Eyeworld

EW FEATURE 50 Refractive surgery in military personnel and first responders • July 2016 "They have been, for the most part, strongly supportive of refractive surgery being conducted in their hospitals, and that has resulted in an overwhelmingly successful program in all 3 services," he said. "I think we're close to having performed 1 million procedures to date since the startup of these programs." EW Reference 1. Tanzer DJ, et al. Laser in situ keratomileusis in United States Naval aviators. J Cataract Refract Surg. 2013;39:1047–58. Editors' note: Dr. Hofmeister has no financial interests related to her comments. Dr. Tanzer has financial interests with Abbott Medical Optics. Contact information Hofmeister: elizabeth.m.hofmeister.mil@mail.mil Tanzer: David.Tanzer@abbott.com wavefront-guided excimer ablations or wavefront-optimized excimer ablations, depending on the plat- form. Many of the centers have access to 2 different excimer lasers. "That broadens the opportunities and applicability of the laser because each laser has slightly different FDA approvals and different refractive ranges that they can treat," Dr. Hofmeister said. Femtosecond lasers are also available at all Navy centers to make flaps. "We also have access to phakic intraocular lenses for select pa- tients," Dr. Hofmeister said. Howev- er, this is not a first-line treatment because it carries a much different set of risks than surface ablation or LASIK. Still, for those who aren't eli- gible for PRK or LASIK because they have such high myopia and their corneas aren't quite thick enough, phakic intraocular lenses are a good option, she finds. "The only restriction in our population is that patients who are in Naval aviation cannot have a phakic intraocular lens. All of the other warfare specialties allow for that," Dr. Hofmeister noted. The reasoning here has less to do with medical concerns than the fact that there are plenty of excellent Naval aviation candidates available. Refractive surgery in the mili- tary has opened many doors. In the 1980s, Dr. Hofmeister said myopia alone was enough to quash the hopes of many who had seen the movie Top Gun and wanted to pursue their aspirations. "Now that playing field is leveled," Dr. Hofmeister said. "People can have refractive surgery and still be a pilot." Dr. Tanzer is likewise enthu- siastic about how far things have come, and he credits the admirals, generals, and other military leaders. Careful continued from page 48 The Air Force is developing a so- phisticated flight simulator to exam- ine visual performance in an avia- tion-specific environment looking at peripheral vision, pursuit vision, etc. in a dynamic simulator following refractive surgery, Dr. Tanzer said. With the aid of such simulators, it has been reported that individuals who were treated with LASIK or PRK were as good as or better at properly detecting and identifying the target in a night combat environment after surgery compared to when they wore glasses or contacts, Dr. Tanzer said. The technology being used for refractive surgery is state of the art, Dr. Hofmeister said. "We have 6 Navy centers, and all the centers have the latest generation excimer lasers, and we're using the most advanced ablation profiles that are available on those platforms," she said, adding that this includes LASIK procedure being performed. The flap has been created and the patient is under the excimer laser. Dr. Schallhorn examines Capt. Oginsky's eyes before he undergoes LASIK. Source (all): Steven Schallhorn, MD The LASIK flap has been retracted, patient fixation has been confirmed, and the photoablation is about to proceed. Marine Capt. Michael Oginsky was the first Naval aviator to undergo wavefront-guided LASIK with the femtosecond laser.

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