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At least 505 records · Page 28Linked to original sources
PubMed1996

Photorefractive keratectomy (PRK) in the military aviator: an aeromedical perspective.

Refractive surgery to visually rehabilitate refractive errors of the eye continues to evolve at a significant pace and is here to stay. The surgical manipulation of the cornea by carefully planned incisions, as in radial keratotomy, represented the first procedure to evolve for the correction of ametropia and is an area of continued active development and improvement. However, many concerns mitigate against this procedure in the aeromedical arena. More recently, photorefractive keratectomy using laser technology to ablate and recontour the corneal surface has emerged as a viable modality. This paper explores the aeromedical factors surrounding this new revolutionary procedure and discusses the issues relevant to evaluating its applicability to the modern military aviator as well as reviewing results of the latest clinical trials currently in progress. The goal is to provide the aeromedical community with the fundamental information required to formulate aeromedical decisions and policy-making in regard to a new procedure that is certain to have tremendous impact on the selection of future aircrew candidates.

Aerospace Medicine↗
PubMed1996

The sleeping aviator--aeromedical disposition of Kleine-Levin syndrome.

We present the case of an aviator with Kleine Levin syndrome (KLS). History, physical examination, and special studies presented confirm the diagnosis of this syndrome. Our patient presented as an atypical case of KLS with respect to the presenting symptoms and to frequency of the episodes (6 years apart). He exhibited only intense somnolence, easy arousability, photophobia, hyperacousis, and a voracious appetite. Following a complete medical work up we recommended that an applicant with such a classical case of KLS be disqualified as a crewmember; however, in cases such as that presented above a limited waiver may be considered. The aeromedical significance of this case is to reinforce the importance of screening candidates and seeking precise diagnosis of a past illness or hospitalization.

Adult↗
PubMed1996

Intracerebral bleed, retinal detachment, cataract removal, and intraocular lenses in an Army aviator.

A 54-yr-old U.S. Army Reserve helicopter pilot was evaluated at Brooks AFB, TX for a flying waiver with a history of intracerebral hematoma, superior oblique palsy, rhegmatogenous retinal detachment and bilateral cataract extractions with intraocular lens replacements. The USAF has waivered flyers with category 5 severe head injury (includes intracerebral bleed) in 7 (44%) of 16 cases evaluated and submitted after a 5-yr uneventful observation period, but never with an intracerebral bleed (0 of 3). Flyers with rhegmatogenous retinal detachment have been cleared for a waiver by ophthalmologists in 40 (89%) of 45 cases: the USAF ultimately granted 28 (62%) of the 45 flyers waivers with the others denied for additional diagnoses. Of the 45 detachments, 17 (38%) were asymptomatic and discovered during routine eye evaluation. Increased "G" exposure has not been shown to increase the risk of either retinal detachment or intraocular lens displacement. Of 54 intraocular lenses in the USAF Study Group, 50 (93%) are located in the posterior chamber. Waivers have been granted for 38 (86%) of 44 flyers with intraocular lens replacements; only 3 (7%) of 44 have been denied waivers for ophthalmological complications. The preferred cataract surgery for aviators is extracapsular cataract extraction with placement of a posterior chamber intraocular lens, yielding the best visual results with fewest complications. This pilot was denied waiver recommendation because his neurological observational period had not yet lasted 5 yr, although he would have received a favorable recommendation for his ophthalmological diagnoses.

Aerospace Medicine↗
PubMed1997

Aviation spatial orientation in relationship to head position and attitude interpretation.

BACKGROUND: Conventional wisdom describing aviation spatial awareness assumes that pilots view a moving horizon through the windscreen. This assumption presupposes head alignment with the cockpit "Z" axis during both visual (VMC) and instrument (IMC) maneuvers. Even though this visual paradigm is widely accepted, its accuracy has not been verified. The purpose of this research was to determine if a visually induced neck reflex causes pilots to align their heads toward the horizon, rather than the cockpit vertical axis. HYPOTHESIS: Based on literature describing reflexive head orientation in terrestrial environments it was hypothesized that during simulated VMC aircraft maneuvers, pilots would align their heads toward the horizon. METHODS: Some 14 military pilots completed two simulated flights in a stationary dome simulator. The flight profile consisted of five separate tasks, four of which evaluated head tilt during exposure to unique visual conditions and one examined occurrences of disorientation during unusual attitude recovery. RESULTS: During simulated visual flight maneuvers, pilots tilted their heads toward the horizon (p < 0.0001). Under IMC, pilots maintained head alignment with the vertical axis of the aircraft. CONCLUSION: During VMC maneuvers pilots reflexively tilt their heads toward the horizon, away from the Gz axis of the cockpit. Presumably, this behavior stabilizes the retinal image of the horizon (1 degree visual-spatial cue), against which peripheral images of the cockpit (2 degrees visual-spatial cue) appear to move. Spatial disorientation, airsickness, and control reversal error may be related to shifts in visual-vestibular sensory alignment during visual transitions between VMC (head tilt) and IMC (Gz head stabilized) conditions.

Aerospace Medicine↗
PubMed1998

Case report: cough syncope in a U.S. Army aviator.

Syncope is a very common presentation to the primary care provider and the emergency room physician. The consequences of syncope while driving can be tragic. Likewise the consequences in the flight environment can be devastating. This case presents tussive syncope while driving in a 41-yr-old previously healthy male aviator. The diagnosis, management, and aeromedical disposition are presented.

Accidents, Traffic↗
PubMed1998

An abscess that wasn't: renal calyceal diverticulum in a student Naval aviator.

The authors report a case of a 24-yr-old female Navy student pilot who presented with pyelonephritis, and on workup, was found to have two diverticula arising from calyces in her left kidney. Her infection resolved after several weeks of antibiotic therapy. She was granted a waiver to return to flight status based on the judgment that her risk of recurrent infection, sudden incapacitation, future need of surgery, and compromise of mission effectiveness were acceptably low. She has remained asymptomatic after more than 48 mo of follow-up. Renal calyceal diverticulum has not previously been discussed in the literature of aerospace medicine. The definition, anatomy, possible etiologies, epidemiology, presentation, treatment options, and aeromedical disposition, including human-machine interface issues, for calyceal diverticula are discussed. Aviators with calyceal diverticula are at increased risk of urinary tract infection and other complications; aeromedical disposition should rest on evaluation of such risk on a case-by-case basis.

Abscess↗