OphthalmologyWeb
Refractive Surgery in Dynamic Individuals: Military and Civilian Perspective D. J. Tanzer; C. D. Reilly; S. D. Barnes; E. M. Hofmeister; V. A. Panday; M. F. Torres; J. M. Gooch; D. D. Koch; J. D. Stevens; E. D. Donnenfeld; S. C. Schallhorn
Army
About 500,000 active army soldiers, 500,000 in reserve
½ need glasses or contact lenses
Glasses get broken, dirty. Not compatablie with NVGs, masks etc.
Contact lenses shouldn’t be worn in theatre. Over 400 K ulcers last year in the field
Army WRESP (Warfighter Refractive Eye Surgery Program)
WRESP Eligibility: Active duty, at least 18 mos left, combat arms/MPs given priority, have deployment orders, commander’s auth, strictly volunteer
- Spec ops PRK only (no LASIK)
- Aviators can have LASIK or PRK, return to flying by 6 wks
- Applicants to flight school can apply after 6 mos of stability after PRK or LASIK
- Not deployable for 1 mo after LASIK, 3 mos after PRK
68,000 treated so far through sep 08 (started in 2001). 11,000 in 2008 alone
12,500 in FY 09 predicted
Army mostly does PRK. Less than 10% is LASIK. All centers have femtosecond lasers.
Challenges: potential lack of medical support while deployed
Air Force
1997 laser purchased
2000 PRK program established
2004 wavefront guided LASIK done in June 2004 for aviators who flew at less than 14000 ft
Now LASIK and PRK allowed for everyone, but only those two
Only WHMC can perform lasik in pilots
Non deployable for 1 mo with Lasik and 4 mos with PRK
20/20 is actually 2 SD below average AF Pilot so goal is 20/15 and 20/10
60K total treatments so far
15 surgeons in the AF perform laser vision correction
82% PRK, 18% LASIK
93% 20/20, 35% 20/15
Quality of vision issues: Night vision, glare, halos
AMO VISX with IR
60 Hz Intralase
Screening Criteria
- Conservative
- 1 year of refractive stability
- CL out 2 weeks before work up
- Low risk of ectasia
- Pentacam - Anterior elevation 12-15 microns borderline, Posterior elevation 17-20 microns borderline
- I:S ratio >1.5D no LASIK on placid disc topographer
- Residual bed limits 300 microns for LASK, 400 for PRK (includes 50 for epithelium)
- No LASK for <500 microns, no PRK for <450 microns
Intraoperative Management
Surgical technique varies among surgeons in the DoD
Post-op Considerations for LASIK
PF/Vig QID x 1 wk
NP AT q 15 min
PRK <3.5 D
Remove CL at POD 4
Flarex QID x 2wks, taper ever 2 wks
Vig QID x 1 wk