Eyeworld

53 EW FEATURE July 2016 • Refractive surgery in military personnel and first responders repositioning, it's going to be early in the postop phase," Dr. Vukich said. Similarly, for such patients un- dergoing PRK, Dr. Vukich instructs them to perform light duty activi- ties until the bandage contact lens comes out, and he emphasizes that their vision won't be fully corrected until about 5 days postop. First responder patients are especially diligent in following the postop drop regimen. "They are used to following orders and the rules to progress in their jobs," Durrie said. "So they are some of the best patients we have." Dr. Vukich agreed that first re- sponder patients are very motivated to do whatever is required to main- tain good vision, and they are gen- erally comfortable with any require- ments because they are surrounded by colleagues who have already had the treatment and discussed it with them. "This is a group of patients who are extremely grateful, who under- stand the need, and who see it as an investment in their personal well-be- ing and future," Dr. Vukich said. EW Editors' note: Dr. Durrie and Dr. Vukich have no financial interests related to their comments. Contact information Durrie: ddurrie@durrievision.com Vukich: javukich@gmail.com they have to be able to see clearly to make important judgments to decide which avenue to pursue, in terms of which level of response they need to use. In order to do so safely, they have to be able to see." Such life-or-death challenges have led law enforcement officers and agencies to increasingly view refractive surgery not just as a luxu- ry but something they need to take care of themselves and to ensure public safety. The critical visual challenges for law enforcement were most vividly illustrated to Dr. Vukich through the 2014 testimony at the Food and Drug Administration's review of the KAMRA corneal inlay (AcuFocus, Irvine, California) by Steven Bowen, a bomb disposal technician in Salt Lake City. Mr. Bowen described the need to wear heavy protective equipment, including a helmet and face shield, to protect himself from bomb blasts as he tries to disable them. The dangerous job requires good close vi- sion to examine wires and schematic diagrams. "He doesn't have the luxury of putting reading glasses on because he can't take his helmet off to put them on," Dr. Vukich said. "The ability to see up close for him was not just the luxury of not needing reading glasses. For him it was being able to do what he had to do to pro- vide safety for himself and others." Less dramatic assistance provid- ed through refractive surgery by Dr. Vukich included a recent treatment to help a local sheriff's deputy ad- dress his increasing difficulty meet- ing marksmanship requirements. The treatment allowed him to avoid reassignment to desk duty and en- abled him to progress in his career. Helping others Among the ways that other first responders, like firefighters and para- medics, can benefit from refractive surgery is that it eliminates the pos- sibility that glasses or contact lenses will become dislodged when wearing a breathing apparatus. Additionally, uncorrected vision requirements for firefighters are sometimes only 20/100, Dr. Durrie noted. So even those professionals who meet their organization's vision requirements may still benefit from treatment. "Often we have people doing these jobs who don't see as well as they should, and they are in hostile environments trying to save us and protect us," Dr. Durrie said. The need and potential benefits led both Dr. Durrie and Dr. Vukich to offer discounts to first responders, who may be unable to afford the treatment. "This is one of those logical things we should be offering to make it as affordable as possible not only because it helps them, but it also makes our communities safer," Dr. Durrie said. Surgical implications Dr. Durrie said the job challenges of first responders do not further complicate their surgical selection. Generally, intense activities such as participation in aggressive contact sports—like mixed martial arts— would lead him to perform a surface ablation instead of a flap procedure. "If someone is a cage fighter on the weekend then I may look at do- ing a surface ablation rather than a flap procedure, regardless of whether they are a policeman or a firefight- er," Dr. Durrie said. Dr. Vukich noted that previous concerns by the Armed Forces about the rare cases of dislodged flaps generally were limited to combat sit- uations and the need to evacuate a soldier for repositioning of the flap. But first responders could be more easily treated in the rare situation of a dislocated flap from a severe impact. Among special postop instruc- tions for first responders, Dr. Vukich recommended office duty for at least 3 days postop for police officers, firefighters, and paramedics who undergo LASIK. First responder patients sometimes take this time off of work. "If there is going to be trauma to a LASIK flap that will require EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send an online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the hundreds of physicians who take a minute a month to share their views, please send us an email and we will add your name. Email carly@eyeworld.org and put "EW Pulse" in the subject line. Poll size: 122

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