After cataract surgery or another procedure that replaces the eye's natural lens with an intraocular lens, pilots and air traffic control specialists can have their eye doctor complete this two-page FAA summary. It records the surgery date for each eye, whether the minimum recovery period for the lens type has passed, complications, medications, visual symptoms, and distant, near and intermediate acuity.
The ophthalmologist or optometrist completes, signs and dates it, or writes a current, detailed Clinical Progress Note covering every item instead. The applicant fills in name, birthdate, applicant ID and PI number.
Download the current version from the source each time; forms change without notice.
Eyes - Lens Implant Status Summary
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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The status summary sets minimum recovery periods by lens type: two weeks for a standard monofocal or toric lens, six weeks total for a light adjustable lens, and twelve weeks for multifocal, extended depth of focus or other presbyopia-correcting lenses. The eye must also be free of complications and released from postoperative care.
No. The FAA notes that clinical records may be submitted instead, but the summary helps streamline and significantly decrease FAA review time. If the eye doctor writes a progress note instead, it must address every item on the summary.