LASIK

Am I Clear for Takeoff?

LASIK and altitude, elevation.

Dr. Natasha Balani SharpeVision

By Dr. Natasha Balani

January 21, 2023

Nearly 100,000 flights take off and land every day all over the globe. Our patients often ask us, “Am I safe for takeoff?” The short answer is yes, most patients can fly as early as the day after their procedure, but there are a few things to keep in mind to make your travels and adventures as seamless as possible. In this blog we’ll review the ins and outs of flying, aviation, rock climbing and trekking the highest of peaks after refractive and lens based procedures.

Travel by Air

“I’m visiting my parents for the holidays and I have to go back to Florida to start classes next week. Can I still have my LASIK on Friday?” You sure can. “I travel for work and I need to be on a plane to catch a meeting on Thursday. Do I have enough time?” Yes again! With air travel more common now than ever before, it is good news that there are no added risks associated with flying after refractive or lens based surgeries. As a precautionary measure, we do recommend patients come in for their initial post op appointment, so one of our doctors can assess your fitness to fly. At this visit, we’ll check your vision and evaluate the corneal epithelium, flap, and the lens to make sure you are safe and ready for takeoff. Interestingly, we have the ability to grant this same clearance not just for passengers, but for pilots too. Dr. Sharpe and Dr. Barker have both performed surgeries on a number of commercial, private and navy pilots over the years.

Vision & FAA Standards

Federal Aviation Regulations require that a pilot’s distant vision be 20/20 or better, with or without correction, in EACH eye separately to hold a first or second class medical certificate. Pilots and controllers with cataracts whose vision does not correct to 20/20 at distance may be recertified to fly and control after having a surgical implantation of an artificial intraocular lens. These individuals may also be required to wear glasses to provide optimum visual acuity. For our aviation aficionados and professional pilots, we are happy to help work with you to ensure all required FAA and other paperwork is completed.

Do the Same Rules Apply for All Types of Eye Surgery?

Not quite. While we have the green light for the refractive surgery procedures we do at SharpeVision: LASIK, PRK, ICL, RLE and Cataract surgery, your surgeon may make recommendations for other eye surgeries. For example, following retinal detachment surgery, your surgeon may recommend that flying be completely avoided for about 3 to 4 weeks. During certain types of retinal repair, a gas bubble may be used to help keep the retina in place. Flying can pose a significant risk to a patient who has had gas injected into their eye, because at higher altitudes, the gas in the eye can expand and potentially cause a damaging and painful increase in eye pressure. Although commercial airplane cabins are pressurized, the amount of pressurization is typically inadequate to prevent such an event.

High Altitude and Elevation

“I was planning to climb Mount Rainier this summer, can I still do that?” Yes! The effects of extreme altitude or space on refractive and cataract surgeries is a well studied topic that dates back to the ‘90s. We have come to understand that the stability and function of a normal healthy visual system is susceptible to mild (transient) changes under extreme circumstances such as great depth or high altitudes.

History

Early in the 1990s, it was reported that patients exposed to altitudes of 9000 ft after undergoing an incisional refractive procedure called radial keratotomy (RK), could experience an acute hyperopic shift. A dramatic example of this phenomenon was the experience of Dr. Beck Weathers in the Everest tragedy of May 1996. Dr. Weathers had bilateral RK years before the expedition and noted a decrease in vision starting early during his ascent. Author Jon Krakauer wrote that “…as he was ascending from Camp Three to Camp Four, Beck later confessed to me, ‘my vision had gotten so bad that I couldn’t see more than a few feet.’ This decrease in vision forced Dr. Weathers to abandon his quest for the summit shortly after leaving Camp Four.” Because of this type of fluctuation, and other complications that arose from compromised corneal biomechanical stability as a result of RK, this procedure quickly fell out of favor and is no longer performed today.

PRK and LASIK Data

As RK has been more or less abandoned, corneal treatments performed with the excimer laser are the focus of interest when extreme pressure situations are looked at. There is compelling evidence that excimer laser surgery (LASIK and PRK) instead of RK is safer and a far more ideal refractive surgical procedure for mountaineers. Excimer surgery behaves differently. In 2001, Mader et al. showed that PRK, also known as surface ablation, with the excimer laser did not lead to the corneal flattening and the hyperopic shift at higher altitude that was found in RK patients. A 2003 investigation of the visual experiences of climbers with prior LASIK by Dimmig and Tabin reported visual acuity of 12 LASIK eyes of 6 Mount Everest climbers: 3 climbers noted no problems and perfect vision at the summit of Mount Everest; 1 reported mild blurring with ascent above altitudes of 16,000 feet that improved with descent or a prolonged stay at altitude; 2 climbers reported blurred vision at 27,000 and 28,500 feet, respectively, which improved with descent. The authors concluded that LASIK surgery represents a good option for people who engage in high-altitude activities such as climbing. Nevertheless, in extreme altitudes above 26,000 feet, patients should be aware of possible fluctuation in vision. Other studies of mountain climbers who had LASIK have also concluded that LASIK may be a good choice in high altitude activities, but those achieving extreme altitudes should be aware of possible fluctuation in vision. Climbers who do not ascend beyond moderate altitudes should not experience any post-LASIK refractive shift.

Pro-Tips

  • Be sure to come in for your initial post op appointment. We will assess your vision and check to make sure everything is in good shape so you are cleared for takeoff.
  • Preparation is key! Make sure your carry-on is well equipped with artificial tears. Cabin air tends to have low ambient humidity. Use tears liberally, every 1-2 hours while in flight.
  • Consider repositioning or partially closing the overhead vent to reduce the amount of forced air emitted that can dry out the ocular surface.
  • If you plan to hike through sandy, dusty, or windy terrain, remember eye protection like sunglasses or goggles.
  • We are here to help. Feel free to reach out with any questions! P.S. Don’t forget to tag us in your epic photos! #sharpevision_modernlasik

References: 1. Dupps WJ Jr, Wilson SE. Biomechanics and wound healing in the cornea. Exp Eye Res. 2006 Oct;83(4):709-20. doi: 10.1016/j.exer.2006.03.015. Epub 2006 May 23. PMID: 16720023; PMCID: PMC2691611. 2. Dimmig JW, Tabin G. The ascent of Mount Everest following laser in situ keratomileusis. J Refract Surg. 2003 Jan-Feb;19(1):48-51. doi: 10.3928/1081-597X-20030101-10. PMID: 12553606. 3. Kohnen, Thomas MD, PhD, FEBO. Effects of refractive surgery in extreme altitude or space. Journal of Cataract & Refractive Surgery 38(8):p 1307-1308, August 2012. | DOI: 10.1016/j.jcrs.2012.06.013 4. https://everywakingminute.com/lasikmyth9/

Dr. Natasha Balani SharpeVision

Dr. Natasha Balani

Optometric Physician and Director