PRK and LASIK Information

[Guest goducks]

Look more closely at the two procedures and what your doctor recommends. I just had Wavefront PRK in August and couldn't be happier. I know LASIK is fine for pilots, but I was told by my doc a lot of doctors prefer PRK due to less side effects, no flap, etc.

The general concensus among military docs (and I think that civilian docs would agree as well) is that PRK is a safer procedure for eyes up to about -2.00 D of myopia. With PRK there are no flap concerns and optically the outcome may be better than LASIK. From -2.00 to -4.00 either PRK or LASIK may be appropriate and above -4.00 LASIK becomes the preferred choice for two reasons: 1) There is more risk of significant haze when performing PRK on eyes with higher myopia and 2) PRK becomes less predictable above -4.00.

Having said that, you may have a very good outcome with LASIK on a lower myope and PRK on a higher myope. It's just that the risk/reward balance shifts based on where your eyes are starting.

[Guest r6pilot]

I had LASIK done almost six years ago and had zero problems. With that being said, many people have told me the big differences were [a] LASIK is a little more risky, but your vision is excellent and usable the very next day whereas PRK is less intrusive but takes much longer for the healing process, but ends with better results many times due to no flap and a slower healing process.

Good luck with whatever you choose. You'll be very glad you did it.

[JoeNJ]

The key with laser eye surgery is post-op. Be religious with the steroid and antibiotic drops and whatever else your doctor gives you. I'm speaking from the PRK side, I don't know what you get post LASIK.

[Guest P27:17]

The key with laser eye surgery is post-op. Be religious with the steroid and antibiotic drops and whatever else your doctor gives you. I'm speaking from the PRK side, I don't know what you get post LASIK.

Great advice...and I would add to make sure you get all of your post op evaluations done and documented...Brooks is very specific and hardlined on having the proper pre/post op medical records before you see them!

[Guest amlamarra]

Thanks for all the information, goducks. I think my eyes were -3.25 before the surgery so that eases my fears a little bit. Now I just gotta hope they documented everything correctly.

[Guest goducks]

Thanks for all the information, goducks. I think my eyes were -3.25 before the surgery so that eases my fears a little bit. Now I just gotta hope they documented everything correctly.

You should be fine as you're not close to any limits. As long as everything turned out OK, shouldn't be anything to worry about.

[Hot Dogs!]

I'm back with another question. I just got back from my LASIK consultation appointment and am scheduled for surgery on March 5th, unless anything opens up sooner (but no sooner than January 15th). Since the application cut-off date is 13-Mar-09, this means there no chance of me applying to the 09-03 board since I need the three month waiver after surgery to apply. If the board doesn't convene until 13-Apr-09, would there still be a chance of me being able to send my application in for the 13-Mar cut-off without the waiver, and getting the three month waiver taken care of and sent in by the board convening date or is that looked down upon?

Sorry for the confusing question, but I'm just curious if there's even a possibility of getting my application in for the 09-03 board, or if I should just slow down and wait for the 10-01 board so I can be sure to get it right. My opinion is that I should probably wait for the 10-01 board and make sure I get this right since I'm not age critical, I just don't want to wait an extra six months since I just moved back home after my lease ran out, thinking I would be off to OTS in the next month or two.

Edited December 19, 2008 by MikeI

[Guest amlamarra]

I'm back with another question. I just got back from my LASIK consultation appointment and am scheduled for surgery on March 5th, unless anything opens up sooner (but no sooner than January 15th). Since the application cut-off date is 13-Mar-09, this means there no chance of me applying to the 09-03 board since I need the three month waiver after surgery to apply. If the board doesn't convene until 13-Apr-09, would there still be a chance of me being able to send my application in for the 13-Mar cut-off without the waiver, and getting the three month waiver taken care of and sent in by the board convening date or is that looked down upon?

Sorry for the confusing question, but I'm just curious if there's even a possibility of getting my application in for the 09-03 board, or if I should just slow down and wait for the 10-01 board so I can be sure to get it right. My opinion is that I should probably wait for the 10-01 board and make sure I get this right since I'm not age critical, I just don't want to wait an extra six months since I just moved back home after my lease ran out, thinking I would be off to OTS in the next month or two.

Sounds to me like you'll have to apply to the 10-01 board. But don't take my word for it. At least then you'll have more time to make your package better. Retake exams, get more volunteer hours, etc.

[Hot Dogs!]

I'm back again with one more question. Surgery is scheduled for a week and half from now and I was looking back through the waiver guide and I thought of something. It says one of the required pieces of information for the waiver is the "pre-op cycloplegic refraction", which - if I'm not mistaken - is the refraction after having the eye drops to dilate your eyes. When I went in for the consultation appointment, they did do a refraction test after giving me eye drops, but they didn't affect my vision nearly as much as the ones that I had during my FC1 (as in, I could still see and read, even just a few hours after the drops), which makes me think it wasn't the exact same way they did it during the FC1. I would imagine that the dilation test I had done at the consultation would qualify as the pre-op cycloplegic refraction, but if it doesn't for some reason, would the refraction test I had done at my FC1 back in September count as a pre-op test?

Thanks for any help. I just wanted to make sure I'm crossing all the t's and dotting the i's, so this is the last time I have to do all this.

[Guest goducks]

I'm back again with one more question. Surgery is scheduled for a week and half from now and I was looking back through the waiver guide and I thought of something. It says one of the required pieces of information for the waiver is the "pre-op cycloplegic refraction", which - if I'm not mistaken - is the refraction after having the eye drops to dilate your eyes. When I went in for the consultation appointment, they did do a refraction test after giving me eye drops, but they didn't affect my vision nearly as much as the ones that I had during my FC1 (as in, I could still see and read, even just a few hours after the drops), which makes me think it wasn't the exact same way they did it during the FC1. I would imagine that the dilation test I had done at the consultation would qualify as the pre-op cycloplegic refraction, but if it doesn't for some reason, would the refraction test I had done at my FC1 back in September count as a pre-op test?

Thanks for any help. I just wanted to make sure I'm crossing all the t's and dotting the i's, so this is the last time I have to do all this.

Mike,

Shouldn't matter. You're right, they probably used a weaker dilating agent at the surgical center. FCI uses 2 drops of Cyclopentolate, while the "standard" dilation using either Tropicamide or Phenylephrine (or both). The latter do not knock out the focusing system nearly as much or nearly as long as Cyclo.

Bottom line is that you've had a documented pre-op cycloplegic refraction and you're not near any limits so it's not significant. If you were close to -8.00, then the specifics become important. In your case, it's just a matter of filling the boxes.

I don't want to imply that nothing can go wrong, but keep in mind that hundreds of UPT applicants/students are coming in after refractive surgery so this is somewhat routine today. It wasn't that way 8 years ago when the program started, but things have changed and the rules have been relaxed regarding how much pre-op refractive error is allowed. As long as you don't have a major complication you should be fine.

I should also note that since you are over -5.50 (which was the old pre-op limit), they are very specific about any retinal pathology. Higher levels of nearsightedness are associated with a greater incidence of retinal problems in the form of tears and detachments. Current policy is that anyone whose pre-op Rx was over -5.50 must have no evidence of retinal pathology, including lattice degeneration. Chances are you don't, but just wanted to make sure you were aware and you may want to ask the docs if they saw anything.

Good luck.

GD

[Bayou_Eagle_Driver]

GD -

Amazing information, and hopefully very re-assuring.

I'm going in for Wavefront-Guided LASIK tomorrow, and my Cyclo Refraction (Pre-Op) is -8.00 Diopters (@ the limit) and my Astigmatism is also at the limit of 3.00 Diopters.

Hopefully everything will go fine, and I'll be able to get a waiver. (Fingers crossed)

[Guest theHUNTED]

I'm scheduled to have lasik done at TLC. I talked to my local recruiter and he said do not get it done because it will disqualify me from being able to fly. His reasoning was that the procedure needs to be done by an AF Doc. I know this has been discussed here in this thread that it matters not where I get the surgery done; however, is there written documentation of this somewhere that I can access so that the recruiter won't be so scared? Just curious.

[Guest SCtrojan]

I'm scheduled to have lasik done at TLC. I talked to my local recruiter and he said do not get it done because it will disqualify me from being able to fly. His reasoning was that the procedure needs to be done by an AF Doc. I know this has been discussed here in this thread that it matters not where I get the surgery done; however, is there written documentation of this somewhere that I can access so that the recruiter won't be so scared? Just curious.

Air Force Waiver Guide

https://aviationmedicine.com/resources/file...Guide%20PDF.pdf

p. 439 Refrative Surgery

"Non-active duty pilot applicants (civilians, ROTC) must

pursue RS at their own expense and follow-up by civilian providers. They will be evaluated at the

ACS at the time of medical flight screening (MFS) to determine if they meet waiver criteria."

[Bayou_Eagle_Driver]

Talk about pushing the envelope!

I'm 1 week post-surgery - I have 20/15 in right eye, 20/20 in the left - over all 20/15.

As you noticed, pre-op I was exactly at the limits for Cyclo refraction. Any idea what my chances are of being granted a waiver at Brooks now that I think my visions has been corrected significantly?

Also - does anyone have a list of the vision tests they do at brooks? I know there is a standard battery of tests, and then some additional testing if you're looking for a RF waiver. I remember seeing some of the tests on this forum, but I can't seem to find them.

Thanks,

LS

Edited March 7, 2009 by Sinnerman

[Guest goducks]

I'm 1 week post-surgery - I have 20/15 in right eye, 20/20 in the left - over all 20/15.

As you noticed, pre-op I was exactly at the limits for Cyclo refraction. Any idea what my chances are of being granted a waiver at Brooks now that I think my visions has been corrected significantly?

Also - does anyone have a list of the vision tests they do at brooks? I know there is a standard battery of tests, and then some additional testing if you're looking for a RF waiver. I remember seeing some of the tests on this forum, but I can't seem to find them.

Thanks,

LS

LS,

Everybody gets a standard ophthalmic evaluation consisting of visual acuity, intraocular pressure, color vision, phorias, ocular motility, depth perception, corneal topography, cycloplegic refraction and visual inspection of the entire eye using microscopes to rule out any pathology. I probably missed something, but you get the idea. If it's in AFI 48-123 then it's probably tested.

The battery for RS waivers depends on what type of surgery you had and whether there are any apparent complications, but can include any or all of the following: high and low contrast acuity, contrast sensitivity, and glare testing (ie. visual function under glare conditions). There are more than 4 tests, but those are the basic visual skills being assessed.

If you met all of the pre-RS requirements, had a successful RS outcome and your eyes are otherwise normal and healthy, you should get a waiver. As far as the surgical outcome goes, it is only in cases where there is a complication which results in functional vision loss that a recommendation is made against an RS waiver. This is relatively uncommon with today's laser technology, but obvious still happens occassionally.

While I've got my keyboard warm, I wanted to make sure that you understood how refractive errors are qualified per USAF RS policy. You said your cyclo refraction was at -8.00 D and your astigmatism was at 3.00 D. Depending on whether your Rx was written in plus or minus cylinder this could mean your overall Rx was -8.00 D (meets policy requirements) or -11.00 D (exceeds policy requirements) Do you know which it is?

GD

[Bayou_Eagle_Driver]

While I've got my keyboard warm, I wanted to make sure that you understood how refractive errors are qualified per USAF RS policy. You said your cyclo refraction was at -8.00 D and your astigmatism was at 3.00 D. Depending on whether your Rx was written in plus or minus cylinder this could mean your overall Rx was -8.00 D (meets policy requirements) or -11.00 D (exceeds policy requirements) Do you know which it is?

GD

GD -

You sure are a huge help, if nothing more than a reassurance.

As for my Rx, I believe it was written in minus cylinder. I could be wrong, but my eye surgeon and eye doctor (both airforce affiliated) went over the waiver regs and said I was just within limit.

EDIT: Here are my Rx Specifics:

Cycloplegic Refraction: OD -8.00 + 3.00 x 85

OS -8.00 + 2.75 x 100

Manifest Refraction: OD -8.50 + 3.00 x 85

OS -8.50 + 2.50 x 100

However, my dry refraction was a bit higher than my cyclo, something like -8.50 D - do you think this will come into play at all?

Thanks again for all your knowledge.

`LS

Edited March 7, 2009 by Sinnerman

[Guest goducks]

GD -

You sure are a huge help, if nothing more than a reassurance.

As for my Rx, I believe it was written in minus cylinder. I could be wrong, but my eye surgeon and eye doctor (both airforce affiliated) went over the waiver regs and said I was just within limit.

EDIT: Here are my Rx Specifics:

Cycloplegic Refraction: OD -8.00 + 3.00 x 85

OS -8.00 + 2.75 x 100

Manifest Refraction: OD -8.50 + 3.00 x 85

OS -8.50 + 2.50 x 100

However, my dry refraction was a bit higher than my cyclo, something like -8.50 D - do you think this will come into play at all?

Thanks again for all your knowledge.

`LS

LS,

Cycloplegic is all that counts. Based on what you have posted, you are indeed right at the limit.

BTW- for reference, the Rx is written in plus cylinder (second number is positive).

Good luck.

GD

[Guest Jayrome]

Hey everyone! This is my first post on the baseops forum but I'm a frequent reader. I'm trying to get a AFR Airlift Pilot Slot but my vision is way over the limit:

R: -4.25 s +0.75 cx 123

L: -4.00 s +.075 cx 076

I know Lasik is my only option and I know about the 12 month waiting period. I recently had a Lasik consultation visit and the Doctors said I would be a prime candidate for SBK (Sub-Bowman's Keratomelieusis) aka IntraLASIK or "All-Laser" LASIK surgery. I've done a search but I couldn't find anything on this type of surgery. Is this type of Lasik surgery also approved by the AF?

[Guest goducks]

Hey everyone! This is my first post on the baseops forum but I'm a frequent reader. I'm trying to get a AFR Airlift Pilot Slot but my vision is way over the limit:

R: -4.25 s +0.75 cx 123

L: -4.00 s +.075 cx 076

I know Lasik is my only option and I know about the 12 month waiting period. I recently had a Lasik consultation visit and the Doctors said I would be a prime candidate for SBK (Sub-Bowman's Keratomelieusis) aka IntraLASIK or "All-Laser" LASIK surgery. I've done a search but I couldn't find anything on this type of surgery. Is this type of Lasik surgery also approved by the AF?

Jayrome,

SBK is essentially the same as Intralase or IntraLASIK, just using a thinner flap. It is approved by the USAF. From the CRS policy:

1.9. For the purpose of this policy, RS includes......

1.9.2.3. Technological advances of the basic LASIK procedure, such as femptosecond technology "all laser LASIK"

GD

[Guest Jayrome]

Jayrome,

SBK is essentially the same as Intralase or IntraLASIK, just using a thinner flap. It is approved by the USAF. From the CRS policy:

1.9. For the purpose of this policy, RS includes......

1.9.2.3. Technological advances of the basic LASIK procedure, such as femptosecond technology "all laser LASIK"

GD

Thanks for the reply goducks, I wanted to be absolutely sure! I have the surgery scheduled for next month. Now I'm keeping my fingers crossed hoping that the AF shortens the 12 month waiting period.

[Guest goducks]

Thanks for the reply goducks, I wanted to be absolutely sure! I have the surgery scheduled for next month. Now I'm keeping my fingers crossed hoping that the AF shortens the 12 month waiting period.

I have zero inside knowledge on policy changes, but I would be surprised if the waiting time was changed. Here's why. Corneal haze can first appear months after PRK. The 12 month wait was put in place to ensure that no surprises would occur after the FCI/MFS evaluation. LASIK does not have the same issues with corneal haze, although it can take up to 3 months for eyes to fully stabilize after LASIK. It is my interpretation that although one could argue it's not necessary to wait a full 12 months after LASIK, the AF did not want to have a shorter waiting period for LASIK versus PRK . That might influence people to get LASIK based on this factor alone, which may not always be the best medical choice. LASIK is a little more risky than PRK (IMHO), especially since we still don't know what's going to happen when someone who is post LASIK ejects from a fast jet or is exposed to rapid decompression conditions. I believe, the AF wants people to choose the most appropriate treatment based on their particular situation.

This is obviously just my opinion based on what I've seen and heard.

GD

[Guest Jayrome]

I have zero inside knowledge on policy changes, but I would be surprised if the waiting time was changed. Here's why. Corneal haze can first appear months after PRK. The 12 month wait was put in place to ensure that no surprises would occur after the FCI/MFS evaluation. LASIK does not have the same issues with corneal haze, although it can take up to 3 months for eyes to fully stabilize after LASIK. It is my interpretation that although one could argue it's not necessary to wait a full 12 months after LASIK, the AF did not want to have a shorter waiting period for LASIK versus PRK . That might influence people to get LASIK based on this factor alone, which may not always be the best medical choice. LASIK is a little more risky than PRK (IMHO), especially since we still don't know what's going to happen when someone who is post LASIK ejects from a fast jet or is exposed to rapid decompression conditions. I believe, the AF wants people to choose the most appropriate treatment based on their particular situation.

This is obviously just my opinion based on what I've seen and heard.

GD

Oh ok, well that makes sense. SBK LASIK is a better choice for me since I'm 23 and my eyes are still too young for LASIK surgery and I have irregularly shaped corneas because of my astigmatism. SBK doesn't disrupt as much tissue in the cornea, which is believed to contribute to a lower incidence of surgery induced dry eye and provides added stability for thinner corneas.

It seems to me that since less tissue is disturbed, your eyes would less susceptible to injuries due to extreme forces. If that's not the case, than I guess it's good that I'm only looking at airlift squadrons.

[Guest goducks]

Oh ok, well that makes sense. SBK LASIK is a better choice for me since I'm 23 and my eyes are still too young for LASIK surgery and I have irregularly shaped corneas because of my astigmatism. SBK doesn't disrupt as much tissue in the cornea, which is believed to contribute to a lower incidence of surgery induced dry eye and provides added stability for thinner corneas.

It seems to me that since less tissue is disturbed, your eyes would less susceptible to injuries due to extreme forces. If that's not the case, than I guess it's good that I'm only looking at airlift squadrons.

Jayrome,

For clarification, no airframe restrictions are made for people having LASIK or one of its variants. There was a period of time where there was a restriction, but that was dropped with the latest policy change (May, 2007). I'm just pointing out that the USAF may not want to be encouraging people to have LASIK when it may not be the best medical choice. In your case, LASIK or SBK may be the best choice without regard for other factors.

GD

[Bayou_Eagle_Driver]

Goducks -

I've got another couple questions for you, thanks again for all the information you've provided up until this point!

I just got done with my 1-month post-op checkup, and it looks like a bit of astigmatism has crept back after surgery. Here's my latest RX, for BVAC

Overall vision - 20/20

R) +.50 - 1.25 x 005

L) +.75 - .75 x 175

First off - if I've done my reading correctly, this is still within all limits correct? I thought I read the astigmatism limit was +/- 1.50

Secondly, this is my RX for my best acuity, I can read the 20/20 line with no correction. How does brooks work? Do they find your BVAC or just test you at 20/20?

Thanks. I hope my eyes stabilize and I don't need to go in for an "enhancement" - do you have any information about candidates who have had multiple RF Procedures? I would think they would be very wary to take a candidate who went under the knife more than once.

Over all, vision is such a frustrating aspect of this process, I have *zero* control over how my eyes heal, it's just luck of the draw.

Thanks again for all your help.

LS

[Guest goducks]

Goducks -

I've got another couple questions for you, thanks again for all the information you've provided up until this point!

I just got done with my 1-month post-op checkup, and it looks like a bit of astigmatism has crept back after surgery. Here's my latest RX, for BVAC

Overall vision - 20/20

R) +.50 - 1.25 x 005

L) +.75 - .75 x 175

First off - if I've done my reading correctly, this is still within all limits correct? I thought I read the astigmatism limit was +/- 1.50

Secondly, this is my RX for my best acuity, I can read the 20/20 line with no correction. How does brooks work? Do they find your BVAC or just test you at 20/20?

Thanks. I hope my eyes stabilize and I don't need to go in for an "enhancement" - do you have any information about candidates who have had multiple RF Procedures? I would think they would be very wary to take a candidate who went under the knife more than once.

Over all, vision is such a frustrating aspect of this process, I have *zero* control over how my eyes heal, it's just luck of the draw.

Thanks again for all your help.

LS

LS

You would still meet all refractive standards with your as your Rx currently stands. There are no special standards that apply to people post-CRS; you have to meet the same ones everybody else does. The standard for astigmatism is 1.50 D, but waiverable up to 3.00 D.

There is nothing in the policy that talks about enhancements and I don't think that requiring multiple procedures would play into waiver consideration as long as everything turns out OK and you are 1 year past the last procedure. Having said that, most docs won't touch an eye until at least 6 months post surgery as changes may still be occurring.

Residual astigmatism is common after any refractive procedure and it typically goes away with time. Given where you started, I think your outcome to this point is very good. Just give it a little more time.

Something else to think about is that if you have an enhancement, your post-CRS refractive error becomes your pre-CRS refractive error for the second surgery. As it stands now, you would not meet policy for waiverability as you are over the +0.50 D limit. So be very careful about another procedure.

GD

Edited March 31, 2009 by goducks