As a part of the Pilot Protection Services to our fellow aviators, we here at AOPA have put a lot of effort and time into reviewing vision and FAA vision testing requirements for your medical recertification. I’ve used this space in the past to cover general topics on how our eyes function and some specifics on color and night vision.
It’s obvious to all of us that anything that poses a risk to our vision is a huge concern here on the ground and especially up in the air. One of those risks is posed by the recent fad of “vaping.” These little battery-powered things are affectionately known as “e-cigarettes,” continuing our newly found social trend of making everything in our lives electronic or digital. A lot of advertising dollars are spent telling us that vaping is a safe alternative to smoking cigarettes, but there’s lots of digital chatter in the medical world that such is not the case. The CDC released a good review of this just a few months ago giving significant supporting evidence that vaping is no better, and even worse in some ways, than smoking regular cigarettes. And don’t get me wrong, that habit is terrible for your health too.
To start, vaping solutions often have much higher nicotine levels than cigarettes. These levels of nicotine are enough to raise your blood pressure and heart rate. In patients with cardiac conditions, this can cause enough stress on your heart to lead to chest pain and heart attacks, and even sudden death has been reported. Nicotine affects concentration, learning, memory, and brain development, according to data in a new report from the surgeon general. That’s a real concern especially for adolescents in school as recent surveys indicate more than 20% of high school kids vape. As you all know, especially those who try to quit, nicotine is highly addictive so it’s an especially bad habit to pick up at a young age. Nicotine is also toxic to developing fetuses, posing a real health danger for pregnant women and their babies. There’s enough nicotine in vape solutions to cause acute nicotine poisoning if the liquid is directly absorbed by swallowing, snorting, or absorbing it through the skin or eyes. Multiple children as well as adults have been poisoned in this way and more than 50% of calls to U.S. poison control centers dealing with e-cigarettes are for children less than 5 years old with acute nicotine poisoning!
The vapor that carries these solutions is no better. The particles you inhale while vaping contain heavy metals such as nickel, tin, and lead along with other irritants that can cause inflammation (swelling) and irritation in your lungs. This can lead to lung damage like scarring and narrowing of your bronchioles—the little tubes that bring air in and out of your lungs. It can also trigger asthma attacks in susceptible individuals. Just as in regular cigarettes, there are chemicals in the vapor of these little things that are known carcinogens—cancer causing—like propylene glycol, aldehydes, toxic oxidants, and glycerin. The various and unregulated chemicals that provide the “taste” in vaping solutions are like inhaling antifreeze as stated in a recent report from the Australian Department of Health.
It’s not like all of these health concerns about vaping aren’t serious enough. Added to it is another more sinister side effect that directly relates to us pilots. These little battery-powered things appear to pose specific risks to our vision. Presenting to your favorite AME for your exam and found to have impaired or blurred vision is a sure way to lose your medical ticket. In an article published just last month in the journal Ophthalmology researchers found that adults who use electronic cigarettes had more than double the risk over non-users of developing an eye condition that causes blurred vision called “uveitis.” These risks were found to persist for up to 4 years after initial use of vape products. This increased risk was observed across all age groups and affected men and women as well as all ethnic groups equally. They found that the onset of this condition could come on as early as one week after smoking e-cigarettes and also that there’s a higher risk for uveitis in people who use both e-cigarettes and traditional cigarettes.
The American Academy of Ophthalmology describes uveitis as an inflammation of the middle layer of the eyeball called the uvea. The uvea is a critical part of the structure of the globe (eyeball) that contains the blood vessels needed to carry oxygen and energy nutrients that supply the eye. Infection or inflammation of this crucial structure can damage vital eye tissue, leading to distortions in our vision and even permanent vision loss. There are 3 types of uveitis based on which part of the uvea affected. Swelling of the uvea near the front of the eye is called ”anterior uveitis,” which starts suddenly, and symptoms can last many weeks. Some forms of anterior uveitis are ongoing, while others are intermittent and go away but keep coming back. Inflammatory reactions of the uvea in the middle of the eye are called “intermediate,” and that can last for a few weeks and up to many years. It can also be frustratingly elusive and go through cycles of getting better, then getting worse. Swelling of the uvea toward the back of the eye is called ”posterior uveitis,” and that also can affect your eyes for many years. There are a number of different things that can bring on uveitis like infections of the eye and systemic inflammatory diseases like rheumatoid arthritis, but smoking and vaping are the most common cause. The symptoms include redness of the eyes, eye pain, sensitivity to light, blurred vision, and “floaters,” which are dark specks or moving clouds in front of your eyes. It’s not like we don’t see enough clouds in front of our eyes in the sky already!
The takeaway lesson from all of this is pretty obvious. E-cigarettes are not a safe alternative to smoking and the habit poses a specific risk to our vision. A recent tune, “Amnesia,” by a UK combo group said it all pretty well:
I’m blurry-eyed, but don’t think I’m feelin’ it
I’m blinded by the smoke that I’m breathin’ in
I’m hypnotized, maybe I’m not alright
An obvious part of flying safely and for that matter doing anything here on the ground safely is our ability to see clearly. Don’t risk it; Amnesia is correct and you’re probably not “alright” if you’re puffing on the end of an e-cigarette. So live a safe and healthy lifestyle, and as always, keep your eyesight clear so you can fly safe!
