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Shift in location
14. Persons with alternating strabismus may note a shift in the apparent position of objects when they
alternate fixation and be disturbed by this.. This seems more likely to cause problems in large angle
strabismus.
Location shift is incompatible with safe flying. Alternating strabismic patients who always fixate with the same
eye for distance and the other eye for near will not experience shift in location and may be fit for flight. Changes
in refraction may result in an unstable fixation pattern incompatible with safe flying.
Binocular vision
15. The evaluation of binocular vision can be considered under screening tests and detailed
assessment.
Screening
16. The applicant who is asymptomatic and has no past history of strabismus treatment with patching,
orthoptics or surgery should be evaluated with regard to visual acuity, refraction, ocular motility and general
health of the eyes. Ocular alignment should be tested with cover testing using the appropriate spectacle
correction or contact lens correction. Sensory testing with the Worth four-dot test, measurement of stereopsis
and measurement of fusional amplitudes are useful in evaluation of the binocular status.
Assessment
17. Applicants who do not normally pass the screening tests mentioned ought to be examined by an
eye specialist. Based on a full sensory and motor evaluation of the applicant, the specialist may be able to
estimate the risk of diplopia or shift in location.
Part III. Medical Assessment
Chapter 11. Ophthalmology III-11-63
Symptoms of diplopia or location shift or a high risk of these would disqualify the applicant for class 1 and 2
certificates. Moderate risk of these symptoms may be acceptable for class 2 certificate. Minor risk of these
symptoms may be acceptable for class 1 certification.
___________________
ICAO Preliminary Unedited Version — October 2008
Part III
Chapter 12. OTORHINOLARYNGOLOGY
Page
Introduction...........................................................................................................III-12-1
The external ear ....................................................................................................III-12-1
The tympanic membrane.....................................................................................III-12-2
The middle ear ......................................................................................................III-12-3
Post-surgical assessment ......................................................................................III-12-6
Hearing assessment...............................................................................................III-12-7
Anatomy and physiology......................................................................................III-12-9
Noise ............................................................................................................III-12-10
Personal ear protection ........................................................................................III-12-11
– Ear protectors ................................................................................................III-12-11
Hearing tests and functional examinations .......................................................III-12-13
– Whispered and spoken voice tests...............................................................III-12-13
– Tuning fork tests ..........................................................................................III-12-13
– The Weber Test............................................................................................III-12-14
– The Rinne Test.............................................................................................III-12-14
Malingering ...........................................................................................................III-12-14
– The Lombard Test........................................................................................III-12-14
Audiometry............................................................................................................III-12-15
– Masking........................................................................................................III-12-16
– Audiogram ...................................................................................................III-12-16
– Calibration of audiometers ..........................................................................III-12-16
– Speech audiometry.......................................................................................III-12-17
Examination procedure for applicants with a
potential hearing disorder ................................................................................III-12-18
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Manual of Civil Aviation Medicine 2(70)
