Pachychoroid Neovasculopathy, Intravitreal Injection, and Implications for Aeromedical Decision Making
BACKGROUND: Optimal visual function is essential in aviation to ensure flight safety and mission effectiveness. Pachychoroid neovasculopathy is a relatively recently recognized clinical entity of choroidal neovascularization, belonging to the pachychoroid spectrum, for which intravitreal therapy (IVT) is the standard of care. The main aeromedical considerations are degradation of visual function from disease progression, which could preclude aircrew from flying duties, and the compatibility of IVT with flying.
CASE REPORT: A trained Republic of Singapore Air Force aircrew operator on board the Fokker-50 first presented with a reduction in visual acuity at his annual aircrew medical examination, for which he was restricted from flying duties for further evaluation. He was diagnosed with central serous chorioretinopathy and treated conservatively, but subsequently developed pachychoroid neovasculopathy. He was started on monthly IVT for 3 mo before being placed on a treat-and-extend regimen. After 10 mo of treatment totalling five doses of aflibercept IVT, he achieved resolution of subretinal fluid and recovery of visual acuity, stereopsis, and color vision. He was returned to flying duties upon full recovery, with a close follow-up regimen with his attending ophthalmologist and flight surgeon.
DISCUSSION: Pachychoroid neovasculopathy can cause degradation of visual function and visual incapacitation, posing differential threats to flight safety and mission success based on an aircrew’s vocational roles. The aviation environment could also influence disease progression. Furthermore, aeromedical considerations for IVT are increasingly relevant as IVT becomes the standard of care for prevalent conditions, including neovascular age-related macular degeneration and diabetic macular edema.
Yang WYL, Chay IWJ, Lim HB, Tan MCL, See B, Low JW. Pachychoroid neovasculopathy, intravitreal injection, and implications for aeromedical decision making. Aerosp Med Hum Perform. 2025; 96(10):940–946.
Spectral domain optical coherence tomography of the left eye at first presentation in August 2022 showing neurosensory detachment with subretinal fluid (arrow). There is a small serous pigment epithelial detachment (arrowhead).
Findings of the left eye in February 2023, including A) color fundus photograph showing pigment epithelial detachment without drusen, and B) spectral domain optical coherence tomography demonstrating a sliver of subretinal fluid (arrow), subfoveal pigment epithelial detachment (arrowhead), and intraretinal fluid suggestive of neovascularization (asterisks).
Spectral domain optical coherence tomography of the left eye in A) July 2023, B) September 2023, and C) December 2023 showing a stable sliver of subretinal fluid (arrow) and subfoveal pigment epithelial detachment (arrowhead).
Aeromedical-decision framework, where the aeromedical disposition of aircrew with posterior segment conditions requiring IVT but meeting the prescribed vision requirements are concerned.
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