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Surgery increases vision, readiness

By Staff Sgt. C. Todd Lopez

WASHINGTON (Jan. 13, 2003) -- In little more than a year's time, the Air Force has improved mission readiness with a program designed to eliminate the need for contact lenses and glasses.

The Air Force Warfighter Photorefractive Keratectomy Program went active at the end of 2001. The program provides PRK surgery to all Air Force servicemembers who qualify -- surgery that in most cases eliminates the need for glasses or contact lenses, said the program's director.

A patient receives laser eye surgery at Wilford Hall Medical Center at Lackland Air Force Base, Texas. Air Force doctors have performed the photorefractive keratectomy procedure on more than 4,000 servicemembers. U.S. Air Force photo by Tech. Sgt. Lance Cheung.

"Nearly 100 percent of our patients do not need glasses to see after this procedure," said Lt. Col. Robert E. Smith, chief of cornea and refractive surgery at Wilford Hall Medical Center here. Smith is also the Air Force surgeon general's refractive surgery consultant.

"That's at least 20/40 vision, what I call 'get around' vision. The vision we really strive for though is 20/20 or better. Our chances of getting that kind of vision (with this surgery) is 85 to 90 percent," Smith said.

In some cases, said Smith, the surgery can only improve a person's vision enough to get them off corrective lenses most of the time. He said that while the surgery cannot completely free everybody from glasses or contacts, it can reduce nearly everyone's dependence on them.

Since the program began, the Air Force has eliminated the need for or reduced the dependence on glasses for more than 4,000 servicemembers.

According to the Air Force Surgeon General's office, the purpose for the program is to increase the readiness of warfighters by eliminating the need for glasses or contact lenses. Smith said corrective lenses can be a hindrance in the field or in the cockpit.

"We are increasing the readiness aspect of our warfighters by reducing their dependence on glasses and contact lenses," Smith said. "Right now we have a lot of folks out there in the desert who use chemical gear, who use night-vision goggles or other optical devices, or who do a lot of different things that can be impeded by glasses and inserts."

Removing that impedance, Smith said, is the true goal of the Air Force Warfighter PRK Program.

"Glasses and contacts, we learned in Desert Storm, don't do well out in the desert," Smith said. "If we can reduce our warfighters dependence on spectacles, they become better warfighters. That is the ultimate goal of refractive surgery in the Air Force. This is not cosmetic surgery."

Currently, there are five locations where Air Force people can get the PRK procedure, including Wilford Hall Medical Center; Travis Air Force Base, Calif.; the U.S. Air Force Academy, Colo.; Keesler AFB, Miss.; and Wright-Patterson AFB, Ohio. While the Air Force does not reimburse members if they receive the surgery from civilian doctors, there are a few other Defense Department centers where the surgery is available, he said.

"We are a tri-service treatment team," Smith said. "This means that we treat not only eligible Air Force members, but also Army and Navy members as well. That (treatment) is reciprocated at most of the DOD refractive surgery centers. The Army and Navy both have a similar program."

While the majority of Air Force members can seek the PRK treatment at nearly every DOD treatment facility, Smith said Air Force pilots and boom operators must go to Wilford Hall. Other aviators can go to any of the other warfighter treatment centers.

The PRK procedure is, according to Smith, quick, painless and unobtrusive, involving use of an "excimer laser" to remove anywhere from 5 to 20 percent of the cornea -- no more that the thickness of three human hairs.

"Basically we need to remove the top layer of the cornea," he said. "We use a polisher to do that, and then we do the laser treatment. All of this is painless. The polisher part takes about five seconds. The laser procedure takes anywhere from 10 to 40 seconds. Then we put a soft contact lens on your eye, and we are done. The total time for the procedure is about one minute per eye."

The soft contact lens reduces discomfort after surgery and helps the eye heal during a three- to four-day recovery period, Smith said.

According to Smith, Air Force members should start at their local medical facility's Web page if they think the procedure may be right for them.

"Everybody is not a candidate for refractive surgery," Smith said. "About two out of every 10 who come for surgery are eliminated because their corneas aren't quite normal. But the overall goal is (to) treat as many qualified candidates as possible.

"Go to your local optometrist and get the application package. They will also do the initial screening. If that exam meets qualifications, then we bring the individual in for another complete refractive surgery exam. If everything looks good, they can get the surgery."