The U.S. Navy's Doctrine of Laser Eye Surgery 547
The New York Times reports that laser eye surgery — now performed on nearly a third of every new class of midshipmen — is transforming Naval careers. Navy doctors are performing these operations with "assembly-line efficiency," allowing older pilots to continue flying, and those who might otherwise have been disqualified to pursue flight school. The number of procedures has reportedly climbed from 50 to 349 over the past five years. The Navy uses a different procedure than that used on civilians — grinding the cornea rather than cutting a flap — out of fears that the flap could come loose in supersonic combat.
It's certainly a better method..... (Score:3, Interesting)
The problem with Lasik is that the burn area is only so big and some people's pupils dilate past that point resulting in all kinds of weird effects on the vision. Grinding would seem to allow much more control over the treatment area.
If you're going to get conventional Lasik here are some things to remember....
1. It IS surgery contrary to how "routine" Lasik places try to pass it off
2. Research your doctor doing the procedure
3. If you're lucky your doc possesses a cornea fellowship from Emory University
They've been doing this in the Army for a while... (Score:5, Interesting)
I got out quite a few years ago, before this was possible. My cousin however is still in, and he got the surgery done, for free. They offer it to everyone, and encourage you to do it. It makes all aspects of being a soldier - particularly an infantryman, much easier. Now you can wear off the shelf eye protection, no longer are gas masks a pain in the ass to put on, nightvision goggle, scopes, sights in a tank, are all easier to use.
I think it's a great idea, myself.
Navy? (Score:1, Interesting)
Re:Grinding? Is this at least available to consume (Score:1, Interesting)
Re:Let a military doc operate on my eye? (Score:5, Interesting)
Re:PRK Experience (Score:5, Interesting)
Exam notes:
It was intresting. I had filled out the eye history sheet before I went
in. They gave me a quick eye exam, but it wasn't like a normal one.
First up was the typical Big E projected on the wall (no glasses!)
"Nope, can't see it."
Next up they took two pictures of each eye. It was a weird device, it
was cone shapped, and I was looking into the big end of it. The inside
was black, with many concentric circles of purple light, with a lens at
the center. It made a topographical map of my corneas.
Next up was a device that measured my perscription. I had to stare at
a little picture while it zoomed in and out of focus. Apparently this
determines my exact perscription, none of that "Is this better, or that"
lens swapping. I wonder why eye doctors don't use this all the time.
Last of the inital measurements was another corenal mapper. Nothing to
see, just a red light.
Then I got a 10 minute vides summerizing LASIK. I knew all that stuff
already from my research.
Then I got to speak with the doctor. She did a few more measurements,
including measuring the thickness of my corenas. Then we got down to
the nitty gritty.
I am NOT a good canidate for LASIK. The corena mappings reveal that
they're buldging on the lower sides, kinda pear shapped. LASIK can be
done, but by pealing back the flap, my corenas loose some of their long
term strength, and I risk having them thin so much I may need a corena
transplant in the years to come.
However....I am an exceptional canidate for PRK, which is basicly LASIK,
but with no flap, they just burn off the extra portions of the cornea.
The recovery time is a bit more involved, and would likely be unable to do
much of anything for a couple of days. I'd have to wear contacts as
bandages while the areas where tissue was removed healed.
Lots of questions with the doctor, but generally very optimistic about
my final result being 20/40 or better. Like 95%+
Then I was off to the office manager for the bottom line. $3700, for
both eyes, all the pre and post care (7 appointments!), and any
additional corrections for life. This about what I expected. And
that's with 15% off from my insurance. I asked, normally they'd give a
cash discount, but I can't combine it with my insurance. Then she gave
me several consent forms and whatnot to review.
4 hours post op:
Well, I did it, and I'm not blind.
It went very smoothly. Arrived, filled out a couple (more) consent forms, one last cornea mapping, and had a last minute chat with the doc. Got a perscription for some vicoden, and got my final post-op instructions. Paid the nice lady, and she gave me some Advil and a valium. Back to the waiting room for 10 minutes.
The proceedure itself I can't really describe, as most of the time I was staring at a bright light 6" from my face. But, they gave me a stylish hair net, and ploped me in a dentist like chair. Leaned me back, and it slid me under the light/laser/camera.
They gave me a half dozen eye drops in each eye and let me sit for a few minutes. I know one of them was an anastetic, hence the wait. They put a plastic shield over my left eye, and taped it in place. Then they tapped my eyelashs/eyelids open on the right eye. They put in the thingy that holds my eye open, which wasn't as uncomfortable as I thought it would be. Few more drops, and then they (according to C) put a little white disk over my cornea. I couldn't see anything, but after they lifted it, I could see the q-tip removing the outer layer of my cornea. Then, he used what looked to be a ice scrapper, I swear. Couple more drops, and then "Don't move, stare at the light" Then they fired up the laser, it made a clicking noise for about 40 seconds. The light went from really blurry to mostly blury, and then they popped in a "bandage" contact, and removed the thingy and left ey
Re:Eye surgery... gah! (Score:4, Interesting)
But to respond to your worries, they do give you drugs to calm you down if you want them (I would recommend it) although they do not put you under you have to stare at a light while the laser goes to work on your eye. The actual worst part is when they cut the flap - they had to wait a few minutes while my eyes dialated, so for a little while had a flap cut in my eye and was just sitting in a chair in a dark room. But altogether it took only half an hour and it was time extremely well spent.
Re:Grinding your eyeball? (Score:5, Interesting)
Sure, eye surgery can solve these problems and it's not very likely that the surgery will "backfire". But that just is not a risk I would like to take with my eyesight.
Like lots of things, I think it's a risk/reward question. In my case, I wear glasses and will continue to wear glasses, but my vision isn't that bad so the reward I'd get from eye surgery isn't all that great. The glasses sharpen my vision and make it easier for me to read road signs, but I can actually get along just find without them.
My wife, on the other hand, was blind as a bat without her glasses, to the point that she had to carefully place her glasses in the same place next to the bed each evening, because she had to find them by touch in the morning. She could not see them. She got Lasik about three years ago, and it has significantly improved her life. Before the surgery, for example, she didn't dare participate in any sort of water sports because losing her contacts or glasses would leave her completely blind. Now she SCUBA dives and I expect to get her up on water skis this summer. Even more important is the sense of freedom she has, being able to see without assistance. After the surgery, her sight was 20/20, but has gradually declined to where she is contemplating getting glasses again to sharpen her vision a bit. She could have the surgery re-done (for free, even, since a followup was included in the original price) instead of getting glasses, but it's no longer worth the pain or the risk.
I know others with similar stories, and I can definitely see how someone who'd like to fly military jets would perceive the risk/reward tradeoff as a good deal. Heck, I'd get the surgery if it meant someone would let me fly an F-14.
PRK is most popular in Europe (Score:5, Interesting)
Re:Navy? (Score:2, Interesting)
The Army has planes, too. The Air Force doesn't have exclusive rights to flight. The branches all serve different purposes, but do have some overlapping capabilities.
My sister is part of an AWACS crew with the Air Force. My understanding is that both the Air Force and Navy have their own AWACS.
Long Term Effects of Lasik (Score:5, Interesting)
Last time I asked (I'm around -4.5 in both eyes), they were worried about the long terms of removing part of the lens in either eye. Apparently, part of the lens is also removed as a treatment for cataracts, and they had some worry that
a) Laser eye surgery could remove enough of the lens to make cataract treatment later in life difficult or impossible, and, also
b) There weren't any large scale long term (20+ yrs) studies on the rusults of the surgery.
As I said, this is secondhand... perhaps if there's a MD or a Optometrist on these boards they could comfirm/deny/just explain better?
I have had Lasik - The Flapping Kind (Score:2, Interesting)
One note, on second surgery of first eye (They werent close enough the first time) they had to draw a line on my eye where the old cut had been made so they could cut in the same place again. I hope nobody ever has to have some draw on there eye, it was not at all pleasant and truely blew out my blood pressure for the day.
Re:Let a military doc operate on my eye? (Score:5, Interesting)
The commonly held belief back then was these docs (and dentists... don't get me going on this one...) were only in the military because they couldn't hack private practice.
More like because they couldn't afford medical school another way.
My experience with military docs is that they're reasonably good physicians, but that the health care system in the military lacks continuity, and that causes problems. Also, because most of the doctors leave the military after they complete their obligation, the active duty doctors all tend to be young and somewhat inexperienced. The best thing to do, if you can, is to get one of the doctors who is a reservist.
My anecdote: The Army doctors at Fort Hood nearly killed my younger sister because she had condition (pyloric stenosis [wikipedia.org]) that is rare in girls, so each doctor wanted to exhaust all other possibilities first, and didn't really trust that the other doctors had done their job. In desperation because my baby sister was dying of dehydration and malnutrition, my parents eventually took her to a nearby civilian hospital, where they operated and corrected the problem within a few hours. To the Army's credit, they admitted their error and the correctness of my parents' actions, and covered the civilian medical bills.
In contrast, my parents now get all of their medical care through the nearby Air Force base hospital, which is generally staffed by a rotating group of reserve physicians who seem to be uniformly excellent doctors. The docs recognize the need for continuity of care and make heavy use of referral to local civilian docs for any condition that requires the sort of continuity they can't provide. They also try to arrange so that each patient sees the same doctor for routine physicals, etc.
Re:Navy? (Score:3, Interesting)
A CVBG (carrier battle group) is mobile. The fact that the carrier itself carries multiple platforms which each excell at different types of missions helps.
Also, in a CVBG you also have (usually) two guided missile cruisers, two to three guided missile destroyers, a frigate or two, two attack submarines, and a supply ship (refueling/resupply of ammo). With this combined platform, you have the following:
-Air superiority, covered by the carrier.
-Long range missile strike capability, from the guided missile cruisers.
-Multi mission surface combat, mostly the destroyers
-ASW (Anti Submarine Warfare) provided by the Destroyers, multiple platforms from the carrier, the frigate, and the attack submarine
-AAW (Anti-Air Warfare) provided by the carrier and the destroyers.
The reason the US Navy places emphasis on the role of the carrier is due to its versatility. One carrier alone (though this would never happen) has the capability to take care of AAW, ASW, and Surface Warfare, along with the ability to strike inland targets.
The reason for the emphasis on the training of Navy pilots is the fact that landing a plane is much (on the range of ten times harder) than landing on an airstrip.
If you were wondering about the source of my knowledge, it comes from my NROTC experience and my family. (Navy family, though my uncle's a Marine...close enough...)
Re:Grinding your eyeball? (Score:4, Interesting)
Into Thin Air (Score:2, Interesting)
Supersonic Flapping (Score:2, Interesting)
I wonder if this means that people who have had eye surgery in the civilian sector are also ineligible for flight school, or if the military has even considered asking people if they have had the procedure before admitting them.
Re:Grinding your eyeball? (Score:3, Interesting)
Re:They've been doing this in the Army for a while (Score:1, Interesting)
Ready to enlist? Because if you aren't, STFU.
Generally speaking even in peacetime the military is a fairly hard lifestyle. When I was in (during the Gulf War) we worked out that we were getting paid about $2.25 an hour for work that was either very boring or very dangerous.
Guaranteed: food, shelter (gotta love those two man tents), medical care, and maybe a few perks after you've exited the service (GI Bill rocks). Also guaranteed: a chance to go to a third world shithole and either get killed outright or seriously maimed, and in my unit 55-80 hour work weeks.
That being said, in the Army I met two damned fine dentists (out of five) and one damned fine doctor (out of at least eight). I'm not sure where everybody gets the cheery "they're awesome" opinion of military docs, but I'm guessing that the Navy and Air Force have real standards when it comes to physicians.
Considering (Score:3, Interesting)
My mother had radial keritotomy (sp?) 15-20 years ago. My understanding of the procedure is that it is the equivalant of Lasik but using a blade to make the incisions instead of laser. My point is that she is in her mid sixties now and has developed glaucoma and will be forced to take eye drops every few hours and have regular checkups to keep it under control for the rest of her life. She has been told that her eye surgery may have put her in an elevated risk group for glaucoma, but not until now.
Until I hear of more long term studies on the effects of Lasik... I think I'll wait.
Re:PRK Experience (Score:3, Interesting)
a little picture while it zoomed in and out of focus. Apparently this
determines my exact perscription, none of that "Is this better, or that"
lens swapping. I wonder why eye doctors don't use this all the time.
My optometrist has one and uses it but says it is not nearly as accurate as a manual exam with the lenses. It's just there to give him a rough estimate as a starting point, but it tends to overprescribe.
End of the day, or the year, or your lifetime... (Score:3, Interesting)
But at the end of the day I know that I can see - with my glasses.
At the end of the day, people with laser surgery can basically see. Some have problems with glare, and some develop vision problems that can't be corrected even with glasses, but the procedure basically works for most people despite the risks.
That's at the end of the day. How about at the end of the decade, or of your lifetime, though? This thing has only been done for a short while now, and the longitudinal studies aren't in, by definition.
Military organizations, again, have done studies over shorter periods [dtic.mil]. Eighteen months is not the measure of this surgery, though. It's performed on a sensitive organ that already has problems with deterioration with age. Given that, I'm not exactly jumping to get it done because of the deals on those special ads that come with the Sunday funnies in my paper.
Are contact lenses such a problem? I can see it for jet pilots, okay, maybe. But for everyday people, what -- you absolutely can't wear goggles when you swim?
optical astronomy (Score:2, Interesting)
eye surgery. Combined with an increased risk of glaucoma (and no end in sight to the prohibition of the one medication that is effectively indicated for glaucoma), I believe I will continue to make myself be satisfied with the highest quality glasses I can get.
Re:PRK Experience (Score:3, Interesting)
The reason more docs don't have them? They're horrendously expensive (up to $50,000)
Anecdotal evidence (Score:3, Interesting)
Your point about the med school funding -- I'm considering med school, so I know whereof you speak -- is well taken.
I did have a friend in the Navy, though, who underwent a nightmarish wisdom tooth extraction. The Navy dentist gave him conscious sedation (a narcotic) instead of a general anesthetic, and then proceeded to perform an extraction that would have given any Civil War surgeon pause. My friend described the fear very effectively. Said he never slept on his back after that, because it reminded him of the surgery chair somehow.
In general the reputation of the military's medical services was that of a poor-to-middling staff model HMO, based on my friend's description of the general situation. Maybe that reflected all the young doctors doing their five years and gaining experience, maybe not.
Re:Let a military doc operate on my eye? (Score:3, Interesting)
I worked at Walter Reed Army Medical for years on a software project for the chief of neurosurgery. I came to find that he was considered one of the best neurosurgeons in the world. Why? Because the military sees a lot of spinal injuries of course. Walter Reed is the same place that works on the President of the US, congressman, etc. Is the president going to get a hack for a doctor?
I also was in the Army and worked with the doctors at Ft Knox for my asthma. I have yet to see an asthma expert that knew as much as these guys.
Re:PRK (Score:3, Interesting)
That's not quite accurate. "Most" doctors will recommend PRK for those with thin corneas. You need a certain amount or corneal tissue available to be ablated (12 microns per diopter of correction), that leaves your eyes with enough structural integrity that you won't get ectasia.
A LASIK flap will re-seal its outer interface within 5 days, but it actually continues to heal further over the next two years, forming a basement of tissue over the Bowman's layer, and the further adding tendrils of biomechanical 'thread'. At the end of about 18 months typically, a LASIK flap is (figuratively) sealed, glued and stiched to your eye. While the interface always exists, at this point the pressure required to dislodge it would damage any normal eye.
The fact that the military is doing PRK really only speaks to the fact that the LASIK prodecure gives you more immediate results (and much faster healing), but takes longer for the eye to return to full integrity.
PRK rocks! (Score:3, Interesting)
Not...
I had it a couple years ago. I reposted my blog entry afterwards here in my slashdot journal [slashdot.org].
Excerpt:She took her time. A swipe swipe here, a swipe swipe there, here a swipe, there a swipe... After she satisfactorily buffed away the covering of my eyeball, she used an actual broom to sweep away the leftover shit in my eye. I know this because I heard her say the word "broom" before she used it. There were other tools used. Again I express my thanks to the inventors of those magical eyedrops. She continues to remove the last remnants of the covering of my eye like one might remove a proof of purchase from a can of Jif to win the $300,000 grand prize, gently now, don't want to ruin the serial number.
Re:Anecdotal evidence (Score:3, Interesting)
Re:Supersonic Flapping (Score:2, Interesting)
Any dentistry that isn't done right is fixed by military dentists - or you get disqualified from some jobs. One can't be expected to perform on high-altitiude jumps & flights or high-pressure underwater dives when air bubbles inside fillings could expand / boil / explode.
It makes sense that certain medical procedures need to be done to a different tolerance level in the military.
Re:How many eye doctors do this do themselves? (Score:1, Interesting)
The Army does this, too (Score:3, Interesting)
Re:Grinding your eyeball? (Score:3, Interesting)
It might sound a little scary, but laser eye correction is a routine procedure performed on millions of people every year.
Re:Let a military doc operate on my eye? (Score:4, Interesting)
Re:Grinding your eyeball? (Score:2, Interesting)
Re:Long Term Effects of Lasik (Score:3, Interesting)
As it turns out, I have perfect vision in my right eye and near perfect in my left. It's certainly disconcerting to have someone peeling your eye, burning part of the front off, then gluing the peel back on (that's my maximum-gross-out version of what happens), but I no longer wear glasses. The bridge of my nose smoothed out, but the dents behind my ears seem to be permanent. I can see in the shower and in the rain, I can kiss my wife without taking off my glasses first, etc.
I remember, for the first time, realizing I didn't have to look down while walking in the rain because there were no glasses to get spotty. I stopped, looked up, and watched the rain fall on my face. It was beautiful.
I now have a large collection of sunglasses. I could never wear them before without putting on contacts first, and contacts were a pain to deal with. Now I have a selection, and I'm never without a sporty pair.
I wish I'd done it about 10 years sooner, but the procedures and the equipment for performing them weren't as advanced as they are now.
Re:Grinding your eyeball? (Score:4, Interesting)
Re:Grinding your eyeball? (Score:2, Interesting)
The article's not about you. You presumably work in a field where contacts or glasses are an option. If you're a fighter pilot and your vision is failing your career is simply over. That's completely understandable-- Glasses fall off, they fog, they skew perception. Contacts tend to fall out at inopportune times (like when the wind is in your face) and have to be taken out and cleaned, which would be less than convenient in a combat situation. They can get the surgery and continue to fly, or they can fret about the risks and go fly 747s for Delta.
Look at it from the Navy's perspective, too-- it takes years, if not a decade to train a "Top Gun", as well as hundreds of thousands of dollars. These guys are difficult to replace, to say the least. If minor and routine surgery will extend a pilot's usefulness you can damn well bet they're going to push for it.
Finally-- these guys are more than willing to take risks and even lay down their life for their country. What's the chance eye surgery will go wrong, versus the chance of sustaining a more serious injury (or worse) in a combat situation, or due to equiptment failure?
Re:Let a military doc operate on my eye? (Score:3, Interesting)
Re:Grinding your eyeball? (Score:4, Interesting)
My wife also had a great experience. So good that I decided to get it done myself.
I am now one of many others who have not had such a pleasant experience even after coughing up thousands of dollars and spending many hours finding the best surgeon in the Columbus Ohio area. Luckily, I can still see with glasses after my botched surgery, but it was one of the most frightening experiences of my life. The microkeratome [oasismedical.com] lost it's grip (suction) on my left eye during the actual cutting of my cornea. Now my eyes cannot create tears and I will be using artificial tears every couple of hours for the rest of my life.
Is it worth it? No way! [pcli.com]
Re:Grinding your eyeball? (Score:3, Interesting)
I'm sure once you get down into the sub 1% instances of side effects with a good doctor, many of those effects are due to some dumbasses not following the doc's instructions and not owning up to their f-ups. If you're a healthy person who is semi-disciplined, I'd recommend it.
I did my research, but you should do yours. I see better now than I ever remember with contacts or glasses.
On a side note, the funny thing is you would think the top places in the world to have the procedure done are in US, Europe or Japan. As it turns out, Saudi Arabia and Columbia have the tops.
Re:Grinding your eyeball? (Score:3, Interesting)
Me, I'm 22. I got my eyes done last year because the cost of glasses is high enough that the treatment is seriously offset, and have healthy enough eyes of the right shape/type/etc that I have fantastic vision now, 99% or more of perfect. To those who can afford it early, it's a great saving over time; I even got it done at a clinic with 10000+ treatments rather than on the high street store that was doing it at half the price, because they're the only eyes I have. But until my eyes start to deteriorate - 20 years at least, on the going average - I can now see everywhere that I couldn't before, in the rain, in any steamy room, in bed. Add that to the cost saving, and permanence becomes irrelevant - even when my eyes do start to go, they'll start going from 0/0 instead of -2.5/-3.5.