AME Guide Grand Rounds August 2026 Session

Federal Aviation Administration · 42m04 · source

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Summary of Medical Certification Guidance

Main Topics

New Manmark Registration Process Overview
Introduction of the Designee Management System (DMS) for refresher training.
Online course called Manmark as an alternative to on-site seminars.
Registration process involves logging into designee.fa.gov through login.gov using appropriate customer links based on citizenship status.
Detailed step-by-step explanation of course and registration steps.
Amblyopia Disposition Table
Guidance for issuing Class 1 medical certificates to zero-hour applicants with mild amblyopia, where one eye has 20/40 vision but no other pathology.
Emphasis on resolving issues such as retinal detachment in the other eye before considering certification.
Diplopia Evaluation
No issue if Diplopia is stable and controlled using prisms or due to childhood strabismus that has been surgically corrected.
Detailed reports from ophthalmologists are necessary to assess risk of Diplopia under fatiguing conditions.
Corio Retinitis Management
Issuance possible for stable conditions post-treatment, requiring detailed eye reports and visual field testing or OCT if the condition is not fully resolved.
Retinoscise (Retinal Scanning)
Condition involves potential risk of retinal detachment; typically an incidental finding.
Detailed reports from specialists are required to assess stability and safety for certification.
Boogers Disease
Not a common issue but noted for AMEs’ reference, with the main concern being active smoking during TAO (Thyroid Eye Disease).
POTS Syndrome (Postural Orthostatic Tachycardia Syndrome)
Requires detailed documentation from cardiologists or neurologists to confirm diagnosis.
Issuance deferred pending confirmation of POTS syndrome and other treatments tried.
AVMs (Arteriovenous Malformations)
Updated guidance for both neurological AVMs, which require deferral and review by a neurologist, and peripheral AVMs, where certification can proceed if stable without symptoms or treatment required.
Congenital Sucrase Isoamaltase Deficiency (CSID)
Guidance for issuing medical certificates based on stability and management of the condition.
Detailed GI reports needed for cases with complications, requiring special issuance review by FAA.
Osteomyelitis
Criteria for issuing or deferring certification based on episode history and current status, with recurrent infections leading to additional documentation requirements from infectious disease specialists.
Subpoena Handling
Procedures for responding to FAA subpoenas, including the importance of sending copies to regional flight surgeons.
Summary that FAA attorneys cannot represent AMEs but can provide guidance on legal processes.
Asthma AASI Changes
Previously, pilots were limited to taking no more than three medications for asthma; this included combinations like triple therapy (trilogy) plus short-acting albuterol, which technically excluded them from the AASI.
The update now removes restrictions on the number of medications a pilot can take, allowing most pilots to qualify under the khaki criteria, such as using inhaled steroids, SABA, and LABA.
FEV1 Standards
FEV1 requirements for an AASI have not changed; however, the khaki standard is now set at 80% compared to the previous 70%.
Sarcoidosis Updates
The clinical wording for pulmonary stage one has been updated to specify only bilateral or bilateral hyalur lymphadenopathy.
The status summary now more clearly states that a hematocrit higher than 54% is of concern due to potential clotting issues, eliminating the gap between 54 and 55%.
Anxiety Depression (AASI) Changes
Pilots currently on an AASI for antidepressants will need a new authorization letter under the new program.
Once authorized, pilots follow a less frequent visit schedule: once a year with a physician and every six months with a non-physician.
Chief Pilot Reports Removal
Chief pilot reports are no longer required for pilots on SSRI or antidepressant protocols, simplifying the process.
However, for substance abuse programs involving alcohol or drugs, chief pilot reports may still be necessary.
Migraine Medication Updates
Migraine khaki requirements have been expanded to include medications like Frova and Zofran, with a wait time reduced from 24 hours to 48 hours.
CGRP medications like Brevylla and Nertuzumab are now on a 24-hour no fly period.
Osteoporosis Medications
New osteoporosis medicines added include SERM (selective estrogen receptor modulator) and conjugated estrogen, both now allowed.
Weight-Loss Medication Adjustments
GLP medications for weight loss or prediabetes have a one-week no fly period after starting them.
Formulation changes from injection to pill or vice versa require only 48 hours of observation.
Diabetic Medications
The chart for acceptable diabetic medications has been rearranged, with insulin at the top as it counts as one medication regardless of type.
Third class pilots using CGM now have a 90-day observation period instead of 180 days.
Acceptable Combinations List
Updated lists for different combinations of diabetes medications reduce downtimes and increase flexibility, with color-coded groups for easier reference.

Summary of Medical Certification Guidance

Main Topics

New Manmark Registration Process Overview
Introduction of the Designee Management System (DMS) for refresher training.
Online course called Manmark as an alternative to on-site seminars.
Registration process involves logging into designee.fa.gov through login.gov using appropriate customer links based on citizenship status.
Detailed step-by-step explanation of course and registration steps.
Amblyopia Disposition Table
Guidance for issuing Class 1 medical certificates to zero-hour applicants with mild amblyopia, where one eye has 20/40 vision but no other pathology.
Emphasis on resolving issues such as retinal detachment in the other eye before considering certification.
Diplopia Evaluation
No issue if Diplopia is stable and controlled using prisms or due to childhood strabismus that has been surgically corrected.
Detailed reports from ophthalmologists are necessary to assess risk of Diplopia under fatiguing conditions.
Corio Retinitis Management
Issuance possible for stable conditions post-treatment, requiring detailed eye reports and visual field testing or OCT if the condition is not fully resolved.
Retinoscise (Retinal Scanning)
Condition involves potential risk of retinal detachment; typically an incidental finding.
Detailed reports from specialists are required to assess stability and safety for certification.
Boogers Disease
Not a common issue but noted for AMEs’ reference, with the main concern being active smoking during TAO (Thyroid Eye Disease).
POTS Syndrome (Postural Orthostatic Tachycardia Syndrome)
Requires detailed documentation from cardiologists or neurologists to confirm diagnosis.
Issuance deferred pending confirmation of POTS syndrome and other treatments tried.
AVMs (Arteriovenous Malformations)
Updated guidance for both neurological AVMs, which require deferral and review by a neurologist, and peripheral AVMs, where certification can proceed if stable without symptoms or treatment required.
Congenital Sucrase Isoamaltase Deficiency (CSID)
Guidance for issuing medical certificates based on stability and management of the condition.
Detailed GI reports needed for cases with complications, requiring special issuance review by FAA.
Osteomyelitis
Criteria for issuing or deferring certification based on episode history and current status, with recurrent infections leading to additional documentation requirements from infectious disease specialists.
Subpoena Handling
Procedures for responding to FAA subpoenas, including the importance of sending copies to regional flight surgeons.
Summary that FAA attorneys cannot represent AMEs but can provide guidance on legal processes.
Asthma AASI Changes
Previously, pilots were limited to taking no more than three medications for asthma; this included combinations like triple therapy (trilogy) plus short-acting albuterol, which technically excluded them from the AASI.
The update now removes restrictions on the number of medications a pilot can take, allowing most pilots to qualify under the khaki criteria, such as using inhaled steroids, SABA, and LABA.
FEV1 Standards
FEV1 requirements for an AASI have not changed; however, the khaki standard is now set at 80% compared to the previous 70%.
Sarcoidosis Updates
The clinical wording for pulmonary stage one has been updated to specify only bilateral or bilateral hyalur lymphadenopathy.
The status summary now more clearly states that a hematocrit higher than 54% is of concern due to potential clotting issues, eliminating the gap between 54 and 55%.
Anxiety Depression (AASI) Changes
Pilots currently on an AASI for antidepressants will need a new authorization letter under the new program.
Once authorized, pilots follow a less frequent visit schedule: once a year with a physician and every six months with a non-physician.
Chief Pilot Reports Removal
Chief pilot reports are no longer required for pilots on SSRI or antidepressant protocols, simplifying the process.
However, for substance abuse programs involving alcohol or drugs, chief pilot reports may still be necessary.
Migraine Medication Updates
Migraine khaki requirements have been expanded to include medications like Frova and Zofran, with a wait time reduced from 24 hours to 48 hours.
CGRP medications like Brevylla and Nertuzumab are now on a 24-hour no fly period.
Osteoporosis Medications
New osteoporosis medicines added include SERM (selective estrogen receptor modulator) and conjugated estrogen, both now allowed.
Weight-Loss Medication Adjustments
GLP medications for weight loss or prediabetes have a one-week no fly period after starting them.
Formulation changes from injection to pill or vice versa require only 48 hours of observation.
Diabetic Medications
The chart for acceptable diabetic medications has been rearranged, with insulin at the top as it counts as one medication regardless of type.
Third class pilots using CGM now have a 90-day observation period instead of 180 days.
Acceptable Combinations List
Updated lists for different combinations of diabetes medications reduce downtimes and increase flexibility, with color-coded groups for easier reference.

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AME Guide Grand Rounds August 2026 Session

Summary of Medical Certification Guidance

Main Topics

Summary of Medical Certification Guidance

Main Topics