‘Ditch the specs’ - Relief is in sight for the figher pilots!
Monday, March 24th, 2008A military surgeons thoughts about the future of lasik and fighter pilots eye sight.
By Maj. E. Mark Shusterman, flight surgeon and Capt. Angela Plant, optometrist of the 507th Medical Squadron
These days, it is very difficult to listen to the radio for more than an hour or to read the newspaper without coming across at least one advertisement for “laser vision correction” that promises to “forever eliminate your dependence upon glasses or contact lenses.” Until recently, having such a procedure was likely to eliminate or restrict your Air Force career.
However, new medical policy changes will allow even those in certain flying positions to dump the old spectacles in the trash. There are currently three operations (Corneal Refractive Surgeries) popularly used to correct nearsightedness (myopia), farsightedness (hyperopia), and astigmatism: radial keratotomy (RK), photorefractive keratectomy (PRK), and laser in situ keratomileusis (LASIK).
Additional techniques exist, but these are by far the most common. All are based on the fact that myopia, hyperopia and astigmatism result in part from a misshapen cornea, the clear outer surface on the front of the eye, which prevents proper focusing of light upon the retina, the tissue lining the back of the eye. This produces a blurred image in the visual cortex of the brain—a problem very similar to that of a badly focused photo camera, where an improperly adjusted lens sends a distorted picture to the film.
RK is one of the earliest surgical methods developed to correct myopia. It utilizes a number of radial incisions in the surface of the eye to flatten the cornea. This procedure results in a very weakened eye structure and often permanent “starburst” visual patterns due to scarring. These complications are not compatible with aerospace safety and lead to an absolute medical disqualification of those who have undergone the operation.
PRK and LASIK, however, utilize a special laser technology called excimer, which is “cool” laser light that does not burn tissue. The laser energy vaporizes a very precise area of the cornea, without damaging the surrounding eye. The surgeon can effectively “sculpt” the cornea to produce the desired reshaping without making deep incisions or causing permanent scarring. Furthermore, since only a very thin layer of the cornea is removed, there is no substantial weakening of the eye’s structure.
PRK “sculpts” the outer cornea, whereas LASIK lifts a thin flap of the outer tissue, “sculpts” the deeper corneal layers and then replaces the flap to act as a biologic dressing for the wound. Two new technologies in LASIK surgery are currently available and are in part why the Air Force has redefined its Corneal Refractive Surgery Policy. The first, called Intralase Femtosecond LASIK differs from traditional LASIK in that the outer tissue flap is created by a laser rather than a blade and results in a more stable flap with less complications post surgery.
The second is called Wavefront Guided LASIK, or Custom LASIK, which utilizes a technologic enhancement to conventional LASIK that reduces the likelihood of creating night vision or glare/ halo problems post surgery. The Air Force prefers these new technologies when available and clinically acceptable to the patient and surgeon. Both PRK and LASIK procedures can provide excellent permanent vision correction with very few long-term side effects.
The choice of procedure rests upon a number of individual factors relating to the patient and the surgeon. With the advent of new surgical techniques and the availability of overwhelming civilian and military data regarding their safety, the Air Force has reevaluated its prohibition of surgical vision correction. While RK still remains “taboo” for the above-mentioned reasons, LASIK and PRK are no longer disqualifying to non-flyers, and under certain conditions these procedures are no longer disqualifying to certain flying positions.
In September 2006, the Air Force released a very clear and specific Corneal Refractive Surgery Policy that encompasses who is eligible for the surgery and what type of refractive surgeries Air Force members are allowed to undergo. If you are on flight or non-flight status and are considering Corneal Refractive Surgery, it is critical to read the new Air Force guidelines and follow the proper procedures before obtaining the surgery.
As stated in the September 2006 policy, “Air Force Reserve members may undergo Corneal Refractive Surgery at their own expense, but must meet appropriate pre-operative criteria, submit application documents, obtain approval to proceed, and accomplish and meet post-operative requirements.” Compliance with this new policy is mandatory. All Air Force Active Duty and Reserve members who undergo unauthorized Corneal Refractive Surgery treatment may be disqualified or restricted from certain duties or aircraft platforms.
To read the new policy in its entirety, go to http://www.brooks.af.mil/web/consult_service/opto_sect/crs.htm or come to the Optometry Clinic during regular UTA hours.
Chapter 4 of the policy covers requirements for refractive surgery in new applicants to aviation and aviation-related special duty flying training programs. Chapter 5 includes requirements for trained aviation and aviation-related special duty personnel, and Chapter 6 covers all warfighter or non-flight personnel. This new policy clearly states the requirements and restrictions for all Air Force members pursuing Corneal Refractive Surgery.
The most important issue to keep in mind when considering laser vision correction is how this will affect your career now and in the future. You may be approved to proceed with surgery under your current job description, but if you decide to change career pathways, the surgery may limit your occupational options. However, the great news is that the Air Force has lifted many previous restrictions in the area of surgical vision correction and is allowing many members to undergo surgery to get rid of spectacles forever.
So, if you too have been itching to ditch the specs, relief is in sight, so to speak!
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(Originally published in US Air Force Magazine)
By Maj. E. Mark Shusterman, flight surgeon and Capt. Angela Plant, optometrist of the 507th Medical Squadron
