Eyeworld

EW FEATURE 44 Refractive surgery in military personnel and first responders • July 2016 AT A GLANCE • Just a few decades ago, some military occupations were closed to certain individuals due to visual acuity restrictions. • Refractive surgery research pioneered by the military in the 1990s found this is a safe and effective option to improve job performance and safety. • Thanks to the availability of PRK and LASIK, restrictions have been lifted in all branches of the military for its most dynamic of occupations requiring unfettered vision. by Liz Hillman EyeWorld Staff Writer procedure not yet approved by the U.S. Food and Drug Administra- tion at the time, as an alternative refractive procedure for some of its personnel. RK at the time was also known to have the possibility of "signifi- cant refractive changes at altitude," among other complications, such as halo, glare, progressive hyperopia, ir- regular corneal curvature, and more, according to Dr. Butler, leading to the desire for other surgical options. As the director of the Naval Special Warfare Command Biomed- ical Research Program at the time, Dr. Butler piqued the interest of leadership about PRK and was con- nected in 1993 with Dr. Schallhorn to conduct the first studies using of Pensacola, Florida, a retired Navy SEAL captain, described the case of a SEAL who had RK and later suffered a ruptured globe after blunt trauma. It was Dr. Butler's job to evaluate this SEAL for diving afterward. In doing so he made these 3 recom- mendations to the Navy Bureau of Medicine and Surgery: 1) that RK remain a disqualifying condition for military divers; 2) that the SEAL in question be an exception since "he was such a high value to the military"; Dr. Butler noted that this SEAL never suffered other RK complications even after he returned to diving; and 3) that the Navy research the benefits of photorefractive kera- tectomy (PRK), an investigational vision correction thanks to the work pioneered by Dr. Schallhorn. "We went full circle. He ended up getting the kind of surgery that would have enabled him to be a Navy pilot, had the clock been moved forward 20 years," Dr. Schallhorn said. In the decades since its approval for military personnel, refractive surgery has transformed the lives of thousands of men and women who would otherwise have been excluded from or removed from certain occu- pations due to impaired vision. "Refractive surgery has been wonderful for the military," said Charles "Chaz" Reilly, MD, Rashid, Rice, Flynn & Reilly Eye Associates, San Antonio, former chief of U.S. Air Force Ophthalmology, who retired from the military as a lieutenant colonel. "In aviation in particular, it has had a large impact. Fully 25% of Air Force personnel enter- ing pilot training have undergone refractive surgery, and they graduate pilot training at a higher rate than those who have not had to undergo refractive surgery. The U.S. Navy has also seen a large increase in its mid- shipmen from the Naval Academy seeking aviation training because of refractive surgery." Laser vision correction approval Wearing glasses can impede and restrict the use of certain head- gear. Contact lens hygiene in the field can be virtually non-existent, creating an environment ripe for vision-threatening complications. Some duties, based on their physical demands and stresses, are not suited for glasses or contacts as a whole. There's also the issue of oth- erwise highly qualified candidates being passed over only because of their refractive error. "The military wants the very best and brightest to serve and often that is someone who needs glasses or contact lenses," Dr. Schallhorn said. Thus entered the possibility of refractive surgery. Prior to laser surgery, the most common refractive surgery was radial keratotomy. But this was not suited for all military personnel, for example, a Navy SEAL diver. Frank Butler, MD, Navy Hospital Laser vision correction has opened the door for a new pool of candidates, improved safety and performance S teven Schallhorn, MD, in private practice, San Diego, intended to go to medi- cal school, but when he graduated with an under- graduate degree from Colorado State University, he and a friend decided "on a whim" to enter the U.S. Navy with the goal of joining its aviation program. That was 1977. But the friend with whom Dr. Schallhorn applied for military service found he couldn't be a Navy pilot. "Back then, you had to have 20/20 uncorrected vision," said Dr. Schallhorn, who retired from the Navy as a captain. "You could not miss 1 letter on the 20/20 line or you could not be a pilot." This friend was slightly near- sighted in 1 eye. More than a decade later, after training and teaching at the United States Navy Fighter Weapons School (known more popularly as Topgun), Dr. Schallhorn was involved with conducting laser vision correction procedures and studies that would allow applicants like his friend to serve in some of the military's most dynamic roles after successful refractive surgery. About 12 years ago, this same friend received laser Refractive surgery in the military changed the lives of troops The U.S. Air Force changed its policy to allow LASIK surgery for its aviators in 2007. Source: U.S. Air Force/Senior Airman Brian Ferguson

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