Eye Surgery

Of all the inquiries received by telephone, inquiries around refractive eye surgery are among the most common we receive. Hence, I decided to write my thoughts down formally to make answering this common question easier. Basically, I am not a fan.

Let me start out with some fundamentals to reassure inquiring pilots. Yes you can have refractive surgery, and yes, once your refraction reading settle, and the surgery is successful, you can be returned back to active flight status. The mechanism is outlined on the transport Canada website here -

I highly recommend you read this article. Basically, your ophthalmologist has to fill out a post refraction surgery questionnaire (linked in the body of the above reference), send it in, and you get a new sticker for your license booklet that removes the glasses restriction. I would go further to say that the vast majority of people that I interview that have had the surgery, are pleased with it and would definitely do it again.

So why am I not a fan? Firstly, the surgery is elective. Basically it is being considered by an individual who generally has very good vision, when wearing lenses or glasses. So they are taking a highly acceptable situation and seeking to improve on it. Specifically, they want to live life without glasses. Given that the surgery is not inexpensive, I often get this inquiry by somebody in their late 30s or early 40s, which is the first age at which they can actually afford it. What they do not seem to realize is that this surgery is on the outer surface, the cornea, of the eye and does not affect the lens. Typically, the lens, inside the eye, stiffens with age and becomes less flexible. It is the elasticity of your lens, the ability for it to spring back into a “fat” position that allows individuals to focus up close. As we age, the lens becomes less able to do this until in your late 40s or 50s the lens hardens and is stuck in distance focus. So in order to read things or focus close-up you require “reading glasses” which are simply small magnifiers that take the place of the inactive lens. This will happen whether you have refractive surgery or not. As such, if you have refractive surgery and turn your eye into a optically perfect instrument that focuses at a distance, when you hit your mid-40s or 50s you are going to need reading glasses and you are going to be every bit as disabled, in that the world will be quite blurry from about five feet inwards. So really you are not escaping glasses at all. Secondly, the surgery is acknowledged to cause some haloing around light sources at night, and slightly decrease your night vision through decreased contrast sensitivity. The amount of this varies between individuals and is not predictable before the surgery. Most individuals adapt to this just fine but you need to be aware of this. Lastly, and happily rarely, the surgery can be a failure. This renders your cornea chronically unstable, and it is exceedingly difficult if not impossible to correct your vision with glasses. As such you are quite disabled visually and you will not be holding a pilot license again. This is a very steep price to pay for a few years without glasses. There are some further technical reasons why some of my ophthalmology colleagues are not enthusiastic about refractive surgery, but these are somewhat abstract in nature and do not really need to be discussed here. I would strongly encourage you to get a second opinion, as you would with any major life decision, from a qualified ophthalmologist to does not perform the surgery and is therefore unbiased about recommending it or discouraging it.

So as with everything else in life it is “buyer beware”, a phrase that Transport Canada uses in their article above. There is a price to be paid for everything in life and discarding your glasses is not exempt. Consider this major decision very carefully, and should you decide to proceed with it, you will likely be able to fly again without any difficulties.