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.
Misleading summary (Score:4, Informative)
Not that the word 'ablate' is any more paletable than 'grind' when it's coupled with the word 'cornea.'
Full Article Text (Score:5, Informative)
Nearly a third of every 1,000-member Naval Academy class now undergoes the procedure, part of a booming trend among military personnel with poor vision. Unlike in the civilian world, where eye surgery is still largely done for convenience or vanity, the procedure's popularity in the armed forces is transforming career choices and daily life in subtle but far-reaching ways.
Aging fighter pilots can now remain in the cockpit longer, reducing annual recruiting needs. And recruits whose bad vision once would have disqualified them from the special forces are now eligible, making the competition for these coveted slots even tougher.
But the surgery is also causing the military some unexpected difficulties. By shrinking the pool of people who used to be routinely available for jobs that do not require perfect eyesight, it has made it harder to fill some of those assignments with top-notch personnel, officers say.
When Ensign Michael Shaughnessy had the surgery in his junior year at the Naval Academy, his new 20-20 vision qualified him for flight school. And that is where he decided to go after graduating last month ranked in the top 10 percent of his class, rather than pursuing a career as a submarine officer.
"The cramped environment in submarines is something that turned me off," Ensign Shaughnessy, 22, said.
For generations, Academy graduates with high grades and bad eyes were funneled into the submarine service. But in the five years since the Naval Academy began offering free eye surgery to all midshipmen, it has missed its annual quota for supplying the Navy with submarine officers every year.
Officers involved say the failure to meet the quota is due to many factors, including the perception that submarines no longer play as vital a national security role as they once did. But the availability of eye surgery to any midshipman who wants it is also routinely cited.
"Some of the guys with glasses who would have gone to submarines or become navigators are getting the chance to do something they'd rather do, and the communities that are losing the people are not as happy about it as the aviation community, which is gaining better candidates," said Cmdr. Joseph Pasternak, the ophthalmologist who oversees the program at the National Naval Medical Center in Bethesda.
In the Naval Academy's class of 2006, 349 of the 993 midshipmen had the surgery, up from 50 five years ago, according to Naval Academy records. Fewer than 30 percent of the academy students whose eyes qualify for the surgery choose not to get it, and the number of holdouts is dropping every year, Commander Pasternak said.
Last week, a little after 10:40 a.m., Colin Carroll, a 21-year-old midshipman from Olney, Md., put anesthetic drops in his eyes and lay down under the laser as Capt. Kerry Hunt, a Navy doctor, and two assistants prepared to begin. "We're locking the laser on now," Captain Hunt told him.
Midshipman Carroll had originally hoped to enter flight school but discovered not only that his eyes were not good enough, but also that he was prone to kidney stones, ruling him out of aviation entirely. He said he was "resigned" to entering the Marine Corps or becoming an officer on a surface ship, neither an assignment requiring perfect vision.
But he decided to get the surgery anyway.
By 10:49, both eyes were done, though extremely bloodshot, and Mr. Carroll walked out wearing sunglasses, declaring he could already see better.
The procedure used by the Navy, photorefractive keratectomy, or PRK, is different from the one used on most civilians. That approach, known as laser-in situ keratomileusis, or Lasik, requires cutting a flap in the surfa
PRK (Score:5, Informative)
While taking a week or more off work is tough for some - YOU'RE PUTTING FRIKKIN' LASERS IN YOUR EYES in either way. Why not take the more permanent / durable approach? Don't chose 'Hi Dr. Nick' budget solution either. That's just stupid.
flap? (Score:3, Informative)
*checks*
At least mine doesn't have a flap.
Re:Grinding? Is this at least available to consume (Score:3, Informative)
PRK Experience (Score:5, Informative)
The only drawback was the day of "oh-my-god-what-have-I-done-get-these-icepicks-ou
Best money I ever spent, and I'd do it again in a heartbeat.
Re:Let a military doc operate on my eye? (Score:5, Informative)
Also, the doctors who treat the President are from the Navy, and Bethesda Naval and Walter Reed are known to be very good medical centers. So I think your post is basically quoting people who have some slant against the military.
-dave
Re:Let a military doc operate on my eye? (Score:3, Informative)
Re:Let a military doc operate on my eye? (Score:5, Informative)
They must have, if your opinion was ever valid in the first place. I was an operating room tech (Surgeon: "Scalpel." Me: Passes scalpel) at Naval Hospital San Diego in the mid '90s, and the surgery they were doing was absolutely first class. We had lots of famous visitors - a friend of mine got to scrub in on a chest case with Dr. DeBakey [wikipedia.org] - and we performed a lot of routine operations that you're only now seeing in the civilian world.
I won't say that there aren't any bad doctors in the military, but there are plenty of brilliant ones to bring up the average. I wouldn't have thought twice about getting medical care for me or my family from the Navy.
Re:It's certainly a better method..... (Score:3, Informative)
Veteran care almost seems like an afterthought.
You need to drive 50+ miles to be seen at a clinic, you have to book routine visits months in advance, etc.
Declining budgets, closing offices etc.
Some subjective facts (Score:3, Informative)
The "flap" is a thin, transparent layer over the cornea which is peeled back to allow the laser to shape the cornea, then it is placed back over the cornea and it heals. Older surgeries used to discard the flap entirely, but a crescent heals faster and with less discomfort.
In my case the flap was discarded, it grew back with no problem. There was discomfort for the first week or so.
I was awake during the entire process. They gave me a mild sedative but I don't really think it was necessary - there was nothing particularly exciting about it. The eye was anesthetized, of course, and this was tested before the procedure began. I was using the eye up to and during the surgery, at which point it was bandaged over.
The actual laser part involved looking at a particular spot while the doc counted up some numbers like he was zeroing in on some chosen value. That's all there was: just look at some spot for about a minuts and it's done. No laser (visibly), no sound, no feeling, no buzzing or cutting or anything like that.
The anesthesia wears off a couple of hours later, and the eye hurts like it has a bad foreign object in it, but it the pain was periodic and not excruciating. It didn't prevent me from working on the computer.
There's nothing particularly exciting or scary about the procedure, and when it's all over you get to see clearly without glasses.
Re:Grinding? PRK is available to consumers. (Score:5, Informative)
Photorefractive Keratectomy (PRK) is available to consumers and is actually a better procedure than LASIK, but is more expensive, requires a longer healing period and fewer physicians are trained to perform it (takes longer to get certified, LASIK certs can be obtained via short, vendor classes).
In PRK, the outer surface of the cornea is ablated by the laser (on an lower power) and then reshaped at a higher power. A protective contact lens is applied to patient and remains on for about 5 days, then is removed by the doctor. The patient applies drops to the eye several times a day for about a month while the outer cornea heals.
The benefits of PRK are the lack of any "flap" problems (incorrect cut, complete cut [ouch], misalignment, dislodgment, halo effects, etc...) and ability to correct some visioin situations not correctable via LASIK.
While my wife wasn't a good candidate for the procedure and didn't have it performed, I highly recommend the physician who evaluated her, Dr. Bruce Bodner [vec2020.com] Associate Professor of Ophthalmology at EVMS [evms.edu].
Re:Grinding your eyeball? (Score:1, Informative)
Yes, there are risks, as with any surgery, but they've been doing PRK in the USA for over 20 years. PRK has lower risk of healing problems and infections because they do not create the corneal flap, but it does take longer to fully heal. Check out the doctor and facility, see if you can find someone else who went there, and make your decision from there. I poo-pooed the idea at first but after doing the research and balancing the risks, I went for it anyway.
Re:Let a military doc operate on my eye? (Score:4, Informative)
Re:Let a military doc operate on my eye? (Score:5, Informative)
My friend is a Army dentist in Germany. The army picked up his 3 years of dental school, which cost around $200,000. He owes them 3 years now. He gets paid less than the average dentist, but he's stationed in Germany and since he left he's travled to the Olympics and the World Cup, not to mention all around Europe.
Also, the Army eye surgery isn't LASIK. It's PRK, which is a different procedure. They don't cut a flap in your eye for this one. My brother, a LT in the army, had it done. He had to use eye drops to treat dry eyes about 6 months.
Re:Grinding your eyeball? (Score:2, Informative)
Re:Grinding your eyeball? (Score:4, Informative)
You do realize that statistically over the course of your life contacts are a greater risk to your eyes than one quick surgery.
Re:Grinding your eyeball? (Score:0, Informative)
Re:Grinding your eyeball? (Score:2, Informative)
Re:Grinding your eyeball? (Score:5, Informative)
I was in the Air Force in the 70's and tried to fly; no dice with 20/400 vision.
It was never vanity, but practical reasons that caused me to take a chance on eye surgery. I've always been involved in sports and martial arts. I've had a zillion cuts and bruises on my face (nose especially) from that. Then in 1995, I started fighting full contact with some serious folks. Now, I always fought WITHOUT glasses because I only had to see the shape in front of me, right?
Nope. A circular technique like a roundkick didn't "show up" in my field of vision until too late to block or duck effectively. After two concussions and some broken bones, I went under the knife on both eyes. Today, I'm still 20/20 in both eyes and love it.
I retired from fighting about a year ago but my last fight was in a small ring with 3 opponents at least 10 years younger than me. We went about 20 minutes non-stop and as one of them commented later "we never got a clean shot in even once!"
Yeah...I'm real unhappy with eye surgery...NOT!
Seriously, do a lot of research and shopping for a good doctor. Check with his patients who are 1, 2, 5 and 10 years out from their work. See what they say. Then, do it!
Hell, it was worth it not to have permanent furrows on either side of my nose anymore from the weight of the coke bottle bottom glasses I had to wear from age 5 on.
Actually, it's mostly in subsonic combat (Score:4, Informative)
Actually, LASIK concerns relate to high-g combat which is mostly subsonic. That's where pilots experience the highest inertial forces which could (theoretically) tear open a LASIK-cut cornea and eyeball. For every aircraft the optimum (quickest turn rate) turning speed is subsonic, and the ability to change the aircraft's attitude is paramount in tactical engagements.
Re:Long Term Effects of Lasik (Score:2, Informative)
Cataracts occur when the lens or portions of the lens become opaque, and when they become large enough to cause problems with daily living (the technical term is ripe), they are treated by surgically removing the lens and replacing it with an artificial lens.
So let's review: Cornea - outer part of the eye. Lens: inside the eye. PRK: reshaping of the cornea, nothing to do with the lens. Cataracts: lens gets opaque, treated by removal/replacement, nothing to do with the cornea.
Sounds like someone could use an anatomy brushup.
Re:Let a military doc operate on my eye? (Score:5, Informative)
Re:It's certainly a better method..... (Score:2, Informative)
Well, there is good reason to be afraid of military medical care - they are the ones that faked treatment to blacks with syphilus in order to study the long-term effects. And the trials with LSD experimentation on enlisted men without proper risk notification. But I know a number of vets that choose to go to VA hospitals. The bureaucracy is daunting, but the actual treatment, assuming you get to see the proper person there for your treatment, is top quality.
Re:Grinding your eyeball? (Score:4, Informative)
It is a big step to take though, and I can truly understand the uneasiness some feel about this procedure, but I am a complete convert now. It is the best money I have ever spent. If you live in Houston Tx I would seriously go the Mann Eye institute and at least take advantage of the free evaluation. Hell get evaluated by 2 or 3 doctors.
On the waiting list.... (Score:1, Informative)
Re:Grinding your eyeball? (Score:2, Informative)
Re:349 (Score:3, Informative)
Re:Grinding your eyeball? (Score:2, Informative)
Re:Latent Nystagmus (Score:0, Informative)
Re:Supersonic Flapping (Score:3, Informative)
Correcting some innacuracies. (Score:5, Informative)
Lasik, cuts a flap into the stroma, this is not the same flap that is removed for PRK as some folks have been characterizing. Alarmingly this flap never full seems to heal. It has been lifted YEARS after the original surgery. Lasik permanently weakens the cornea.
PRK is essentially moving or removing the epithelium. A thin surface layer that will grow back, not the deeper flap cut in the above. Variant (LASEK or epi-Lasik) attempt to preseve the epithelial layer and use it as a sort of bandage during healing. This helps speed the healing and lower pain, but it is still not as good as traditional Lasik.
Bottom Line:
PRK and variants, better/slower/more painful. Laskik has more issues/complications, but is more comfortable/faster.
The navy is making the right choice here.
Re:Grinding your eyeball? (Score:5, Informative)
Lasik has several risks [fda.gov], but just counting flap complication rates [diamondvision.org] = (0.1-0.5%) = 1 per 200-1000, which doesn't include some of the other side effects mentioned by the FDA.
Correction -- parse error. (Score:2, Informative)
Re:It's certainly a better method..... (Score:1, Informative)
Re:Long Term Effects of Lasik (Score:3, Informative)
Your parents are being very cautions, but they seem a little out of the loop as far as refractive surgery goes. There are, in fact, 20 year studies on the first PRK patients (and yes, the first guy can still see fine). LASIK is newer, 1991 I think, and so there are 15-year studies for that.
As far as cataract surgery and such goes, you can have the docs measure your eye with a sonic sensor that measures corneal thickness, and thus tells you what the danger range is. PRK should not be an issue at all.
Re:Grinding your eyeball? (Score:3, Informative)
Re:Grinding your eyeball? (Score:4, Informative)
Apparently a 10% failure rate of the surgery. The blinding rate is far lower than that, probably not the 1/20 I quoted (I must have had the 2 mixed up in my head). But there's a spectrum here- of the 10% that fail, a portion will have no negative effect (discounting temporary pain), a portion will have low negative effects, a portion will become blind. When the alternative is just needing to wear glasses, even a 1% worsening my vision at all is too much. I'd happily take risky surgery if it was that or lifelong debilitation/death, but these are just glasses.
Re:What's it called? (Score:3, Informative)
http://www.wisegeek.com/what-is-an-autorefractor.
Re:PRK Experience (Score:3, Informative)
Everyone else is commenting on this and I thought I would, too.
Most lens prescriptions consist of two parts: how many diopters of spherical correction you need for an eye, and a modification of that correction to account for astigmatism, which consists of a 2-D curve, a cylinder, added to the existing spherical correction. So you have a sphere of a given magnitude, and a cylinder of another magnitude, and an angle at which the cylinder overlays the sphere.
The 'one better, two better' machine measures this.
The machine that maps your cornea A: costs $70,000, and B: actually generates a topographic map of your cornea. That's great if you're going to work on the cornea, but it doesn't map the lens beneath the cornea (which could be responsible for some of the astigmatism) so it can't correct for problems with the lens or other aberrations that are below the surface. And, more to the point, if you're handing a lens prescription that only has three variables (spherical, cylindrical, and angle of cylinder/sphere) you don't need and cannot use most of the information in a topographic map. If people ground lenses that accommodated for every lump and bump in your eye, then it'd be very useful (though it wouldn't work for glasses, since they don't move with your eyes) but we don't do that. We approximate it with bifocals/trifocals/gradient lenses, sort of. But corneal topography measures something different than the 'one better, two better' machine, and while it's very useful for laser surgery, in figuring out how to resculpt the cornea, it isn't a replacement for measuring the optic system of the eye.
Re:Grinding your eyeball? (Score:5, Informative)
I, on the other hand, get by reasonably comfortably with glasses. LASIK would be entirely elective for me, and I don't really want to spend the money or undergo the risk for it. The expected value of the improvement to my life is lower than the expected cost of the risks.
Re:Grinding your eyeball? (Score:3, Informative)
-h-
My ulcerated cornea experience (Score:3, Informative)
Re:Grinding? PRK is available to consumers. (Score:3, Informative)
Re:It's certainly a better method..... (Score:2, Informative)
I had a combo-surgery done - a point laser does a 6mm correction, and then a slit-scanning laser "tapers" the correction out to 11mm, all while maintaining a aspheric shape (the natural shape of the cornes, as opposed to most places with do a spheric correction.)
Takes a bit longer to do the surgery, and a bit longer to heal, but the results are supposed to be much better in the long term.
Re:Grinding your eyeball? (Score:4, Informative)
Re:Grinding? PRK is available to consumers. (Score:3, Informative)
Re:Grinding? PRK is available to consumers. (Score:2, Informative)
Yes, I understand that this can happen depending on the amount of correction required and (probably more important) the size of your pupils -- the larger, the more possible the effect. You shouldn't get the extreme form possible with LASIK that't due to the hard edge of the flap cut though. Most mild to moderate effects from PRK usually diminish over time. The sibling poster to your message (kasparov) had some good info.
All the best.
Re:Grinding your eyeball? (Score:2, Informative)
Jet Fighters no... recreational aviation yes.
My wife has a prescription of something close to -6.5 and -7.5. To be honest, i really dont know what this means, but I can assure you she is almost as blind as a bat when she isnt wearing her glasses/contacts.
She was able to get her aviation medical for a private pilots license. She has some restrictions, like she must carry a spare pair of glasses in case a contact falls out midflight etc, but there is no reason you cannot fly if you wear glasses.
Just dont expect to be able to fill gaps in the national guard airforce left by George W.