Van B. Nakagawara 

Ronald W. Montgomery

Kathryn J. Wood

Civil Aerospace Medical Institute

Federal Aviation Administration

Oklahoma City, OK 73125

April 2004

Final Report

This document is available to the public

through the National Technical Information

Service, Springfield, Virginia 22161.

Office of Aerospace Medicine

Washington, DC 20591

DOT/FAA/AM-04/6 Demographics and Vision 

Restrictions in Civilian Pilots: 

Clinical Implications
NOTICE

This document is disseminated under the sponsorship of

the U.S. Department of Transportation in the interest of

information exchange. The United States Government

assumes no liability for the contents thereof.
i

Technical Report Documentation Page 

1. Report No. 2. Government Accession No. 3. Recipient's Catalog No. 

DOT/FAA/AM-04/6 

4. Title and Subtitle 5. Report Date 

 

Demographics and Vision Restrictions in Civilian Pilots: April 2004 

Clinical Implications 6. Performing Organization Code 

 7. Author(s) 8. Performing Organization Report No. 

Nakagawara VB, Montgomery RW, Wood KJ. 

9. Performing Organization Name and Address 10. Work Unit No. (TRAIS) 

FAA Civil Aerospace Medical Institute 

P.O. Box 25082 

Oklahoma City, OK 73125 11. Contract or Grant No. 

 12. Sponsoring Agency name and Address 13. Type of Report and Period Covered 

 

 

 

Office of Aerospace Medicine 

Federal Aviation Administration 

800 Independence Ave, S.W. 

Washington, DC 20591 14. Sponsoring Agency Code 

 15. Supplemental Notes 

16. Abstract Background: The Federal Aviation Administration (FAA) permits airmen with certain medical conditions or diseases to be 

medically certified, provided that such action does not compromise aviation safety. The FAA Office of Aerospace Medicine 

helps guide policy decisions through the study of common medical pathologies, including visual disorders and the use of new 

ophthalmic devices and refractive procedures by airmen. To perform this function properly, an in-depth knowledge of the 

airman population is required. This study examined demographic statistics for the civil airman population, including vision 

pathologies, for the period 1976 to 2001 and their relevance to the clinical care of aviators by eyecare practitioners. Methods:

Medical certification data were extracted from FAA publications and databases for all civil airmen who were active on 

December 31st of each year from 1976 to 2001. Frequency and medical restriction data were delineated into 5-year 

increments and analyzed to identify population trends for the 25-year study period. Results: Although the total number of 

airmen has decreased over the study period (-17%), the population of male and female airmen holding first-class medical 

certificates has grown by 119% and 1,241%, respectively. The percentage of airmen ≥ 40 years of age has increased by 17%, 

and the average age rose from 36.8 to 42.3 years of age. Additionally, the increase in near vision restrictions (13%) was more 

than double that of distant vision restrictions (6%) during the study period. As of 2001, 92% of all medical restrictions were 

vision related. Conclusion: The changing demographic profile of the civil airman population, which includes a growing 

number of first-class certificate holders, first-class female aviators, and the increasing maturity of the pilot population, may

compound the challenge to eyecare practitioners tasked with advising aviators concerning the proper choice of refractive 

correction. To guide the clinician in recommending the most appropriate form of refractive correction, the unique aviation 

vision demands, ergonomic considerations, and environmental conditions experienced by the civilian pilot are discussed. 

 

17. Key Words 18. Distribution Statement 

 

 

Vision; Age; Aviation Certification, Aeromedical; Pilots Document is available to the public through the 

National Technical Information Service; 

Springfield, Virginia 22161 19. Security Classif. (of this report) 20. Security Classif. (of this page) 21. No. of Pages 22. Price 

Unclassified Unclassified 13 

Form DOT F 1700.7 (8-72) Reproduction of completed page authorized

1

DEMOGRAPHICS AND VISION RESTRICTIONS IN

CIVILIAN PILOTS: CLINICAL IMPLICATIONS

BACKGROUND

The origin of the Federal Aviation Administration 

(FAA) can be traced back to May 20, 1926, when then 

President Calvin Coolidge signed the Air Commerce Act 

into law. The act instructed the Secretary of Commerce 

to foster air commerce; designate and establish airways; 

establish, operate, and maintain aids to air navigation; 

arrange for research and development to improve such 

aids; license pilots; issue airworthiness certificates for 

aircraft and major aircraft components; and investigate 

accidents. On April 6, 1927, William P. MacCracken, 

Jr., Assistant Secretary of Commerce for Aeronautics, 

received Pilot License No. 1, thus becoming the first 

person to obtain a pilot license from a civilian agency of 

the U.S. Government.

Since then civil aviation has become a major commercial and technological industry that has a substantial 

impact on the United States economy. Based on the most 

recent study by Wilber Smith Associates, which examined 

the civil aviation’s economic impact for the year 1998, 

commercial and general aviation contributed $976 billion to the U.S. economy and generated 10.9 million 

jobs with annual earnings in excess of $278 billion (1). 

To sustain the current level of usage and allow for future 

expansion of the National Airspace System (NAS), the 

FAA permits airmen with certain medical conditions or 

diseases to obtain aeromedical certificates, provided that 

such action does not compromise aviation safety. The 

Office of Aerospace Medicine helps guide policy decisions through the study of common medical pathologies, 

including visual disorders and the use of new ophthalmic 

devices and refractive procedures by airmen in the aviation environment.

The FAA medical certification process requires that 

each airman hold a current medical certificate of the appropriate class. In the U.S., there are approximately 5,000 

aviation medical examiners (AMEs) that are responsible 

for the medical examinations of more than 650,000 pilots. 

First-time pilot applicants and those seeking re-certification may apply for one of three classes of medical certificate. 

First-class certificate holders include air transport pilots, 

who often fly large, sophisticated passenger aircraft. Second-class certificate holders include commercial pilots, 

who may fly cargo aircraft, commuter aircraft with 30 

passengers or less, or provide aero-application services, i.e., 

“crop dusters.” Third-class certificate holders primarily 

fly for pleasure in light, privately owned aircraft.

Aeromedical examinations are periodically administered and require the applicant to meet minimum medical standards needed for a particular category or class of 

flight. For first-class certification, medical examinations 

are performed every 6 months, second-class every 12 

months, and third-class pilots must be examined every 

36 months if they are < 40 years of age and every 24 

months if they are ≥ 40 years of age (2). Medical standards for each class of medical certificate are detailed in 

Title 14 of the Code of Federal Regulations (CFR) Part 

67, §67.103, §67.203, §67.303 (3). Vision standards 

for the three classifications of pilot certificates are summarized in Table 1.

Medical certification criteria have changed through 

the years in response to advances in medical knowledge, 

treatments, and aviation technology. Aeromedical research 

provides substantive data to validate current medical certification criteria or identify the need to change existing 

practices to enhance aviation safety and better serve the 

civil aviator and the flying public. The Aerospace Medical Certification Division of the Civil Aerospace Medical 

Institute (CAMI), located in Oklahoma City, OK, is the 

FAA’s central screening facility and repository for the 

collection, processing, adjudication, investigation, and 

analysis of medical data generated by the aeromedical 

certification and related regulatory programs. Research 

activities performed at CAMI include identifying changes 

in the aerospace and medical industries and conducting 

investigations that provide relevant data required to guide 

the policy-making decisions that advance aviation safety.

CAMI’s Vision Research Team conducts ongoing research concerning current and anticipated vision problems 

associated with aviation activities. Research includes supporting the airman certification process and evaluating 

the effects of aging and chronic disease as they relate to 

the visual requirements of the aviation environment. To 

perform this function properly, an in-depth knowledge of 

the current airman population demographics is required. 

This retrospective epidemiological study examined demographic statistics for the civil airman population, including 

vision pathologies, for the period 1976 to 2001, by age, 

gender, and class of medical certification and discusses 

their relevance to the clinical care of aviators by eyecare 

practitioners.
2 

Table 1: A summary of FAA vision standards.

Restriction First-Class Second-Class Third-Class 

Distant Vision Distant visual acuity of 20/20 or better in 

each eye separately, with or without 

corrective lenses. If corrective lenses 

(spectacles or contact lenses) are 

necessary for 20/20 vision, the person may 

be eligible only on the condition that 

corrective lenses are worn while exercising 

the privileges of an airman certificate. 

Distant visual acuity of 20/40 or 

better in each eye separately, 

with or without corrective lenses. 

If corrective lenses (spectacles 

or contact lenses) are necessary 

for 20/40 vision, the person may 

be eligible only on the condition 

that corrective lenses are worn 

while exercising the privileges of 

an airman certificate. 

Near Vision Near vision of 20/40 or better, Snellen equivalent, at 16 inches in each eye 

separately, with or without corrective lenses. 

Intermediate Vision If ≥ 50 years of age, vision of 20/40 or 

better, Snellen equivalent, at 32 inches in 

each eye separately, with or without 

corrective lenses. 

No Standard. 

Heterophoria 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 duties1

.

No Standard.

Color Ability to perceive those colors necessary for the safe performance of airman 

duties. 

Field of Vision Normal fields of vision. Same as Pathology Standard 

below. 

Pathology No acute or chronic pathological condition of either eye or adnexa that 

interferes with the proper function of an eye, that may reasonably be expected 

to progress to that degree, or that may reasonably be expected to be 

aggravated by flying. 

1

 If more than 1 prism diopter of hyperphoria, 6 prism diopters of esophoria, or 6 prism diopters of exophoria are 

exceeded, the Federal Air Surgeon may require the applicant to be examined by a qualified eye specialist to 

determine if there is bifoveal fixation and an adequate vergence-phoria relationship. The applicant, if otherwise 

eligible, is issued a medical certificate pending the results of the examination (2). 

 1If more than 1 prism diopter of hyperphoria, 6 prism diopters of esophoria, or 6 prism diopters of exophoria are exceeded, the Federal 

Air Surgeon may require the applicant to be examined by a qualified eye specialist to determine if there is bifoveal fixation and an adequate 

vergence-phoria relationship. The applicant, if otherwise eligible, is issued a medical certificate pending the results of the examination (2).

METHODS

Demographic statistics and medical restriction data 

were collected for all civilian airmen who were active on 

December 31st of each study year for the period 1976 to 

2001. These data were extracted from the Aeromedical 

Certification Statistical Handbook, published annually 

by CAMI’s Aerospace Medical Certification Division 

(4) and from data collected by CAMI’s Bioinformatics 

Team. (Note: Publication of the Aeromedical Certification Statistical Handbook was suspended after 1998.) 

Frequency and medical restriction data were examined 

for anomalies, which were corrected or deleted. The data 

were then delineated into 5-year increments and analyzed to identify population trends for the 25-year study 

period. Frequency counts, average age, and percentage 

of restrictions were calculated for various stratifications, 

which included class of medical certification, gender, and 

age category (< 40 and ≥ 40 years of age). Although the 

precise definition of some vision restrictions changed 

slightly during the study period, for this investigation 

the following definitions were applied:

1. Must have available glasses for near vision.

2. Must wear corrective lenses.

3. Must wear corrective lenses for near and distant 

vision.

4. Must wear lenses for distant and possess glasses 

for near vision.

5. Must wear corrective lenses and possess glasses 

for near and intermediate vision.
3

6. Holder shall possess glasses for near and intermediate vision.

7. Must wear prismatic correction.

8. Must wear corrective lenses: extra pair must be 

available.

9. Not valid for night flying or by color signal 

control (color vision).

10. Not valid for night flying (glaucoma).

The vision restrictions were grouped into general 

categories resulting in some overlap within these categories. The vision restrictions listed above were assigned 

to categories as indicated by their item numbers in the 

following manner:

Defective Distance Vision (DDV) = 2-5,8

Defective Near Vision (DNV) = 1,3-6

Defective Intermediate Vision (DIV) = 5,6

Defective Vision (DV) = 1-10

RESULTS

The total airman population in 2001 (650,146 airmen) had decreased by approximately 17% from a total of 

780,408 airmen in 1976. For the same period, second- and 

third-class airman populations decreased by 52% (from 

307,364 to 149,029 airmen) and 19% (from 393,246 to 

318,382 airmen), respectively, while the first-class airman 

population increased by 129% (from 79,798 to 182,735 

airmen; see Figure 1).

The total female airman population decreased by 11% 

from 1976 (44,128 airmen) to 2001 (39,098 airmen). 

However, the first-class female population exhibited the 

largest relative gain (13.4 times or 1,241%) in frequency 

for the period with an increase from 690 pilots in 1976 

to 9,255 in 2001 (see Figure 2). During the study period, the total male airman population decreased by 17% 

overall, while first-class male medical certificate holders 

increased (119%) from 79,108 airmen to 173,480 (see 

Figure 3). The ratio of males to females in the total airman population decreased from 17:1 in 1976 to 16:1 

in 2001. A similar comparison of the first-class airman 

population showed a significant relative increase in female 

aviators from a 115:1 male to female ratio in 1976 to a 

19:1 ratio in 2001.

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

CLASS I 79,798 105,987 115,808 151,350 146,006 182,735

CLASS II 307,364 253,611 207,255 183,374 150,823 149,029

CLASS III 393,246 399,518 369,695 340,343 296,899 318,382

1976 1981 1986 1991 1996 2001

Figure 1: Total Airman Population by Class

F

R

E

Q

U

E

N

C

Y
4 

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

CLASS I 690 2,313 3,049 5,716 5,958 9,255

CLASS II 9,197 10,130 9,740 7,933 6,884 7,704

CLASS III 34,241 34,339 29,126 26,025 21,140 22,139

1976 1981 1986 1991 1996 2001

Figure 2: Total Female Airman Population by Class

F

R

E

Q

U

E

N

C

Y

F

R

E

Q

U

E

N

C

Y

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

CLASS I 79,108 103,674 112,759 145,634 140,048 173,480

CLASS II 298,167 243,481 197,515 175,441 143,939 141,325

CLASS III 359,005 365,179 340,569 314,318 275,759 296,243

1976 1981 1986 1991 1996 2001

Figure 3: Total Male Airman Population by Class
5

In the total civil airman population, the average age 

increased from 36.8 to 42.3 years of age from 1976 to 

2001 (see Figure 4). This trend was also reflected by an 

increase in the percentage of airmen ≥ 40 years of age 

from 38.7% in 1976 to 55.8% in 2001 (see Figure 5). 

By class of medical certification, the percentage of airmen ≥ 40 years of age in the first-class airman population increased from 40.5% to 45.6%, second-class from 

37.1% to 58.7%, and third-class from 39.6% to 60.3% 

during the study period.

From 1976 to 2001, there was a 10.1% increase in the 

number of medical restrictions held by civil airmen (from 

44.4% to 54.5%), which included an 8.6% increase in 

the number of restrictions associated with visual conditions (see Figure 6). The percentage of airmen in the total 

airman population with defective distance vision (DDV) 

increased from 32.6% in 1976 to 38.8% in 2001. For 

the same period, the percentage of those with defective 

near vision (DNV) increased from 8.1% to 21.3%. This 

represents a 13.1% difference in the number of DNV 

restrictions, compared with 6.2% for DDV, from 1976 

to 2001. In addition, the new defective intermediate vision (DIV) restriction category, introduced September 

16, 1996, grew from approximately 0.1% to 4% in the 

last 5 years of this study.

35.0

37.0

39.0

41.0

43.0

45.0

CLASS I 38.2 37.0 38.2 37.1 39.5 38.6

CLASS II 36.8 37.0 39.0 40.2 43.2 43.0

CLASS III 36.5 36.7 38.9 40.8 44.7 44.0

TOTAL 36.8 36.8 38.8 38.9 43.0 42.3

1976 1981 1986 1991 1996 2001

Figure 4: Total Airman Average Age by Class

AV

E

R

A

G

E

A

G

E
6 

DISCUSSION

For the study period, there was an overall decline in 

the total number of civil airmen (-17%) despite a relative 

increase of 8.7% during the last 5 years, from 593,728 

airmen in 1996 to 650,146 airmen in 2001. This increase 

was primarily due to the influx of first- and third-class 

pilots during this 5-year period. However, the first-class 

airman population sustained steady growth throughout 

the entire 25-year study period (i.e., an increase of 102,937 

airmen or 129%). This increase is indicative of the growth 

in air-carrier activity during the study period. The 52% 

decrease in second-class airmen for the study period may 

reflect changes in commercial and commuter aviation 

activities. The 1,241% increase in female pilots within 

the ranks of first-class medical certificate holders may be 

attributed to the socioeconomic and attitude changes that 

have occurred in the United States and other countries 

during this period that encouraged women to seek advancement in traditionally male-dominated vocations. 

While parity within the total civil airman population 

may not be realized for some time, the dramatic decrease 

in the ratio of males to females (from 115:1 to 19:1) for 

first-class airmen during the study period demonstrates 

significant movement in this direction.

According to the 2000 census, people born in the U.S. 

during the early years of the “baby boom” (1946 through 

1950) fueled a 55% increase in the 50- to 54-year-old 

age group, the largest percentage growth between 1990 

and 2000 of any 5-year age group (5). The second fastest 

growing group was 45- to 49-year-olds, which registered 

a 45% increase. This general trend in the U.S. population is reflected in the increase found for the percentage 

of civil airmen ≥ 40 (from 38.7% to 55.8%) and the 

P

E

R

C

E

N

T

A

G

E

35.0%

40.0%

45.0%

50.0%

55.0%

60.0%

65.0%

CLASS I 40.5% 38.6% 43.5% 40.7% 47.0% 45.6%

CLASS II 37.1% 37.8% 44.6% 50.5% 59.8% 58.7%

CLASS III 39.6% 38.8% 44.2% 50.5% 63.8% 60.3%

TOTAL 38.7% 38.4% 44.2% 48.3% 58.6% 55.8%

1976 1981 1986 1991 1996 2001

Figure 5: Percentage of Airmen ≥ 40 Years of Age
7

increase in average age (from 36.8 to 42.3 years of age) 

observed during the 25-year period of the study. In addition, with the continued aging of military-trained pilots 

who became civil aviators after World War II, and the 

Korean and Vietnam Wars, it is understandable that the 

civilian airman population is maturing. Other factors 

such as the high cost of flight training, aircraft rental 

and purchase, aviation fuel, and related expenses may be 

keeping all but the most resourceful younger pilots from 

entering the civil airman ranks.

Within the civil airman population, first-class pilots 

were younger on average (38.6 years) and the average age 

did not increase as quickly as their second- and third-class 

counterparts during the study period (i.e., average age 

increased by 0.4 years, 6.2 years, and 7.5 years for first-, 

second-, and third-class airmen, respectively). The FAA’s 

mandatory retirement rule (i.e., Title 14 of the CFR, Part 

121, §121.383 (c) [6]) for air transport pilots at 60 years 

of age may have influenced the minimal increase observed 

in the average age of first-class airmen. As a result, these 

airmen may be less motivated to seek a first-class certificate 

that must be renewed every 6 months. Interestingly, a 

first-class airman was older than the average airman in 

1976 (38.2 vs. 36.8 years of age) but became younger than 

the average airman by 2001 (38.6 vs. 42.3 years of age). 

In 2001, the average age of male airmen was 42.6 years, 

compared with 36.2 years for female aviators. For the 

study period, male aviators aged an average of 5.5 years, 

while women aviators aged only 4.0 years. This suggests 

that either a disproportionately larger number of young 

females entered the civilian airman population during the 

study period or female aviators did not continue to fly as 

long as their male counterparts as they aged.

The increasing number of females in the first-class 

civil airman population where vision standards are more 

stringent could present a unique challenge for the eyecare 

F

R

E

Q

U

E

N

C

Y

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

DIV 0.00% 0.00% 0.00% 0.00% 0.08% 4.01%

DNV 8.12% 19.64% 20.23% 24.75% 26.07% 21.26%

DDV 32.59% 34.26% 37.10% 39.40% 41.48% 38.81%

VISUAL 42.09% 44.95% 48.39% 51.00% 54.57% 50.68%

MEDICAL 44.40% 46.73% 50.05% 52.56% 56.59% 54.54%

1976 1981 1986 1991 1996 2001

Figure 6: Percentage of Visual and Medical Restrictions by Class
8 

practitioner. Females often have specific vision problems 

that can be exacerbated in the aviation environment. 

Younger females may experience shifts in refractive error 

due to pregnancy or the use of oral contraceptives (7), 

while older females may experience problems with their 

vision due to hormonal shifts associated with menopause 

and/or the use of hormone supplements (8,9,10). These 

problems can include not only a shift in their refractive 

error, but also the increased potential for dry-eye and glare 

disability (11). Poor acuity, dry-eye, and glare sensitivity 

problems could compound difficulties inherent in the aviation environment. For example, pilots are often required 

to “see and avoid” other aircraft, obstacles, or terrain under 

conditions of low humidity and glare from the sun or 

artificial sources. Furthermore, the use of contact lenses 

and refractive surgical correction may aggravate dry-eye 

and glare sensitivity problems and increase the probability 

of eye pathologies for women using cosmetic products 

such as mascara and eyeliner (12,13,14).

The increase in age found in the total airman population may also add to the problem of providing optimal 

correction for a pilot in flight. Vision problems become 

more prevalent as people age and clinical studies now 

estimate that, by 65 years of age, one person in three will 

have some form of visually debilitating eye disease (15). 

Problems with cataract, low-luminance acuity (16,17), 

disability glare (18), contrast sensitivity (19,20), color 

vision (21), stereo-acuity (22), and recovery from glare 

are more common among seniors (23). In addition, the 

increased reliance on reading glasses and intermediate 

vision correction due to the onset of presbyopia around 

40 years of age is a major consideration when prescribing for the older aviator. It has been estimated that the 

presbyopic addition increases in patients from ages 40 to 

50 years at an average rate of approximately 0.25 diopters every 2 years (24). Therefore, older pilots should be 

examined more often to ensure that they are optimally 

corrected for the demands placed on their vision while 

conducting flight operations.

As sophisticated instrumentation that employ multifunction liquid crystal (LCD) and cathode-ray tube 

(CRT) displays become more prominent (i.e., glass cockpit 

technology), even in smaller general aviation aircraft, the 

visual demand on pilots will continue to evolve and create new challenges for eyecare providers. A pilot should 

not only see well at distance, but must also read instrument panels above and below the line of sight as well as 

charts and manifests while flying. Pilots with presbyopia 

should record the distances to critical instruments and 

provide that information to the eyecare practitioner so 

that task-specific lenses can be prescribed for use in the 

cockpit (see Figure 7). In addition, communication and 

protective breathing equipment should be checked for 

compatibility with ophthalmic devices and steps should 

be taken to correct any problems before an emergency 

situation develops. Underscoring the importance of proper 

refractive correction, a recent FAA study found the lack 

of use, misuse, and the application of inappropriate forms 

of ophthalmic correction contributed to a number of 

aviation accidents and incidents (25).

For airmen who choose to wear contact lenses in the 

aviation environment, low barometric pressure and relative humidity may affect contact lens comfort. This may 

be especially troublesome for airmen who are already 

experiencing problems with age- or gender-related dryeye conditions (11,26). In addition, common side effects 

such as dry eyes, glare disability, and loss of contrast 

sensitivity may become more problematic for airmen 

A

C B

D

E

SIDE VIEW TOP VIEW

Figure 7: Presbyopic pilots should measure distances to critical instruments in the cockpit.
9

who opt for laser refractive surgery as an alternative to 

a traditional ophthalmic device (27,28,29). (Note: A 

2000 study reported that females had a higher prevalence 

for refractive surgery in all three classes of aeromedical 

certification compared to males [30]).

Since vision restrictions represent more than 90% of 

all medical restrictions assigned to civilian airmen, it is no 

surprise that vision problems are the single most common 

reason for denial of a medical certificate. The pilot and his 

or her eyecare practitioner should be aware of the vision 

requirements for the class of certification sought. Often, 

it may be necessary to update a corrective device prior to 

an aeromedical re-certification examination. Troublesome 

visual situations, such as glare sensitivity or visual aberrations during nighttime operation, should be discussed. 

Since it is not always possible for the eyecare practitioner 

to know what questions to ask, especially when he/she is 

not a pilot, the patient is ultimately responsible for providing the clinician with the information necessary to ensure 

that he/she is properly corrected. Being familiar with the 

visual demands that are a common part of the aviation 

environment and problems encountered while in flight 

will allow the eyecare practitioner to make appropriate 

recommendations concerning the type of ophthalmic 

correction that will provide the best visual performance 

for a particular ophthalmic condition.

In summary, the demographics of the civil airman 

population changed considerably during the study period. 

Ensuring that aviators maintain appropriate refractive 

correction while conducting flight operations is essential 

to aviation safety. This challenge has become increasingly 

complex due to the proliferation of refractive devices and 

procedures in recent years, in addition to the advances in 

aviation technology and avionics that have placed new 

demands on a pilot’s vision. The changing demographic 

profile, particularly for first-class certificate holders, and 

increasing maturity of the airman population, will compound the challenge to eyecare practitioners tasked with 

advising aviators concerning the proper choice of refractive correction for their particular ophthalmic condition 

and aviation activities. With a working knowledge of 

the unique vision demands, ergonomic considerations, 

and environmental conditions experienced by the civilian pilot, the clinician can advance aviation safety by 

recommending the most appropriate form of refractive 

correction.

REFERENCES

1. Wilber Smith Associates. Economic impact of civil 

aviation on the U.S. economy – 2000. Columbia, 

SC: 2000.

2. United States Department of Transportation/

Federal Aviation Administration: Guide for aviation medical examiners. Washington, DC: Sep 

2003; FAA Office of Aerospace Medicine. At URL: 

http://www.faa.gov/avr/aam/Game/Version_2/

03amemanual/home/home.htm.

3. Code of Federal Regulations. Title 14, Part 67. 

Washington, DC:U.S. Government Printing Office; January 2003.

4. United States Department of Transportation. 

Aeromedical certification statistical handbook. 

1976-1998. Washington, DC: Federal Aviation 

Administration. Civil Aeromedical Institute, 

Aeromedical Certification Division. Report No. 

AC 8500-1.

5. U.S. Census Bureau. (Baby boom brought biggest 

increases among people 45-54 years old.) At URL: 

http://www.census.gov/Press-Release/www/2001/

cb01cn184.html (Jan. 2004).

6. Code of Federal Regulations. Title 14, Part 121. 

Washington DC:U.S. Government Printing Office; 

January 2003.

7. Sharif K. Regression of myopia induced by pregnancy after photorefractive keratectomy. J Refract 

Surg. Aug 1997; 13(5 Suppl):S445-6.

8. Caffery BE, Richter D, Simpson T, Fonn D, 

Doughty M, and Gordon K. CANDEES: The 

Canadian dry eye epidemiology study. Adv Exp 

Med Biol. 1998; 438:805-6.

9. McCarty CA, Bansal AK, Livingston PM, Stanislavsky YL, and Taylor HR. The epidemiology of 

dry eye in Melbourne, Australia. Ophthalmol. Jun 

1998; 105(6):1114-9.

10. Moss SE, Klein R, and Klein BEK. Prevalence of 

and risk factors for dry eye symptoms. Arch Ophthalmol. Sep 2000; 118(9):1264-8.

11. du Toit R, Situ P, Simpson T, and Fonn D. The effects of six months of contact lens wear on the tear 

film, ocular surfaces, and symptoms of presbyopes. 

Optom Vis Sci. 2001 Jun; 78(6):455-62.
10

12. Tlachac CA. Cosmetics and contact lenses. Optom 

Clin. 1994; 4(1):35-45.

13. Davis LJ, Paragina S, and Kincaid MC. Mascara 

pigmentation of the bulbar conjunctiva associated 

with rigid gas permeable lens wear. Optom Vis Sci.

Jan 1992; 69(1):66-71.

14. Detorakis ET, Siganos DS, Houlakis VM, Kozobolis 

VP, and Pallikaris IG. Microbiological examination 

of bandage soft contact lenses used in laser refractive surgery. J Refract Surg. 1998 Nov-Dec; 14(6):

631-5.

15. Quillen DA. Common causes of vision loss in 

elderly patients. Am Family Physician. Jul 1999; 

60(1):99-108.

16. Jackson GR, and Owsley C. Scotopic sensitivity during adulthood. Vision Res. 2000; 40(18):

2467-73.

17. Jackson GR, Owsley C, and McGwin G Jr. Aging 

and dark adaptation. Vision Res. Nov 1999; 39(23):

3975-82.

18. Artal P, Ferro M, Miranda I, and Navarro R. Effects 

of aging in retinal image quality. J Optical Soc Am 

A. Jul 1993: 10(7):1656-62.

19. Carter TL. Age-related vision changes: a primary 

care guide. Geriatrics. Sep 1994; 49(9):37-42,45.

20. Schefrin BE, Tregear SJ, Harvey LO Jr, and Werner 

JS. Senescent changes in scotopic contrast sensitivity. Vision Res. Nov 1999; 39(22):3728-36.

21. Kline DW. Optimizing the visibility of displays 

for older observers. Exp Aging Res. Jan-Mar 1994; 

20(1):11-23.

22. Norman JF, Dawson TE, and Butler AK. The effects 

of age upon the perception of depth and 3-D shape 

from differential motion and binocular disparity. 

Perception. Nov 2000; 29(11):1335-59.

23. Haegerstrom-Portnoy G, Schneck ME, and Brabyn 

JA. Seeing into old age: vision function beyond 

acuity. Optom Vis Sci. Mar 1999; 76(3):141-58.

24. Blystone PA. Relationship between age and presbyopic addition using a sample of 3,645 examinations 

from a single private practice. J Am Optom Assoc. 

Aug 1999; 70(8):505-8.

25. Nakagawara VB, Montgomery RW, and Wood KJ. 

Aviation accidents and incidents associated with 

the use of ophthalmic devices by civilian pilots. 

Washington, DC: Department of Transportation/

Federal Aviation Administration. 2001; FAA Report No. DOT/FAA/AM-01-14. Available from: 

National Technical Information Service, Springfield, VA 22161. Order # ADA396122. At URL: 

http://www.cami.jccbi.gov/aam-400A/Abstracts/

2001TechRep.htm

26. Connor CG, Flockencier LL, and Hall CW. The 

influence of gender on the ocular surface. J Am 

Optom Assoc. Mar 1999; 70(3):182-6.

27. Knorz MC, Hugger P, Jendritzka B, and Liermann 

A. Twilight visual acuity after correction of myopia 

with LASIK. [German] Ophthalmologe. Nov 1999; 

96(11):711-6.

28. Scerrati E. Laser in situ keratomileusis vs. laser epithelial keratomileusis (LASIK vs. LASEK). J Refract 

Surg. Mar-Apr 2001; 17(2 Suppl):S219-21.

29. Holladay JT, Dudeja DR, and Chang J. Functional 

vision and corneal changes after laser in situ keratomileusis determined by contrast sensitivity, glare 

testing, and corneal topography. J Cataract Refract 

Surg. May 1999; 25(5):663-9.

30. Nakagawara VB, and Montgomery RW. Gender differences in a refractive surgery population of civilian aviators. Washington, DC: 

Department of Transportation/Federal Aviation Administration. 2000; FAA Report No. 

DOT/FAA/AM-00-23. Available from: National 

Technical Information Service, Springfield, VA 

22161. Order # PB2001102918. At URL: http:

//www.cami.jccbi.gov/aam-400A/Abstracts/

2000TechRep.htm