Air Force Oks Common Eye Surgery

Hilltop Times, Dec 11, 2003 - Ogden Publishing

The Air Force has approved the start of an expanded program for corneal refractive surgery that will include Laser-Assisted In Situ Keratomileusis, better known as LASIK, for qualified airmen. The procedure joins the military's preferred eye surgery Photorefractive Keratectomy, PRK, in enhancing warfighter vision.

Five Air Force centers are performing PRK while Wilford Hall Medical Center and the Air Force Academy are performing both surgeries.

The military has a better success rate than private practitioners, but it also has strict parameters personnel must fill to be eligible for the procedure and Hill's optometry center at the Base Clinic is the place to go for detailed information.

The military is performing more Photorefractive Keratectomy surgeries than the better-known LASIK. The difference between the two is with PRK the outer layer of tissue is removed from the eye before the laser surgery is done and then grows back and takes a patient about three to four days to recover. The tissue is no thicker than a few strands of human hair.

With LASIK surgery a flap is cut in the tissue before the laser surgery and then placed back. The time to recover is about one day and the patient will notice an improvement in vision within a few hours after the surgery. The problem with LASIK is the flap may cause complications with impact or under intense g-forces, according to Hill AFB clinic optometrist Maj. (Dr.) Court Wilkins.

Airmen electing to have LASIK performed should be aware of potential complications associated with the corneal flap that are not associated with PRK. Under current policy LASIK surgery makes airmen ineligible to train for most aviation fields.

"There are general concerns with corneal-flap-related complications of LASIK that go beyond routine clinical issues that are specific to the aviation and operational environment," said Rhodes. "There is no corneal flap created with PRK. For this reason, PRK remains the preferred procedure, and expectations are that it will continue to be performed in much greater numbers."

Because of the expected high demand for the procedure, patients are assigned an operational priority based on mission requirement. The choice between LASIK and PRK depends on the assigned center's capability, the opinion of the surgeon and patient eligibility based on Air Force specialty code. Depending on demand the waiting list to have the operation done by an Air Force center for a non-aviator is more than a year, while an aviator's wait time is shorter.

Hill airmen wanting to use the Air Force center will likely go to the Air Force Academy in Colorado. They can expect to spend two weeks and provide for room and board. An airman must take personal leave or at the discretion of the commander permissive TDY has been approved by the Air Force.

Airmen who don't want to wait can elect to have the surgery performed by a private practitioner, but should consider the Air Force guidelines before choosing between LASIK and PRK.

"There've been pilots who have lost their wings because they went to a private facility and had LASIK surgery done, which is not approved for aviators," said Wilkins.

"Do your research. You're paying for a delicate procedure and also you're buying the support after the surgery you may need. There are billboards that advertise cheap surgery, but for a year's worth of follow ups and enhancements expect to pay between $2,000 and $2,500," said Wilkins. "TRICARE does not pay for it, but we can help finding the right place for you."

The surgery, though usually successful, is not fool proof. Patients may experience streaks and halos of light. About 20-percent of those who have the surgery will still require contact lenses or eyeglasses for 20/20 vision. There is a slight chance pilots who have PRK will become disqualified for flight duties and there is a chance for decrease in night vision and the ability to detect camouflaged targets.

"We want airmen to come to us first. We can help with pre and post-operative procedures and educate on how to access the military surgical centers," said Wilkins. "The surgical centers have been good at working with individual needs. Most airmen at Hill will go to the Air Force Academy but there are those who choose to have this operation done at a different center."