Ask A Civil Aviation Medical Examiner

Dr. Mindy Gautama is a Transport Canada Civil Aviation Medicinal Examiner (CAME) based at the YBW Aeromedical Clinic in Calgary. She is an experienced family physician who has a strong desire to promote health and safety in the aviation industry.

Here, Dr. Mindy Gautama answers some common questions about Category 1 commercial aviation medicals for professional pilots.

Sometimes people think they must have perfect eyesight to be a commercial pilot. What are the actual visual acuity requirements for a Category 1 civil aviation medical?

Dr. Mindy Gautama: One of the most common questions a Civil Aviation Medical Examiner (CAME) receives is if someone needs to have perfect uncorrected vision to fly. In order to hold a Commercial Aviation Medical Certificate (Category 1), the vision can be no worse than 6/9 (20/30) in either eye and must be 6/6 (or 20/20) in both eyes. The vision requirements can be corrected (with glasses or contact lenses) or uncorrected. There are also requirements for near vision that need correction if the pilot is unable to meet the minimum standard. 

What if a person is colour-blind?

MG: CAMEs perform an in-office test to assess an applicant’s ability to differentiate between colours. If they are unsuccessful in meeting the standard, they may be referred for further testing. Depending on the type of deficiency, a determination will be made if the condition is a risk to flight safety. Some pilots may not qualify for an unrestricted licence and may have a restriction that limits their ability to fly at night or by colour signal control. Before they begin training, potential applicants with a known colour deficiency should see their eye care professional to have the type of deficiency diagnosed for submission to Transport Canada. Anecdotally, some individuals are diagnosed with a colour vision deficiency during their initial pilot medical; many have never had previous testing.   

What if someone has had (or is considering) refractive eye surgery?

MG: Refractive eye surgery (LASIK, PRK, etc.) may be acceptable to Transport Canada and is one of the more common questions CAMEs are asked. Due to the risk of over- or under-correction, loss of visual acuity, haloing, glare, difficulty with night vision, and a number of other potential post-surgical concerns, Transport Canada requires specialist documentation after surgery to ensure visual requirements are met. A pilot will need to have documentation completed at a minimum 30 days after any corrective surgery by their eye specialist in order to confirm visual standards can be successfully met. Prior to having any eye surgery, it is imperative the pilot discuss with the eye care specialist and CAME any risks to their vision that could lead to loss of their medical certification.

What if a person has diabetes? Does this disqualify them from getting a medical? 

MG: Individuals with diabetes may be able to hold a medical certificate if their condition is under good control and deemed to be of low risk to flight safety. At a minimum, a pilot with diabetes will require annual recertification with additional reports, often from their family doctor or endocrinologist, that detail their condition, their sugar measurements (a recent HgbA1C and depending on their risk a blood glucose log), documentation of any low blood sugars and the applicant’s awareness of them, and any end-organ damage (including kidney, eye, nerve or cardiac issues). An ophthalmologist or optometrist’s results on a diabetic eye exam are required; and often, cardiac testing needs to be undertaken regularly depending on the applicant's age, co-morbid conditions and years with diabetes. Those judged to be of low risk are able to maintain a medical certificate without restriction; those at moderate risk may have an accompanying pilot restriction; and those at higher risk are found to be unfit. Those that are judged unfit often have a higher risk of adverse outcomes in flight, including an unacceptable risk of a hypoglycemic or low blood sugar event or an unacceptable risk of a future cardiac event. All pilots with diabetes must be assessed by Transport Canada for certification on an individual basis.

Now, let’s talk about ADHD and medical certification. What are the rules?

MG: From an aviation safety standpoint, both ADHD and the medications used to treat ADHD are concerning. Some of the symptoms of ADHD – including inattention, distractibility, difficulty focusing, and impulsive behaviours – can pose a risk to aviation safety as can the medications commonly used to treat ADHD. Therefore, a diagnosis of ADHD is incompatible for holding a medical certificate, as are the medications used to treat ADHD. Some individuals may have had a previous diagnosis of ADHD that would not meet the medical criteria for a diagnosis today. If a medication used to treat ADHD is discontinued, a neurocognitive assessment is required six months post-discontinuation to determine if the applicant meets the criteria for an ADHD diagnosis. Any medication used to treat ADHD and a true diagnosis of ADHD itself are not compatible with a medical certificate. 

What if a candidate is taking anti-depressants?

MG: If an applicant is taking an anti-depressant or has symptoms consistent with depression or any other mental health condition, they would initially be considered unfit. In order to return to flying, depression symptoms must be in remission and a comprehensive psychiatric assessment by a psychologist or psychiatrist may be necessary. If they have started on an anti-depressant, they can be considered for reinstatement if they are taking a non-sedating antidepressant, (Transport Canada has a list of acceptable antidepressants), and have been on a stable dosage for a minimum of four months without significant side effects. If an individual assessment determines they are fit to resume flying, they will generally have an accompanying pilot restriction for at least 12 months and will require reports from their family doctor every six months, for the first two years, that specify any symptoms related to their mental health or their antidepressant. If symptoms recur, they would be required to self-ground and report to their CAME or Transport Canada for further assessment and consideration.

How about previous heart conditions?

MG: Depending on the condition, medical certification may be possible. Individuals with a history of a myocardial infarction that has been treated and have minimal heart damage and a low risk of recurrence may be considered for recertification after six months, if they remain asymptomatic. Applicants must be non-smokers, have risk factors controlled, and have a report from a cardiologist or internist that includes cardiac testing and risk stratification. If the risk of incapacitation is judged to be low, medical certification may be considered. Many other cardiac conditions, such as arrhythmias and congenital heart disease, may be considered for certification on an individual basis. Considerations will include the nature of the condition, the risk of incapacitation from the underlying issue, if the condition is well controlled and has had a period of stability on medications and freedom from symptoms, and their current cardiac tests do not indicate a significant risk to aviation safety.   

Asthma?

MG: Pilots with very mild or mild asthma are generally considered fit for medical certification. Those who have asthma that is considered out of control (needing Salbutamol regularly, oral steroids, or recent hospitalizations) are not considered fit for medical certification. Depending on their history, a pilot may be required to complete pulmonary function testing or have a specialist review prior to their medical certificate being granted.

What are the rules surrounding cannabis use?

MG: Cannabis, including THC and CBD-containing products by prescription or bought over the counter, are considered incompatible with holding a medical certificate. A pilot must refrain from exercising the privileges of their medical certificate for a minimum of 28 days after their last use. Transport Canada defines “cannabis use” as the use of any cannabis product (including CBD) by any method (including smoking, vaping, eating or applying to the skin) for any purpose (including medical, recreational or other non-medical reasons).

What are some of the other situations you have encountered that have prohibited people from qualifying for a Category 1 medical? 

MG: In addition to the issues already covered, there are other conditions that will be incompatible with holding an aviation medical certificate. Mental health conditions such as bipolar disorder, active substance abuse disorder, any history of psychotic illness, recent suicide attempts or persistent thoughts of suicide can be disqualifying. A seizure disorder is also disqualifying due to the nature of unpredictable and immediately incapacitating events. Untreated kidney stones will render an applicant unfit and may require treatment and specialist follow-up prior to consideration. Untreated sleep apnea, depending on the severity, can also lead to temporary disqualification until it is adequately treated. Strokes, TIAs (or Ministrokes), significant head trauma, and the use of medications that are not compatible with flying (such as older antidepressants, opioids or anti-seizure medications often used for migraines or chronic pain, to name a few common ones)would all be assessed on an individual basis. This list is not exhaustive, and any condition should be discussed with a CAME or Transport Canada prior to commencing training. Depending on the severity, the applicant could be considered unfit to hold any certification. Most often, when an applicant applies with a disqualifying condition, they will be advised of specific testing requirements, time periods of stability that are required, and medical documentation required for a review of their condition.  

In all cases/conditions, are these blanket regulations? 

MG: Typically, there are minimum standards for each medical condition that must be met to exercise the privileges of a Category 1 Medical Certificate. However, certification is considered in the context of the whole individual and their additive risk profile. 

If a person is disqualified but would like a second opinion, what recourse do they have?

MG: As per its website, the Transportation Appeal Tribunal of Canada holds review and appeal hearings at the request of those affected by administrative decisions taken by the Minister of Transport and the Canadian Transportation Agency. Click here for more information.

If you are considering an aviation career and you have a diagnosed condition or believe you may have a condition, you are advised to speak with a Civil Aviation Medical Examiner (CAME) or Transport Canada’s Civil Aviation Medicine department prior to commencing training. 

Looking for more information about aviation medical certificates? Read Transport Canada’s Handbook for Civil Aviation Medical Examiners.