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Photorefractive Keratectomy

Photorefractive Keratectomy. in the Navy/Marine Corps. PRK Works For…. Myopia (near-sightedness) Astigmatism Hyperopia (far-sightedness). Results of the Initial Navy PRK Study. Everyone at least 20/20 uncorrected vision at 12 months post-op Excellent performance results (marksmanship)

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Photorefractive Keratectomy

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  1. Photorefractive Keratectomy in the Navy/Marine Corps

  2. PRK Works For… • Myopia (near-sightedness) • Astigmatism • Hyperopia (far-sightedness)

  3. Results of the Initial Navy PRK Study • Everyone at least 20/20 uncorrected vision at 12 months post-op • Excellent performance results (marksmanship) • No vision-threatening complications • Decreased glare and halos on average • One patient with night-driving complaints

  4. Results from a Recent Study on Aviators Naval Medical Center San Diego • Six months after surgery, 15% of patients still needed glasses for 20/20 vision. (100% needed glasses before surgery.) • After surgery 15% of patients couldn't see as well with glasses as they could before surgery with glasses. • All 382 patients were able to return to flight status - 96% after 8 weeks and 100% after 12 weeks. • Six months after surgery, 4 eyes were not able to see 20/20, even with glasses

  5. PRK in the U.S. Military - The Time Line • 26 DEC 1995 - CNSWC requests that BUMED remove PRK from list of conditions disqualifying for NSW • 15 May 1997 - BUMED msg 151501Z removes PRK as a disqualification for NSW and diving • 29 May 1997 - BUMED establishes waiver policy for refractive surgery in accessions to USN/USMC • 29 Sep 1999 - BUMED relaxes waiver policy • December 1999 - CNO directs Navy-wide implementation of PRK

  6. BUMED PRK Policy Msg September 1999 • PRK waiverable for: • Aviation • Submarines • Surface warfare • USMC • PRK not disqualifying only for SEALs and divers

  7. Priority System for USN PRK • Not dependent on rank or rate • Priority to Warfare Designated Personnel • Based on Commander’s assessment of: • Operational need • Probability of enhancing mission performance • Personal safety in performance of duties

  8. Aviation Community • Ineligible for this program • Separate study in progress - for details click here

  9. Priority System for USN PRK (does not apply to Aviation study) • Priority 1 - Sailor/Marine's duties require work in extreme physical environments without question, frequently and regularly. • Contact lenses/spectacles incompatible • Priority 2 - Duties require work in extreme physical environments frequently. • Contact lenses/spectacles impractical • Priority 3 - Duties require work in extreme physical environments not typically, but periodically. • Priority 4 - Duties require work in extreme physical environments rarely. • Contact lenses/spectacles acceptable

  10. PRK - the Process • Command approval for surgery and assignment of priority by Commander • Screening exam at USN Hospital Okinawa, MCAS Futenma Branch Medical Clinic or Hansen Branch Medical Clinic • Patient forwards packet for scheduling to NMC San Diego for aviators and to NMC San Diego, NMC Portsmouth or NNMC (Bethesda) or any combination thereof for non-aviators. Fax numbers are: • San Diego (619) 524-1731 • Portsmouth (757) 953-6136 • Bethesda (301) 295-4751 Note: all three centers will accept the San Diego consult formfound at the end of this presentation • Notify NH Okinawa Eye Clinic (643-7797) of surgery date • Travel at personal expense for surgery • Surgery performed at NMC San Diego, NMC Portsmouth or NNMC (Bethesda) • Return to Okinawa when directed by operating surgeon • Follow-up at NH Okinawa/MCAS Futenma BMC/Hansen Branch Clinic

  11. Post-op Time-frame • Expect Return to command - 1 week post-op • Expect Return to full Duty - 1 month for myopes/4 months for hyperopes • Follow-up appointments at a minimum: • 2 weeks, 1 month, 3 months, 6 months, 12 months

  12. PRK - the Risks • Corneal infection (rare) • Need for re-operation • Loss of best-corrected visual acuity (1% at 1 year) • Disqualification from special duty • Increased intraocular pressure (2% at 6 mos) • Corneal haze • Increased halos • Increased glare • Ghost images • Night driving problems • Drooping of eyelid • Double vision

  13. You Should NOT Have PRK if You... • Have a history of keloid formation • Have an autoimmune diseases • Have significantly dry eyes • Have a corneal ectasia (keratoconus, etc) • Are currently pregnant or plan to be soon • You are more than 12 diopters myopic, 4 diopters astigmatic or 6 diopters hyperopic

  14. PRK - No Surprises • You may still need glasses after your PRK • You will still need glasses to read in your forties and beyond after having PRK!

  15. So How Do I Sign Up? • Click here to see the check list!

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