LASIK, PRK, Refractive Surgery in the Military
Can you trust a military doctor to speak the truth about LASIK and PRK?
Did Army Surgeon, Scott Barnes, Give Misleading Testimony?
From the article: "While Dr. Barnes spoke about "refractive surgery", his testimony in the context of a special hearing on LASIK implied that his arguments were in support of the LASIK procedure. Indeed, the Summary Minutes of the FDA hearing stated that, "Dr. Barnes of the Warfighter Refractive Eye Surgery Program emphasized the importance of LASIK to the military." The FDA hearing testimony of Lt. Col. Scott Barnes is inconsistent with his recent publications."
Lasik's blurry vision - Salon.com 1/25/2010
From the article: Erik J. Rupard, a doctor and clinical researcher with the U.S. Army, is among those who think such scrutiny is necessary... "I saw lots of dry-eye complications in soldiers in Iraq who had undergone the procedure ostensibly because contacts are too unsafe in that dusty environment, and yet the Department of Defense has done no controlled studies to look at the cost -- human and otherwise -- of these post-refractive issues. I am a clinical researcher, and I know that Lasik, a cosmetic procedure, has never been subjected to the pre- or post-marketing scrutiny that we put even lifesaving drugs through."
Traumatic Flap Striae 6 Years After LASIK: Case Report and Literature Review.
Excerpt: Military, law enforcement, and contact sport personnel should be counseled to consider surface ablation or wear eye protection. Regarding the latter, however, we recommend that safety counseling be broadened to all patients in light of the mundane mechanisms of injury seen and the random nature of trauma. Given the growing evidence for chronic flap vulnerability and the relative youth of many LASIK recipients, long-term risks are increasingly relevant.
Source: Ursea R, Feng MT. J Refract Surg. 2009 Dec 28:1-7. doi: 10.3928/1081597X-20091209-02.
Late traumatic femtosecond LASIK flap loss
A 22-year-old male Marine had femtosecond-facilitated LASIK performed by another surgeon in our facility. The immediate postoperative period was uneventful... Eight weeks after surgery, the patient called the clinic, stating he had been struck in the right eye by a friend’s finger. He described experiencing a feeling of something on his cheek, which he had discarded. He was directed to come to the clinic immediately with a driver. He arrived within 2 hours of the injury; on examination, it was discovered that he had complete flap loss.
Source: J Cataract Refract Surg. 2009 Jun;35(6):1134-7. Visual acuity recovery after late traumatic femtosecond laser in situ keratomileusis flap loss. Thomas KE, Tanzer DJ. Naval Hospital Camp Pendleton, Camp Pendleton, and the Naval Medical Center San Diego, San Diego, California, USA. flykarin@aol.com
Death of soldier linked to hazy vision after laser eye surgery
From the article: One of the four shooters, Staff Sgt. Trevor Alders, had recently had PRK laser eye surgery. Although he could see two sets of hands "straight up," his vision was "hazy," he said.
Post-LASIK night vision problems place Army soldiers at increased risk for injury or death
From a 2008 Walter Reed Army Medical Center study:
"Soldiers experiencing postoperative glare, haze, and starbursts could be significantly impaired in their ability to perform nighttime duties, thereby reducing the ability to perform their military functions safely. In a worst-case scenario, postoperative impairment of night vision may lead to increased risk for injury or even death."
Source: Jayson et al. Effect of brimonidine tartrate 0.15% on night-vision difficulty and contrast testing after refractive surgery. J Cataract Refract Surg. 2008 Sep;34(9):1538-41.
Air Force Lt. Col. Charles D. Reilly, MD: No traumatic flap dislocations after PRK
(4/6/2009) From the article: "U.S. Air Force personnel serving in Iraq and Afghanistan who underwent photorefractive keratectomy suffered no traumatic flap dislocations in a 1-year period."
Editor's note: Of course troops who underwent PRK suffered no flap dislocations -- there's no flap in PRK. Reilly goes on to state that post-PRK haze forced some troops to leave the theater.
Military physician serving in Iraq: LASIK testimonial
Read the experience of a military physician who experienced complications of LASIK and witnesses first-hand the devastating impact of post-LASIK dry eyes on soldiers and marines in Iraq.
Refractive surgery in the United States Air Force
Excerpt: "In 2008 at the Joint Warfighter Refractive Surgery Center, approximately 90% of refractive surgery candidates underwent surface ablation [including PRK, laser-assisted subepithelial keratomileusis (LASEK), and epi-LASIK]... PRK remains the most common refractive surgical procedure performed in the United States Air Force."
Source: Panday VA, Reilly CD. Refractive surgery in the United States Air Force. Curr Opin Ophthalmol. 2009 Apr 24.
Editor's note: Why do you suppose that 90% of refractive surgery performed in the Air Force is PRK, not LASIK? Could it be because LASIK flaps never heal?
Retired Navy Captain Steven C. Schallhorn, M.D. rejects "stack 'em high and sell’ em cheap" allegations
From the article: Mr. Michael O’Keeffe, consultant at the Mater and Temple Street Hospitals in Dublin, claims some of these clinics operate on the basis of "stack 'em high and sell’ em cheap" and are selling what is a complex and sometimes hazardous procedure as if they were selling “cans of beans or handbags.”... Dr. Schallhorn rejected Mr. O'Keeffe's assertion that having a doctor providing all the care is the best model.
Preliminary results of photorefractive keratectomy in active-duty United States Navy personnel
Excerpts from commentary by Leo J. Maguire, MD:
"If the mission is to give all troops 20/20 uncorrected photopic visual acuity 1 year after surgery, then the mission is accomplished-- at least in the first eyes of these two Navy SEALs and 28 other Navy personnel. If the mission is to provide a service that consistently preserves optical quality and accurately corrects refractive error, then we find casualties among the volunteers and some information missing in action".
"Unfortunately, we also have the postoperative minority with severe halos, severe glare, and disabling night vision -- all in a group with relatively low myopia. One can always discontinue contact lenses, but refractive surgery is forever."
"The results are mixed. The surgery is successful in the majority of patients, but the laser still takes prisoners. Upgrades in laser design and study protocols may eliminate these problems. Until then, the Navy should maintain the regulatory guard, and continue to gather intelligence".
Source: Schallhorn SC, Blanton CL, Kaupp SE, Sutphin J, Gordon M, Goforth H Jr, Butler FK Jr. Preliminary results of photorefractive keratectomy in active-duty United States Navy personnel. Ophthalmology. 1996 Jan;103(1):5-22.