Slashdot Mirror
The U.S. Navy's Doctrine of Laser Eye Surgery
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.
I think the phrase 'ground down' used in the summary is a little misleading. It's not an abrasive process which is used to reshape the cornea; rather a laser is used to ablate it.
Not that the word 'ablate' is any more paletable than 'grind' when it's coupled with the word 'cornea.'
The gift of death metal does not smile on the good looking.
BETHESDA, Md., June 17 -- Almost every Thursday during the academic year, a bus carrying a dozen or so Naval Academy midshipmen leaves Annapolis for the 45-minute drive to Bethesda, where Navy doctors perform laser eye surgery on them, one after another, with assembly-line efficiency.
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
The method the Navy uses has been available to civilians for years now. I should know - I had it. In LASIK SURGERY the potential for the flap to come apart exists because only the outer edge of where the cut is made heals. You recover in 3 - 5 days instead of 5 - 8 with PRK. But with PRK you don't have the heebie geebie factor of eye flaps busting loose. In fact most eye doctors will recommend PRK to those under 30 with any kind of an active lifestyle for sports, scuba diving, etc.
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.
Uh, I don't think so.
*checks*
At least mine doesn't have a flap.
If you mod me down, I shall become more powerful than you could possibly imagine.
Well it's not "grinding," unless the meaning of the word "grind" has changed recently, but there is at least one laser procedure available to civilians that doesn't cut a flap.
[b.belong('us') for b in bases if b.owner() == 'you']
I had PRK done in Jan-05, and have been extrodinarily happy with the results.
t -of-my-eyes" pain, and 3 days of "damn my eyes itch" iritation. Not for the faint of heart.
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.
Well, considering how expensive medical school is, one option is to have the military pay for it. You come out without all of the debt, you do your 5 years (I think it's 5) of service, and when you are discharged you have your education, no debt, and 5 years of experience as a doctor. Looks pretty good to me (if I were interested in becoming a doctor).
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
/., where "Apple and Google provide Iran with nukes" will be refuted with "But Microsoft is a convicted monopolist"
There is suing for malpractice. Claims JAGs handle these all the time. Many military bases have JAG dedicated to medmal stuff.
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 - 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.
Dewey, what part of this looks like authorities should be involved?
There is a huge difference between active military personel care and veterans care.
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.
I have actually had this (civillian) type of surgery.
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.
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 Associate Professor of Ophthalmology at EVMS.
It must have been something you assimilated. . . .
I don't think they literally mean grind your cornea off. I had PRK done and they used an alcohol solution to dissolve the outer layer of the cornea then swab it off. After that, they zap your eye with the laser, put in a protective contact lens, and you're done. You keep the contacts for a week, a daily regimen of eye drops for 2 weeks, and a month later your vision should pretty close to 20/20 (or best corrected). I am now 2 months out with 20/15 vision! I've worn glasses since I was 3ish and I could not drive without them. I enjoy swimming and other beach activities, but it is a pain when you have glasses that are constantly coated in sea spray. It is pretty hard to put on a diving mask with glasses too.
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.
I've got to agree with the others posting here. I've known and worked with many MD's who were going to the military after finishing med school to help pay off those huge Med School bills. And this is from top-tier med schools (with top-tier med school bills). The military gets a lot of top-notch MD's right out of med school/internships. Some of them might like the military and decide to stay. By no means are all the military docs bottom of the barrel.
Military pay is also better than what a medical resident makes. So you graduate med school with no debt, AND you get paid better for the next 3-5 years while you train. Then go find a nice job when you get out.
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.
I too would rather keep wearing corrective lens (contacts in my case) rather than risk loosing site for life.
You do realize that statistically over the course of your life contacts are a greater risk to your eyes than one quick surgery.
Oh give me a goddamm break. How f'ing hard is it to know the difference between lose and loose?
Well I have good news for you. There are a few different methods of sugery available to you. The most common method today is lasik, with this method the surgeon cust a flap in you cornea with a small slicing device, performs the refractive correction underneath, the replaces the flap which suctions itself back on. This method has a very quick recovery time and produces the least amount of pain. The flap never "Heals" however it is pretty well sealed by the forces of suction. The one that I assume the navy uses, and the method I opted for in fear of eye integrety was the method called PRK. With this method the laser is used to etch the refractive correction onto the surface of your eye without creating a flap. Your eye is left fully intact execpt for the etching just made. The surgery leaves your eyes feeling as though you have sand in them, but a bandage contact is placed over them to help the healing process as well as comfort. Initial recovery period is 1-2 weeks, and can take up to 6month to fully heal. In my opinon this is the better choice. http://en.wikipedia.org/wiki/Lasik http://en.wikipedia.org/wiki/Photorefractive_kerat ectomy
Well boys and girls, I had my "eyes done" at age 40, which was 10 years ago. I had terrible myopia and astigmatism so bad, I couldn't wear contacts of any kind.
:o)
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.
I am my own gestalt.
out of fears that the flap could come loose in supersonic combat.
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.
Laser surgery on the cornea doesn't do a thing to the lens. The cornea is the outer clear surface of the eye covering the pupil and iris, while the lens is within the eyeball behind the iris. Most (about 2/3) of the bending of the incoming light that's needed to get an image focused on the retina at the back of eyeball is done by the curve of the cornea. Because the cornea doesn't change its curvature, without the lens our eyes would be fixed focus, just like a disposable camera. The lens is flexible and changes in its curvature are what lets us focus on closer objects.
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.
Either you were in many, many moons ago, or you've fallen for the propaganda. I was a USAF medic 1989-1997, then worked as a civilian EMT and ER tech for a couple of years after getting out, and I feel very confident in saying that the standard of care in the military (at least the AF) is as good as or better than the standard on the civilian side. Doctors, nurses, medics, specialty technicians (e.g. lab and x-ray tech) all got away with sloppiness in the civilian medical world that I found shocking, and which would never have been tolerated in the service.
The correlation between ignorance of statistics and using "correlation is not causation" as an argument is close to 1.
Every vet I know says the exact opposite. They are all scared to death of military medical care.
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.
Learn to love Alaska
As a 37y/o that had been wearing glasses and contacts since I was 6, I had many of the same concerns listed in this thread. But this past February I took the plunge and had Intralase Lasik. It is the best money I have ever spent. The worst part of the procedure is the Intralase that creates the corneal flap. The actual Lasik part was really fast, only a couple of seconds per eye. You just have to be very careful for the first couple of weeks after the procedure to give your flaps time to heal. I just had my 3 month check up, and I was able to see 20/10 - 2, which means I could get 2 of the letters on the 20/10 line. This is utterly amazing to me, since my eyesight was so poor.
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.
Its great that they offer this free to enlisted active duty , and its often used as an a recruitment incentive. However in reality the waiting list for this procedure is often atleast 2 years, speaking from personal experience.
Autorefractor? They use those on adults too. I don't know how it tells when the image is in focus, but it does a pretty good job.
That would be 349 procedures on Naval Academy students - a much smaller universe.
http://www.healthscout.com/ency/68/346/main.html Lenses can irritate the eye because of dryness due to problems with tear production, which may be inadequate, especially in older people. The major risk from contact lens wear is corneal ulceration, which is a potentially blinding condition. Among the contact lens wearers in the U.S., there are an estimated 12,000 corneal ulcers per year.
The new laser systems (new as in the last 5 years) have motion detection at a very high scan rate. It tracks your eye through the entire treatment, and if you move at any point, the procedure just takes longer since the machine pauses, waits for your eye to come back where it wants, and continues.
They ask, and yes, the people who have it done are ineligible. The military lets a lot of things go, but the possibility of a pilot suddenly being blinded while in the air isn't acceptable. People who want to become a pilot are told to avoid getting the civilian procedure done, whether PRK or LASIK, and to wait and have the Navy do it for them. Same applies to the Marines, Air Force, etc. They're pretty careful about this.
Remember kids, tin foil doesn't work, so use LeadHat.
The Navy is doing PRK. This was the first procedure done widely on civilians. Lasik was introduced later. The primary Lasik advantage is the patients have usable vision sooner and are pain free sooner. PRK is the better treatment, but in our quick fix society, Lasik is more popular. It is also pushed by many docs as there is less negative feedback from customers, less followups during the shorter initial healing cycle.
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.
From the article you cite: 12,000 ulcers / 24 million wearers = 1 per 2000
Lasik has several risks, but just counting flap complication rates = (0.1-0.5%) = 1 per 200-1000, which doesn't include some of the other side effects mentioned by the FDA.
Intron: the portion of DNA which expresses nothing useful.
"Ladies and gentlemen, my killbot features Lotus Notes and a machine gun. It is the finest available."
The Tuskegee Syphillis study was conducted by the Public Health Service, a U.S. government service, but not a military service.
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.
If Jesus wants me it knows where to find me.
Just FYI it's called Corneal Neovascularization.
DRM 'manages access' in the same way that a prison 'manages freedom'
http://www.telegraph.co.uk/news/main.jhtml;$sessio nid$N24ETIUZ3QYIPQFIQMGCFFOAVCBQUIV0?xml=/news/200 3/05/04/neye04.xml&sSheet=/news/2003/05/04/ixhome. html
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.
I still have more fans than freaks. WTF is wrong with you people?
They're usually called autorefractors.
h tm
http://www.wisegeek.com/what-is-an-autorefractor.
End of Line.
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.
Human being (n.): A genetically human, genetically distinct, functioning organism.
Here's an excellent review of the Bates Method!
-h-
I got an ulcerated cornea from (hard) contact lens several years ago. It was quite painful, debilitating really, but my doctor said he'd never had anyone go blind from it. If you are in good health otherwise and get prompt treatment it isn't a very high risk.
Man, you really need that seminar!
I got a halo effect from my PRK procedure, so it's not perfect.
You can get the "area is only so big" problem with LASIK and PRK. It's know as the ablation zone, and for most lasers it is only 5 or 6mm. If you have 8mm pupils, that is bad. The doc should measure your pupil size first before deciding if you can get the surgery. If they don't measure your pupil size, just find someone else to do the work!
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.
Just because you don't prefer to use single quotes, doesn't mean he has to use double quotes... "Single or double quotation marks are used to denote either speech or a quotation. Neither style is an absolute rule though double quotes are preferred in the USA, but a publisher's or even an author's style may take precedence. The important rule is that the style of opening and closing quotes must be matched." -http://en.wikipedia.org/wiki/%22#Quotation_marks_ in_English
It took me 3 months to heal from my PRK procedure (wow, those first 3 days were hell). For the first 2 months I had a pretty bad halo. I did read that it is very important to make sure that the laser they use is capable of creating a blend zone that is within 0.5mm of your dilated pupil width or a halo problem could could occur as light enters the pupil through both the corrected and uncorrected portions of the eye. Maybe it would be possible to have a wider ablation done to correct the halo?
There's no place I can be, since I found Serenity.
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.
It must have been something you assimilated. . . .
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.