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11.8.39 The above remarks apply to the common, congenital colour vision defects. These are genetic
defects, present from birth and not progressive. The red-green types are inherited as a sex-linked recessive
trait which is typically manifest in men and transmitted by women. There is less information available about
tritanopia which may be polygenetic and inherited as an irregular dominant trait.
11.8.40 Some States use the term “colour vision defective safe” or “colour safe” to refer to individuals who
fail the colour plate tests but can pass testing with an anomaloscope or an accepted colour lantern test or both,
and the term “colour vision defective unsafe” or “colour unsafe” to refer to those individuals who fail both plates
and anomaloscopy and lantern tests. Despite all the work undertaken concerning colour vision, a challenge
remains to determine exactly where the cut-off between “safe” and “unsafe” should be placed with respect to
an initial applicant who chooses aviation as his career or hobby.
Acquired colour vision defects
12 After Willibald A. Nagel, German physiologist (1870-1911)
III-11-54 Manual of Civil Aviation Medicine
11.8.41 Although much less common than congenital defects, acquired colour vision defects do occur.
These may affect one eye more than the other and may be progressive. The more important causes include:
a) Tapeto-retinal degenerations and pigmentary retinopathies
b) Chorioretinitis from any cause including macular lesions
c) Optic neuropathy from any cause including advanced glaucoma
d) Drug toxicity affecting the macula or the optic nerve.
11.8.42 Most drug-induced impairment of colour vision, for example that caused by hydroxychloroquine
(Plaquenil®), digitalis and ethambutol (Myambutol®), is long-lasting or permanent. Sildenafil (Viagra®) is a drug
which is widely used in the treatment of erectile dysfunction in males that has been shown to cause light
sensitivity and bluish colour tinge of viewed objects in 3 to 11 per cent of users. These effects may last up to five
hours or longer and could be dangerous in situations where correct colour identification of blue or green light is
required.
11.8.43 There is no internationally agreed, standardized method for evaluating colour vision in persons
working in the aviation environment. Some Contracting States test all flight crew and air traffic controllers on
a regular basis and test each eye separately using a method which screens for yellow-blue defects in addition
to the more common red-green defects. This allows detection of the uncommon but important acquired colour
vision defects. Suitable tests would be the Japanese SPP plates or the American Optical H-R-R plates or one
of the coloured-chip sorting tests using the principle of the Farnsworth D-15 test.
11.8.44 Aircraft accidents in which colour perception defects have been cited as a contributing factor are
rare but have occurred. One example is the crash of FedEx flight 1448 (a Boeing 727) in Tallahassee in 2002
during a night visual approach to land, where the first officer’s colour deficiency interfered with his ability to
discern the red and white lights of the PAPI13. Studies of colour perception in the aviation environment have so
far been limited. Further research in this area is required to determine precisely the importance of colour
perception and what defects can be allowed without affecting safety.
11.9 ASSESSMENT OF PATHOLOGICAL EYE CONDITIONS
11.9.1 One of the requirements for obtaining a Medical Assessment is that the eyes and adnexa are
healthy. According to Annex 1, 6.3.3.1, 6.4.3.1 and 6.5.3.1, the function of the eyes and their adnexa shall be
normal. There shall be no active pathological condition, acute or chronic, nor any sequelae of surgery or trauma
of the eyes or adnexa likely to reduce proper visual function to an extent that would interfere with the safe
exercise of the applicant’s licence and rating privileges.
11.9.2 The following conditions are usually associated with reduced visual performance and applicants
with them would normally be assessed unfit pending thorough ophthalmic evaluation by an accredited
ophthalmological specialist. In many cases the problems will be treatable, allowing the applicant to reapply
after successful therapy.
13 PAPI: Precision Approach Path Indicator, a series of white and red lights that aid flight crews in determining
if they are on a proper glide slope to the runway.
Part III. Medical Assessment
Chapter 11. Ophthalmology III-11-55
Eyelids and lacrimal system
a) Destruction or malfunction of the lids which impairs protection of the eye or which results in
corneal irritation from in-turned lashes
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