Eyeworld

42 July 2016 by Ellen Stodola EyeWorld Senior Staff Writer EW REFRACTIVE Ophthalmologist and colonel discusses refractive surgery in the military W ith so many different things going on in refractive surgery, Colonel Scott Barnes, MD, chief, U.S. Army, Warfighter Refractive Eye Clinic, Fort Bragg, North Carolina, spoke about what he is experiencing in the Army in terms of technology, studies, and surgery volumes. Current technology In the Army, there are a number of surgical centers across the country and Europe, he said, including some that are combination Army and Air Force centers. Dr. Barnes said there is almost an even split between 2 laser platforms, those from Alcon (Fort Worth, Texas) and Abbott Medical Optics (Abbott Park, Illinois). He said that microkeratome LASIK is no longer performed in the Army, so each center has a femtosecond laser for LASIK flap creation. Army-wide, about 30% of cases are LASIK, and a majority, about 70%, are surface ablation, he said. In some locations this might be closer to 50–60% LASIK, while others are nearly 100% surface ablation. For physicians using the Alcon platform, most around the world do not do wavefront-guided treatments, Dr. Barnes said, and the Army cen- ters follow this pattern by primarily doing wavefront-optimized treat- ments. Centers using the Abbott Medical Optics platform have been doing wavefront-guided treatments and are now looking at the iDesign, Dr. Barnes said. Its newest upgrade has a different type of aberrometer to give a different kind of picture with improved outcomes and better results than with the previous wave- front-guided approach. There are no centers yet doing SMILE (small incision lenticule extraction, Carl Zeiss Meditec, Jena, Germany) because it is still in trials, he said. Now that crosslinking has been approved, Dr. Barnes said this will likely be explored as an option as it could potentially be helpful for numerous young military patients. Right now, only 1 of the Army laser centers has been approved to get the femtosecond cataract suite, Dr. Barnes said, which will likely occur some time this year. In general, since the cost of the procedures cannot be passed down to the patient, Dr. Barnes said it's important to examine what is being delivered to determine if they can justify spending tax dollars on it. Studies Dr. Barnes discussed some of the cur- rent studies that are being conduct- ed or examined within the Army and the military as a whole. "LASIK is such a predominant player in the refractive surgery world," he said. "But in the military setting, the majority of work that we have done is with surface ablation." Many current technologies are not FDA approved for surface ablations and don't have specific indications for PRK, he said. As a result, 1 Army/ Navy/Air Force study will look at multiple sites doing surface ablation with the iDesign. The PROWL study, which was previously conducted, was a Ophthalmology in the Army R efractive surgery in the military has been studied under the most extreme conditions: hypoxia, hypobaria, aircraft ejection, and other high-stress environments. Ophthalmologists in the U.S. Department of Defense have to test the outer limits of refractive procedures because we ask military people to go into harm's way under any and all environmen- tal conditions. We ophthalmologists, and the public in general, should applaud this effort knowing that we are enhancing the safety, capability, and quality of life of our service members. It should also give us confidence in the safety and effectiveness of the refrac- tive procedures that we provide. In this month's "Refractive editor's corner of the world," Col. Scott Barnes, MD, shares what he is experiencing in the Army in terms of technology, studies, and surgery volumes. Steven Schallhorn, MD, refractive editor Refractive editor's corner of the world

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