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BlackMamba

Cup-to-disc Ratio

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Hey,

Does anyone know if having excessive cupping of the optic disc is grounds for DQ or if it is possible to get a waiver (if necessary)? So far the pressure tests were within the limits but the cup to disc ratio was 0.4 and I think it is suppose to be below 0.3. Any information would be much appreciated.

Thanks

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AFI 48-123

6.44.6.6. Optic Nerve.

...

6.44.6.6.5. Optic nerve cupping greater than 0.4 or an asymmetry between the cups of greater than 0.2, unless proven to be physiologic after comprehensive evaluation by an eyecare specialist. This evaluation must include local diurnal pressure checks and visual field testing.

Even if you exceeded 0.4, waiver is automatic as long as you don't also have Ocular Hypertension or Glaucoma. If you do, waiver gets much trickier. See links in my signature. Edited by deaddebate

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Yep, same here. Just had to do an extra test where I stuck my head in a bowl-shaped device and clicked the clicker whenever I saw a point of light somewhere around the periphery of the bowl (I think that's the "visual field testing" deaddebate quoted?). Nonissue.

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Flt Docs...

I'm attempting to return to fly after a long (3 years) DNIF. As part of the process, the optometrist discovered a disc to cup ratio greater than 0.4 and I did all the additional testing. Now ACS wants me to have a brain MRI done.

Other issues that I'm getting waivers for: sleep apnea (barely), GERD, rheumatoid arthritis (bad diagnosis that drove original DNIF), hives (controlled with waiverable antihistamine), kidney stone (one time, no current issues).

Any idea why I need the MRI?

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28 minutes ago, I don't exist said:

Flt Docs...

I'm attempting to return to fly after a long (3 years) DNIF. As part of the process, the optometrist discovered a disc to cup ratio greater than 0.4 and I did all the additional testing. Now ACS wants me to have a brain MRI done.

Other issues that I'm getting waivers for: sleep apnea (barely), GERD, rheumatoid arthritis (bad diagnosis that drove original DNIF), hives (controlled with waiverable antihistamine), kidney stone (one time, no current issues).

Any idea why I need the MRI?

Nothing listed here would drive a brain MRI.  If you want to PM me I can look into it further.

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I was told it couldn't be more of a non-issue. You have to do the peripheral test (sucks) and you have to do 3 separate eye pressure readings. But basically FCI guys at Wright-Patt are trying to make it so that you don't ever have to do additional testing. If it's an actual issue, it would have shown itself well before the doc's visual eye examination (with the light bar and magnifying lense). They told me 20-25% of all people that come through have it... only 3 people who have ever been through Wright-Patt have actually had something wrong that needed a waiver or possibly got them DQ'd. Those 3 people definitely had an issue that showed itself during some of the other tests. I was basically told, "Nothing is wrong with you, but we're required to do the extra tests so just do them. Your vision is awesome." No waiver required.

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1 hour ago, tk1313 said:

I was told it couldn't be more of a non-issue. You have to do the peripheral test (sucks) and you have to do 3 separate eye pressure readings. But basically FCI guys at Wright-Patt are trying to make it so that you don't ever have to do additional testing. If it's an actual issue, it would have shown itself well before the doc's visual eye examination (with the light bar and magnifying lense). They told me 20-25% of all people that come through have it... only 3 people who have ever been through Wright-Patt have actually had something wrong that needed a waiver or possibly got them DQ'd. Those 3 people definitely had an issue that showed itself during some of the other tests. I was basically told, "Nothing is wrong with you, but we're required to do the extra tests so just do them. Your vision is awesome." No waiver required.

Good post.  Do we make it that obvious how much we hate this policy?  It is what it is.  Hopefully it will get changed in the near future.  The techs who run the visual fields will be happier than anyone.  It sucks to take it, but imagine giving the test 5x times a day.

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I had this same issue (enlarged cup-disc ratio, mild esophoria) back in 2000 for my initial.  Went to Brooks for 3 days of tests, waiver was submitted/approved.  I had normal pressures, 20/20, normal depth perception, passed Humphrey visual field 30-2 (head in the box test).  I was put in a study group (of only a few individuals from what I was told) to monitor the condition.  The cup-disc ratio was presumed to be congenital.  I had to submit pressure tests, Humphrey visual field test, and depth perception every year for over a decade to monitor for any abnormalities.  The waiver was renewed every 3 years or so.  To date, still 20/20 with normal pressures etc (fingers crossed).  Good luck!!

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20 hours ago, stuckindayton said:

Good post.  Do we make it that obvious how much we hate this policy?  It is what it is.  Hopefully it will get changed in the near future.  The techs who run the visual fields will be happier than anyone.  It sucks to take it, but imagine giving the test 5x times a day.

Like you said... It is what it is. I'll gladly spend an extra morning doing tests to prove my eyes are good. I have a family member that works for an eye doctor, so I asked if it had come up before. I was told that it was noted, but it's not an issue (just like you guys/gals said). My old man said he has it as well, and that his old ass can still shoot the nuts off of a gnat at 50 yards, can still tell the difference between a 9 and a 10 in a dimly lit bar... and some other stupid shit like that.

Nobody complained about the policy, they just reassured me that I had nothing to worry about--my vision is excellent, and the ratio by itself is an antiquated metric. Great folks with great attitudes at Wright-Patt.

Edited by tk1313

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6 hours ago, I don't exist said:

I'm hearing what you guys are saying...NBD. However, none of you have had to do a brain MRI, right?

You don't get an MRI for excessive optic nerve cupping.

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4 hours ago, stuckindayton said:

You don't get an MRI for excessive optic nerve cupping.

Well, that's exactly what's happening to me. I passed all the ancillary testing, but the waiver authority wants an MRI.

I'm taking your response as, "I don't know bruh."

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17 minutes ago, I don't exist said:

Well, that's exactly what's happening to me. I passed all the ancillary testing, but the waiver authority wants an MRI.

I'm taking your response as, "I don't know bruh."

IF the eyeball portion of your exam is driving an MRI, then you may have something more significant than routine optic nerve cupping such as optic atrophy, optic neuropathy, or optic disk pallor.  Any of those could be associated with excessive cupping as the nerve is essentially degenerating from a pathology which kills nerve fibers and increases the cup size.  It's possible, but would be exceptionally rare for a young healthy person. For IFC I exams, 99.99% of the time excessive optic nerve cupping is simply an anatomic variation of normal and the Air Force's exceptionally conservative policy requires work-ups on a large percent of people who would not be routinely worked up as part of a routine exam.

If you want to know why you're getting an MRI, PM and I'll tell you.  If you'd rather not reveal your identity I totally understand and respect that.  But it's not fair to take my response as "I don't know" when I don't have all the information.

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