Gaining new perspective through vision-correcting surgery
Military applicants were once considered unqualified to join the military if they had a history of refractive surgery, a vision-correcting procedure that usually involves the use of lasers to reshape the cornea. But under the Warfighter Refractive Eye Surgery Program, active duty service members now have this option available to correct their vision. Thanks to advancing technology, refractive surgery is performed to enhance the capabilities of warfighters.
“Vision impacts so much of what we do in the military, and having problems with glasses or contact lenses, especially in a deployed environment, can cause a host of problems,” said Air Force Lt. Col. James Townley, chief of external disease and refractive surgery and refractive surgery consultant to the surgeon general at Joint Base Elmendorf-Richardson in Alaska.
According to the National Institutes of Health, refractive surgery helps improve common vision problems, including nearsightedness, farsightedness, and astigmatism. Townley said the surgery, which typically take as little as 10-20 minutes, changes the focusing power of the eye by making changes to the cornea. When the procedure was first introduced, corneal incisions were made by hand. Now, more precise methods of refractive surgery include tissue removal with laser technology or use of implantable lenses, Townley said.
“Gaining 20/20 vision used to be the goal, but now we have moved on to pursuing much better ‘high definition’ vision where we take image quality and contrast sensitivity, as well as speed of recovery, into consideration,” Townley said.
The Warfighter Refractive Eye Surgery Program was initiated in 2001 as a way to improve vision on the battlefield, where headgear and goggles make use of eyeglasses and contact lenses less than optimal. In order to be eligible for refractive surgery, service members must be at least 21 years old, on active duty status with a minimum of six months left, obtain approval from their commanding officer, and undergo a pre-operative examination. As long as those requirements are met, service members in reserve components are also eligible.
Three refractive procedures are currently available: photorefractive keratectomy or PRK, LASIK, and a small incision lenticule extraction, known as SMILE.
PRK is a surgical procedure that changes the surface curvature of the cornea by shaping it with an ultraviolet laser. Townley said that while this procedure is low risk, vision can take up to six months to achieve its best definition.
LASIK involves creating a surgical flap on the front of the cornea with a laser and sculpting the underlying surface of the cornea with an ultraviolet laser. Recovery time for LASIK is typically a few days to a few weeks, he said.
SMILE, the newest of the procedures, was performed in the Department of Defense for the first time last year at Fort Belvoir Community Hospital. Army Col. Bruce Rivers, director of the Warfighter Refractive Eye Surgery Program and Research Center at FBCH, said a laser creates a thin disc within the cornea, which is removed by the surgeon through a cut created on the corneal surface. Once the tissue is removed, the cornea reshapes to correct nearsightedness.
“SMILE, in a way, combines the faster healing time of LASIK with the stability of PRK because there’s no flap to worry about,” said Rivers. “People may be concerned with LASIK because they’re worried about the flap getting dislodged if they get injured, or maybe they’re worried about dry eyes, but there’s potential for SMILE to not have these issues because there’s no flap.”
Rivers warned that eye-specific issues, such as dryness or having a thin cornea, can prevent patients from being eligible for all three surgeries, but providers will advise them on the surgery that’s best for their needs. For example, PRK preserves the structural integrity of the cornea the most, which is best for patients who have a thin cornea, he explained.
“A common misconception about refractive surgery is that your vision can deteriorate as you age, but only about 3 percent of people regress,” said Rivers, stressing that everyone, even those who had refractive surgery, will need reading glasses eventually. The idea that people with astigmatism can’t get the surgery is another misconception; it’s often correctable with refractive surgery, he said.
“Overall we’re trying to look at what’s the safest for the patient that’s going to give them the best vision we can give them,” said Rivers. “As long as patients qualify for all three surgeries, we allow them to make the decision on their own based on their lifestyles and preferences.”
Priority for the surgery is given to service members who will be deploying, but patients are encouraged to receive the surgery at least three months beforehand, said Townley. Although refractive surgery centers aren’t available in all military treatment facilities, service members who have received approval from their command can travel to one of the military sites where the surgery is available, including those in Hawaii, Germany, and Alaska, to receive the necessary consultation and surgery.
“All service members who are still wearing glasses or contact lenses should be evaluated for refractive surgery,” said Townley. “The longer they go without it, the less time they have to enjoy life without glasses.”