PRK and LASIK Information

[stuckindayton]

1 hour ago, pawnman said:

Anyone run into the "you're not within 100 miles of an MTF" issue?  I'm at a GSU in a non-flying gig, ~150 miles from WPAFB.  Their surgery center told my I can't to PRK with them because I'm not within 100 miles of an MTF...even though WPAFB is my servicing MTF and where I already have to go for aircrew-specific appointments like the soft contact lens program and annual flight physicals.

Anyone have luck fighting this one?  I have family that lives about 2 miles from the hospital, so it's not like I'd get surgery then drive 100+ miles back home the same day.

This is, unfortunately, the rule for Wright-Patt.  Each refractive surgery center is allowed to determine their "catchment" area and for Wright-Patt it's apparently 100 miles.  Since PRK is not a Tricare benefit (it's considered a readiness benefit), then the normal rules don't apply.  Hence, WP might be your servicing MTF, but it's apples and oranges when it comes to refractive surgery.  Historically, they've had a clinic manager who is pretty set in her ways so chances of sweet talking them into changing their mind isn't good.  Off the top of my head, I don't have any really good work-around ideas other than paying out of pocket with a civilian.

Its really a bummer since the resources (millions of $$$$ in LASER and other equipment) are literally sitting right there and the cost to the AF to use it is minimal, but their concern is a person who is greater than 100 miles away may be less likely to show up for mandatory follow-ups.  FWIW, every AF refractive surgery center has a similar policy, but WP tends to stick by the letter of the law more rigidly than others.  Wilford Hall in San Antonio is far more liberal in treating and you might possibly be able to work out a plan with them, but the cost of travelling to SA on your dime probably isn't all that appealing.   

[pawnman]

2 hours ago, stuckindayton said:

This is, unfortunately, the rule for Wright-Patt.  Each refractive surgery center is allowed to determine their "catchment" area and for Wright-Patt it's apparently 100 miles.  Since PRK is not a Tricare benefit (it's considered a readiness benefit), then the normal rules don't apply.  Hence, WP might be your servicing MTF, but it's apples and oranges when it comes to refractive surgery.  Historically, they've had a clinic manager who is pretty set in her ways so chances of sweet talking them into changing their mind isn't good.  Off the top of my head, I don't have any really good work-around ideas other than paying out of pocket with a civilian.

Its really a bummer since the resources (millions of $$$$ in LASER and other equipment) are literally sitting right there and the cost to the AF to use it is minimal, but their concern is a person who is greater than 100 miles away may be less likely to show up for mandatory follow-ups.  FWIW, every AF refractive surgery center has a similar policy, but WP tends to stick by the letter of the law more rigidly than others.  Wilford Hall in San Antonio is far more liberal in treating and you might possibly be able to work out a plan with them, but the cost of travelling to SA on your dime probably isn't all that appealing.   

Guess I'll just wait until I PCS back to a base.

When I was close to San Antonio, the timing wasn't good.  Now that the timing is good, I'm not close to a base.  

[Yeeyee]

What happens if you got refractive surgery a few years ago, but now your vision acuity has decreased again? Can you still go to your FC1? Too many video games...

[Maxa]

Hello there, I had a question regarding with the Pre-RS Cycloplegic requirements for astigmatism under page 631 in table 3 of the AF waiver guide. It says that you must have less than or equal to 3.00 diopters for astigmatism however there is no + or - to indicate the limit unlike the other requirements for Myopia and Hyperopia. Is no sign indicating both, -, or +? Thanks.

https://www.afrl.af.mil/Portals/90/Documents/711/USAFSAM/USAF-waiver-guide-201202.pdf?ver=CfL6CVKyrAbqyXS7A-OX_A%3D%3D

[stuckindayton]

Although astigmatism is written with a sign, in reality it is a difference of two powers and thus the magnitude is important, not the sign.  It's not really a hard concept, but it's hard to explain without pictures.

Take an example where an eye needs a power of -3.00 Diopters in the vertical meridian and -1.00 Diopters in the horizontal meridian for optimal correction.  The astigmatism would be 2.00 Diopters.  There are two forms of writing this physical lens, and thus astigmatism can be written as either a positive or negative number, but it's the absolute value that is meaningful.

[Maxa]

On 12/29/2021 at 9:18 PM, stuckindayton said:

Although astigmatism is written with a sign, in reality it is a difference of two powers and thus the magnitude is important, not the sign.  It's not really a hard concept, but it's hard to explain without pictures.

Take an example where an eye needs a power of -3.00 Diopters in the vertical meridian and -1.00 Diopters in the horizontal meridian for optimal correction.  The astigmatism would be 2.00 Diopters.  There are two forms of writing this physical lens, and thus astigmatism can be written as either a positive or negative number, but it's the absolute value that is meaningful.

Oh ok this makes sense so would lets say for example -3.75 is my astigmatism in both eyes would this be considered disqualifying but waiver eligible? Or is this not enough information to tell?

[stuckindayton]

Based strictly on the 3.75 value, it is potentially waiverable (and it wouldn't be waiverable for FC I if you weren't to get refractive surgery so in this case if you want a shot, get surgery).  Looking at the most recent waiver guide that Google provided me, Table 4 of the "Refractive Surgery" chapter says you can have up to 6.00 D of astigmatism treated with refractive surgery and be POTENTIALLLY eligible for waiver for FC I.  There are lots of other factors (is your myopia/hyperopia within limits, is there any ocular pathology that may be causing 3.75 D of astigmatism, is the outcome optimal, etc), but it is POTENTIALLY waiverable.  I stress the "potentially" because this was a monumental increase from the previous limit of 3.00 D and when the change was made the understanding among the policy makers was that your post-surgery vision and refractive error would have to be stone cold normal.  The waiver guide I'm referencing is a year old so it's not most current guidance, but unless there has been a titanic change in direction, standards aren't getting more strict over time.

[Maxa]

1 hour ago, stuckindayton said:

Based strictly on the 3.75 value, it is potentially waiverable (and it wouldn't be waiverable for FC I if you weren't to get refractive surgery so in this case if you want a shot, get surgery).  Looking at the most recent waiver guide that Google provided me, Table 4 of the "Refractive Surgery" chapter says you can have up to 6.00 D of astigmatism treated with refractive surgery and be POTENTIALLLY eligible for waiver for FC I.  There are lots of other factors (is your myopia/hyperopia within limits, is there any ocular pathology that may be causing 3.75 D of astigmatism, is the outcome optimal, etc), but it is POTENTIALLY waiverable.  I stress the "potentially" because this was a monumental increase from the previous limit of 3.00 D and when the change was made the understanding among the policy makers was that your post-surgery vision and refractive error would have to be stone cold normal.  The waiver guide I'm referencing is a year old so it's not most current guidance, but unless there has been a titanic change in direction, standards aren't getting more strict over time.

Ok thank you, I know for a fact that they could potentially give it to me as long I have a good outcome of this surgery. The doctor has stated that I could be having up to 3.00 D of astigmatism. They eye doc has also stated that I have amblyopia and exotropia although this is barely noticeable and insignificant to affect vision and is correctable. They most likely will have to look at it again. I looked through the waiver and there are mentions of both of these but they didn't state anymore about this according to me, but maybe I'm not reading enough. Are both of these grounds for disqualification or does this depend on their evaluation with them? 

Edited December 31, 2021 by Maxa

[stuckindayton]

Sorry to potentially state the obvious, but.  amblyopia means you have a "lazy" eye.  It can mean an eye turn (which would also be labeled as an exotropia), but more correctly it means an eye that can't correct to 20/20.  Either an eye turn or not correctable are show stoppers for a pilot slot.

[Maxa]

4 minutes ago, stuckindayton said:

Sorry to potentially state the obvious, but.  amblyopia means you have a "lazy" eye.  It can mean an eye turn (which would also be labeled as an exotropia), but more correctly it means an eye that can't correct to 20/20.  Either an eye turn or not correctable are show stoppers for a pilot slot.

Ok that makes sense I had other doctors say that I have no amblyopia or exotropia so this is why they are checking again. I must also ask is there any grounds for DQ for exophoria? 

[stuckindayton]

Yes, but it's not real common.  Having an exophoria is normal, having an extremely large exophoria is a problem.

[Maxa]

2 hours ago, stuckindayton said:

Yes, but it's not real common.  Having an exophoria is normal, having an extremely large exophoria is a problem

What would be considered normal for exophoria? 

[stuckindayton]

15 minutes ago, Maxa said:

What would be considered normal for exophoria? 

10 exophoria is the standard, but there are some waivers available for people who exceed this.  There is not a set limit for what is waiverable.  It depends on a number of factors that are determined when the exam is done.