The FAA has released new updates to the Aviation Medical Examiner’s Guide, and they include important changes that could directly affect your next medical exam. From eye surgery recovery timelines to migraine medications, here’s a breakdown of what’s new.

Eye Conditions

Cataracts & Lens Implants

• If you’ve had cataract surgery with a lens implant, you can usually be cleared after:
  • 2 weeks (monofocal/toric lenses)
  • 6 weeks (light adjustable lenses)
  • 12 weeks (multifocal/extended depth lenses)
• AMEs will want to see proof you’ve fully recovered, stopped eye meds, and meet vision standards.

Refractive Surgery

• Recovery expectations are now clearer. If your vision is stable and without side effects, certification is possible.

Optic Neuritis

• Now has its own review pathway. If you’ve had it, expect documentation requests and possible FAA review.

Mental Health Medication

Vilazodone (Viibryd) has been added as an approved antidepressant.

• Like other SSRIs, it’s not an automatic pass – you’ll need to go through the FAA’s special protocol, including a ground trial and documentation.

Migraines

The FAA now spells out which migraine treatments are acceptable.

Okay for preventive use (with short ground trial):

• Beta-blockers (like propranolol)
• Calcium channel blockers (like verapamil)
• ACE inhibitors / ARBs
• New CGRP migraine drugs (like Aimovig or Nurtec)

Botox: Still allowed, but you’ll need Special Issuance, a one-month trial, and 72 hours on the ground after each treatment.

Not okay: Certain seizure and mood drugs (topiramate, gabapentin, pregabalin, TCAs, etc.) remain disqualifying.

Cholesterol & Diabetes

• Cholesterol meds: Most statins, fibrates, omega-3s, ezetimibe, and PCSK9 inhibitors are fine with a short ground trial. Only one drug (mipomersen) is still off-limits.
• Diabetes meds: The FAA now allows Brenzavvy (bexagliflozin), expanding options for pilots with Type 2 diabetes.

Pulmonary Conditions

Bronchiectasis has been added.

• Mild cases may be issued with documentation.
• Moderate to severe cases require FAA review before you can fly.

Neurologic Conditions

Two new conditions are now on the FAA’s radar:

• Neuromyelitis Optica
• Clinically Isolated Syndrome (CIS)

These aren’t automatic denials, but they will require deferral to the FAA for review. Expect to provide a neurologist’s evaluation and full medical records.

Bottom Line for Pilots

• If you’re planning eye surgery, factor in the FAA’s new recovery timelines.
• On vilazodone or another SSRI? Be ready for the FAA protocol process.
• Suffer from migraines? Good news: you now have more FAA-approved treatment options.
• Managing cholesterol or diabetes? More medications are now acceptable.
• Pulmonary or neurologic conditions? Be prepared to submit reports—some cases will still need FAA review.

Tip: Always talk with your AME before starting a new medication or treatment. These updates give more flexibility, but every case still comes down to proper documentation and FAA approval.