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FAA CACI Glaucoma Worksheet (with Form 8500-14)

Pilots with stable glaucoma or ocular hypertension can be certified at the AME's office under the FAA's CACI program. This worksheet, updated 04/13/2022, requires diagnosis at 40 or older, a treating ophthalmologist's report on Form 8500-14 or equivalent, pressures of 23 mm Hg or less in both eyes, accepted eye drops only and reliable formal visual fields without defects.

Who completes it

The AME completes the worksheet from a current, detailed Clinical Progress Note written after a clinic visit with the treating ophthalmologist no more than 90 days before the AME exam. The ophthalmologist's report on Form 8500-14 or an equivalent supplies the eye findings.

Submitting and payment

How to submit it
If all criteria are met, the AME issues, notes 'CACI qualified glaucoma' in Block 60 and keeps the documents on file without sending them to the FAA; otherwise the AME defers and submits them.
Who pays
The FAA does not set AME examination fees; the pilot pays the examiner, and the FAA recommends the usual and customary local fee for similar services.

Good to know

  • Accepted types are stable open angle glaucoma, ocular hypertension or glaucoma suspect, and treated narrow angle glaucoma after iridectomy or iridotomy; normal tension and secondary glaucomas are excluded.
  • Accepted drops are prostaglandin analogs, carbonic anhydrase inhibitors, beta blockers and alpha agonists, including combinations; pilocarpine or other miotics, cycloplegics and oral medications are not.
  • Visual fields must be Humphrey 24-2 or 30-2 or Octopus testing; confrontation or screening fields are not acceptable, and other formal methods need a call for approval.
  • Documented nerve damage or a trabeculectomy excludes the CACI, so the AME defers and sends the records to the FAA.

Get the official form

Download the current version from the source each time; forms change without notice.

CACI - Glaucoma Worksheet

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

What does the ophthalmologist need to provide for the FAA glaucoma CACI?

FAA Form 8500-14 or an equivalent report documenting the type of glaucoma, age at diagnosis, nerve status and surgery, current drops and side effects, intraocular pressure in each eye and formal visual field results, plus a finding that the condition is stable on the current regimen with no changes recommended.

Which visual field tests does the FAA accept for glaucoma?

Humphrey 24-2 or 30-2, with SITA or full threshold strategy, or Octopus with TOP or full threshold. Other formal tests may be accepted only after the AME calls for approval. Confrontation or screening fields do not meet the worksheet, and any defect or unreliable result disqualifies.