Contrary to the popular belief, you don’t have to be perfectly healthy to fly. Having substandard vision or other health problems doesn’t disqualify you from being a pilot. However, it may significantly complicate the process of obtaining a medical. The authorities need to make sure that your health condition won’t interfere with safety. That will require additional work from you, your AME and other parties.

A regular medical examination lasts for an hour or so. But if questionable health conditions are discovered, then you might be asked to do additional medical examinations and/or a medical flight test (MFT), etc., and that may reasonably last months. You might find it very insightful to review the process of obtaining Class 1 Medical for applicants with monocularity or substandard vision in one eye, as an example of what you could expect from your aero medical examination when you have a substandard health condition.

It may have different names in different jurisdictions (MFT, SFMT, practical test, etc.), but the point is the same. It is a special flight conducted under supervision of a certified examiner / inspector to determine if your condition has any negative impact on safety or not.

If you suspect you might have an uncommon health condition, or if you just want to be in the right hands, take your time to find the proper AME who will be willing to assist you. If things go complicated, you really don’t want your AME to start sabotaging the process, e.g., complaining that this or that is too complex for them or playing busy.

In the Netherlands, I had positive experiences with Aeglia: prompt communication, appointments usually available within a week or two, doctor was able to clearly and concisely explain the process, possibilities and overall situation, and, most importantly: they’re not afraid of uncommon situations, and they stay helpful and responsive all the time even for individual private pilots.

In general, if you expect that you have a non-standard health condition, consider the following advice:

• Obtain the medical before you start any training!
  You’ll know for sure if you are legally allowed to fly before throwing thousands on the training.
• Do your homework. Learn the medical regulations and the process around your health issues yourself (as much a possible). Be a good lawyer of yourself.
  The scrutiny around each health “deviation” vary a lot. Sometimes you need additional medical research with a dedicated medical specialist, sometimes you need an MFT (medical flight test), sometimes both, etc. Research the regulations in advance!
  Remember that, even if your AME is truly willing to help you, they are not facing all the edge cases on a daily basis. They might not know the process well themselves. What’s worse, if an AME is not interested, you may expect them to start pushing back.
  In any event, you may find yourself explaining your AME what to do, not vice versa! So, come prepared!
• Prepare your medical history, consider visiting a specialist in advance.
  Know what issues you have. If you have some papers (reports, etc.) from previous visits to doctors, have them with you during the visit to AME.
  If you don’t have them, but you suspect that your condition may require an additional visit to an external medical specialist, consider arranging some reports in advance. Getting an appointment with a specialist within the Dutch health care system may take anywhere from a couple of weeks up to a year. It means that obtaining your medical certificate will be delayed by exactly this period of time!
  Prior to visiting an AME, you may get in touch with him and discuss which specific reports may be useful and get a reference letter.
• Avoid big medical centers in favor of individual AMEs.
  Bigger medical centers are often occupied with contracts with airlines, and they don’t welcome individual private pilots and their problems. Even if they don’t reject you directly after hearing that you’re a difficult customer, they won’t be enthusiastic to spend much time on you. For them an airline who is the customer, not a pilot.
  It’s a good idea to work with an individual AME. And even better — if this AME is a pilot themselves.
• Upfront honesty is not always the best strategy. Yet, don’t lie!
  If you can’t avoid dealing with a reluctant AME or a busy medical center, then it might be practical to not tell that you’re aware of the administrative difficulties associated with your health condition beforehand.
  For them, it’s harder to start pushing back and be cranky, when you’re already at their office, half-way through your examination. Whether they want it or not, at this point you will have to be dealt with dignity, simply because you are no longer a phone call or an e-mail which can be simply dismissed.
  Make no mistake, though: you must not lie about health condition! Obtaining your medical certificate by providing knowingly false information is a criminal offense!