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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've had glasses since I was 11 months old, and as much as I'd like to get rid of them, getting flaps cut or 'ground down' just dont sound very appealing to me.
Your hair look like poop, Bob! - Wanker.
the flap could come loose in supersonic combat.
there's a circumsicion joke there somewhere
I thought this article was about laser-eye surgery, as opposed to laser eye surgery. Meaning I could FINALLY get surgery allowing me to shoot lasers out of my eyes. Like Superman. I've never been so disappointed in my life.
Eye-eye, sir!
If brevity is the soul of wit, then how does one explain Twitter?
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.
I got out quite a few years ago, before this was possible. My cousin however is still in, and he got the surgery done, for free. They offer it to everyone, and encourage you to do it. It makes all aspects of being a soldier - particularly an infantryman, much easier. Now you can wear off the shelf eye protection, no longer are gas masks a pain in the ass to put on, nightvision goggle, scopes, sights in a tank, are all easier to use.
I think it's a great idea, myself.
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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.
I never understood, why is it that the US have such a concentration of pilots in the Navy rather than the air force?
Because we rarely attack Canada and Mexico. Everyplace else is easier to reach by aircraft carrier.
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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"
When I was in, 10 years ago, the actual doctors (officers) were top-notch. A lot of them were reservists that had a private practice and were spending their two weeks helping out as a way to help cut the costs of college. Now...the enlisted people that you have to shuffle through to get to talk to a real doctor were another story. I had bronchitis in a bad way for three weeks before they decided the standard "cold pack" wasn't cutting it and maybe I should get to see a real physician.
"It is a miracle that curiosity survives formal education." -Albert Einstein
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 are less side effects and the results are almost always better with PRK. It also is easier to do touch ups as needed. The reason why it isn't as popular in the states is that it requires people to take a few days off so their eyes recover. I could afford a week off in countries where you can get more than 2 weeks of vacation. ;-P
Brought to you by the Vacation for everyone lobby.
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. . . .
My parents are both MDs, so I always go to them with medical questions before paying anyone for advice.
Last time I asked (I'm around -4.5 in both eyes), they were worried about the long terms of removing part of the lens in either eye. Apparently, part of the lens is also removed as a treatment for cataracts, and they had some worry that
a) Laser eye surgery could remove enough of the lens to make cataract treatment later in life difficult or impossible, and, also
b) There weren't any large scale long term (20+ yrs) studies on the rusults of the surgery.
As I said, this is secondhand... perhaps if there's a MD or a Optometrist on these boards they could comfirm/deny/just explain better?
Their explanation in both cases was the same: we really don't know the long-term effects of PRK/LASIK/LASEK. It could have side effects (triggering glaucoma, etc) that would render you near blind in 30 years. Is it really worth that risk?
So I'm sticking with glasses. For one thing, I'm over 40 and while I'm still nearsighted, normal age-related presbyopia is setting in. I can deal with it by simply removing my glasses to look at things that are up close. If I had LASIK, I'd need to carry reading glasses with me all the time, so there's not much of a win.
Not that the word 'ablate' is any more paletable than 'grind' when it's coupled with the word 'cornea.'
That depends entirely on how good your vocabulary is.
William of Ockham had no beard. The most likely explanation is that it was chewed off by squirrels every morning.
I'm not qualified to comment on the skills of Navy docs in general, but if I were going to get laser eye surgery, I'd feel pretty comfortable knowing that the doc who's going to be doing it has done literally thousands of that same procedure before, and has turned out results good enough for their patients to qualify as fighter pilots.
Just my $0.02
The commonly held belief back then was these docs (and dentists... don't get me going on this one...) were only in the military because they couldn't hack private practice.
More like because they couldn't afford medical school another way.
My experience with military docs is that they're reasonably good physicians, but that the health care system in the military lacks continuity, and that causes problems. Also, because most of the doctors leave the military after they complete their obligation, the active duty doctors all tend to be young and somewhat inexperienced. The best thing to do, if you can, is to get one of the doctors who is a reservist.
My anecdote: The Army doctors at Fort Hood nearly killed my younger sister because she had condition (pyloric stenosis) that is rare in girls, so each doctor wanted to exhaust all other possibilities first, and didn't really trust that the other doctors had done their job. In desperation because my baby sister was dying of dehydration and malnutrition, my parents eventually took her to a nearby civilian hospital, where they operated and corrected the problem within a few hours. To the Army's credit, they admitted their error and the correctness of my parents' actions, and covered the civilian medical bills.
In contrast, my parents now get all of their medical care through the nearby Air Force base hospital, which is generally staffed by a rotating group of reserve physicians who seem to be uniformly excellent doctors. The docs recognize the need for continuity of care and make heavy use of referral to local civilian docs for any condition that requires the sort of continuity they can't provide. They also try to arrange so that each patient sees the same doctor for routine physicals, etc.
Note to ACs: I usually delete AC replies without reading them. If you want to talk to me, log in.
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.
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.
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.
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.