.00 D for current aircrew. If you are AF aircrew, are you AD, ANG, AFRES? If you are civilian aircrew then disregard, the 6.00 D applies. Even if you only wear contact lenses, you still have to get a refraction during your exam. Plus, if you wear contact lenses, the AF policy states that your physical must be done at least two weeks after d/c contact lenses (Note 4 of Table 1 in the MSD).

Herk, Congrats on being picked up. The photo you show is your prescription for contact lenses. This will correlate, but will not be exactly the same, as your glasses prescription which is measured during all physicals. I have a couple of questions. Did the optometrist at MEPS do a refraction (i.e. which is better, one or two)? Was it done after dilation? That's what determines where you stand. The equipment used at MEPS, however old, should not change this finding. My best guess is that MEPS probably did it wrong. Just my biased guess. If you can't fight their findings, here are your options: 1. Astigmatism greater than 3.00 is not waiverable for flying class one. It's pretty much a hard line. 2. You could get LASIK or PRK. Untrained aircrew (i.e. applicants) are allowed up to 6.00 Diopters before surgery. That changed someone around 2018/2019 so you might be looking at an older policy. My recommendation is to refute the MEPS exam if they didn't do it exactly like it is specified in policy. After 2 drops of cyclopentolate and only to an acuity of 20/20. See Note 3 of Table One of the Medical Standards Directory. Let me know what you find. Cheers, Steve

The test is based around the idea of five stimuli at five contrast levels, but it doesn't always present every stimulus at every level. It uses a staircase algorithm. If you get two stimuli correct at the first (highest) contrast level, it drops down to the third level. If you get two right on that level, it drops down to the fifth (lowest) contrast level. If you get all five right at that level you get a score of 100. If, at any point, you miss a stimulus, it moves back up one contrast level higher (e.g. if you miss one on the third level it bounces back to the second level) and then if you get two more right it bounces back to one level lower in contrast. So although the test is based on a five by five grid, you rarely see all 25 stimuli. Most people see between 9 (the number of stimuli if you never miss anything) and maybe 15 stimuli if you have a mild color deficiency. Of course, this is just for one color for one eye, so multiply that by six (three cones and two eyes) for the complete test. And as I said previously, if your score is near the pass/fail line the entire test repeats for that color to confirm the result. Wright-Patt will almost never repeat the test because: 1) It's already been repeated as part of the computer logic and 2) What score do you take it you fail once and pass once? Like anything in the standards world, it can be very tough to draw the line when someone is on the fence, but it has to be done. I know it sounds a bit like the WP folks might not care (which is absolutely not the case), but they have to process upwards of 50 folks a week and they have limited resources to do so. Difficult decisions have to be made and they are sometimes not what applicants what to hear. But, they will give you every chance to pass that they can. Steve

Nate, I believe Wright Patt is still using the Landolt (directional) "C" CCT. There may be a few other clinics out there using the "C", it just depends on who has updated their equipment in the last couple of years. More than likely, your local flight med will have the letter version. In theory, the two should be equivalent. The "C" was introduced to make the stimulus more consistent in difficulty, whereas the letters vary (Z, V are easier, E, F, R, P are harder). However, your score on each test should be similar (within the test-retest variability for each type of device). The version at Wright-Patt (unless they've changed it since I left) will retest you if you score a 50. You effectively have to score below 55 twice to get that as your official result. Once the machine spits out the final result, it's pretty much final. I wouldn't expect them to retest you again at that point. Hope that help. Best of luck, Steve

ClearedHot, I'm not a flight doc, but I haven't seen one post on here for a long time so you may not get any other responses. Here's the info you're looking for (From the waiver guide dated 16 Feb 22. Waiver for IFC I is possible. Must demonstrate stability after being off meds for one year prior to FC I exam.

Helo, Most of the specifics related to medical have been removed from the AFI and moved to the Medical Standards Directory (attached). The Air Force Waiver Guide (easily Googled) has more information on how medical conditions are dispositioned. Sorry, I don't know have any personal knowledge on the subject. Not my area of expertise. Best of luck. Medical_Standards_Directory.pdf

I'm not that kind of doc, but since you didn't get any other replies I'll give you my thoughts. They will certainly review the history and waiver, but I don't think they'll do any more inspection than what everyone else gets. In all my years working at WP I don't recall anyone being sent over to the medical center for a colon scope. Each department is a little different, but for eye folks, our attitude was that if the AF already waived a condition then we were wasting their time giving them our opinion. The only exception was if the waiver was based on incorrect information. Then we would point that out and let them decide how to proceed. Bottom line is that I wouldn't sweat it.

Sorry, my box was full. Try again.

Agree with both of his statements. Until you are winged, you are untrained. However, I've seen cases where people who had hours in UPT were treated like trained aircrew simple because money had already been invested in them. It's certainly a gray area. You won't get corneal pachymetry annually as the good Capt pointed out, but you will get the air puff. If that reads 22 or above, it will be back to optometry more than likely. But again, if it's been decided your eye pressure is normal for your eye (i.e. given your corneal thickness and lack of evidence of glaucoma) I wouldn't envision it being any issue.

Sent a PM.

10 exophoria is the standard, but there are some waivers available for people who exceed this. There is not a set limit for what is waiverable. It depends on a number of factors that are determined when the exam is done.

Yes, but it's not real common. Having an exophoria is normal, having an extremely large exophoria is a problem.

Sorry to potentially state the obvious, but. amblyopia means you have a "lazy" eye. It can mean an eye turn (which would also be labeled as an exotropia), but more correctly it means an eye that can't correct to 20/20. Either an eye turn or not correctable are show stoppers for a pilot slot.

Based strictly on the 3.75 value, it is potentially waiverable (and it wouldn't be waiverable for FC I if you weren't to get refractive surgery so in this case if you want a shot, get surgery). Looking at the most recent waiver guide that Google provided me, Table 4 of the "Refractive Surgery" chapter says you can have up to 6.00 D of astigmatism treated with refractive surgery and be POTENTIALLLY eligible for waiver for FC I. There are lots of other factors (is your myopia/hyperopia within limits, is there any ocular pathology that may be causing 3.75 D of astigmatism, is the outcome optimal, etc), but it is POTENTIALLY waiverable. I stress the "potentially" because this was a monumental increase from the previous limit of 3.00 D and when the change was made the understanding among the policy makers was that your post-surgery vision and refractive error would have to be stone cold normal. The waiver guide I'm referencing is a year old so it's not most current guidance, but unless there has been a titanic change in direction, standards aren't getting more strict over time.

Although astigmatism is written with a sign, in reality it is a difference of two powers and thus the magnitude is important, not the sign. It's not really a hard concept, but it's hard to explain without pictures. Take an example where an eye needs a power of -3.00 Diopters in the vertical meridian and -1.00 Diopters in the horizontal meridian for optimal correction. The astigmatism would be 2.00 Diopters. There are two forms of writing this physical lens, and thus astigmatism can be written as either a positive or negative number, but it's the absolute value that is meaningful.

Not even close. It's extremely rare when a flight doc is turned down for medical reasons.

Has anyone gotten a waiver for less than 20/20 best corrected vision (for a pilot slot I presume)? Highly unlikely. I've seen many requested for best corrected vision 20/20- in one eye and none got approved. As far as the second question goes...if your eyes did not develop 20/20 vision during childhood, glasses or contacts today aren't going to get you there, nor is PRK as you know. It's kind of odd to have neither eye be 20/20. Usually people have one strong eye and one weaker eye due to misalignment or unequal refractive errors (i.e. glasses prescriptions) that were not balanced by lenses at an early age. But, it is possible to have reduced vision in each eye for other reasons (e.g. congenital cataracts, uncorrected astigmatism, etc.) You referred to "muscles not developing." Not sure exactly what is meant by that. It sounds like a generic term for a lazy eye, but again, that's almost always unilateral, not bilateral. Maybe I can clarify with more background info if you're interested.

I'm not defending the article in any manner..... but, that is standard verbiage that most published research will include in some fashion. It's often to satisfy the peer reviewers who point out potential deficiencies in the work. It's not unique to this write-up.

Standards are actually established through experts in each field (i.e. gastro, ophthal, ortho, etc), although you are correct that flight docs frequently are tasked with interpreting and enforcing them. I won't sit here and defend all standards as I personally don't agree with all of them either, but sometimes there's more to them than meets the eye. For example, a GI problem may not be a big deal for an ABM, but it may be a problem for deploying so it applies to all flying classes across the board. I don't know that for fact, just throwing out a possibility. Agreed wholeheartedly. It seems the AF spends a lot of money training many career fields only to have them split after the ADSC. I would say the majority of my medical appointments at the MDG utilize some type of student, resident or intern simply because the AF has to keep training folks to replace those who don't stay. Nothing worse than a phlebotomist who is still learning the trade.

They are different. He was issued an FAA First Class. That's a completely different animal than a USAF Flying Class I. Apples and oranges. Civilian docs can't issue USAF certificates- only USAF flight docs do that. USAF flight docs MAY also be FAA AMEs and may issue FAA certs. The docs at WP generally offer FAA third class certs to UPT applicants processing through WP who qualify.

Yea, not uncommon situation at all. Without getting your hopes up too high, the vast majority of these cases went OK. The doc (optometrist) can hopefully help sort things out.

I'm assuming you're still at WP. Maybe that's incorrect.