PRK and LASIK Information

[Guest goducks]

Once again GD - your insights and information are great! I check this forum often for any questions you answer.

RE: The above topic (Night vision), do you think a SLIGHT SLIGHT ghosting at night following WFG LASIK (if i squint it goes away, and it's not present under certain lighting conditions....mostly when there's a SINGLE illuminated point in a dark area.) would be of any concern for someone going through brooks?

I function fine at night, and fly regularly at night.

Thanks

`LS

Quality of vision under dimly illuminated conditions is certainly part of the battery that is used at Brooks so it's hard for me to say whether it is a concern, per se, but it will definitely be evaluated. However, generally speaking, it is rare to be DQ'd due to refractive surgery in the absence of some notable complication.

Without going into too much detail, the intent of the testing at Brooks is to identify those who have normal visual function from those that do not. All of the visual tasks are calibrated so that a normal, healthy person can successfully complete them. While they are difficult, the expectations are very reasonable.

GD

[tlr9489]

The important question with the right eye is whether the blurred vision is a result of residual refractive correction (i.e. can be corrected with glasses) or some other factor such as corneal scar tissue or abnormal healing. Ask the doc which it is at your next visit. Needing a little lens correction is no big deal. If there is some scarring, then it's more serious and potentially problematic for waiverability.

USAF vision and refractive standards for post-PRK are generally no different than if you never had surgery. You can be up to 20/70 (or -1.50 D nearsighted) and be within standards as long as it's correctable to 20/20.

Keep in mind that there is a mandatory 1 year wait period after surgery before you can complete your MFS evaluation. If you elected to have the right eye retreated to tweak the Rx, the clock would be reset. If you have some scar tissue that requires the epithelium to be scraped off, I BELIEVE the clock would be reset as well, although I'm not 100% sure about that.

I would advise you to discuss your concerns with the doc. If there is an issue that goes beyond needing some lens correction, it will be identified at the MFS eval and may potentially jeopardize your waiverability. If something needs to be addressed, now is the time to get it done.

GD

I had my 6-month post-PRK this morning, and had 20/20 lt, 20/20 rt, and 20/15 both. Doc said that the reason that my right eye feels different is because he corrected at -0.25 in the right eye, so that I could "see the dashboard when I am 40" -not too sure what this means exactly. He said he only corrects professional baseball players at +0.25 in both eyes. My left eye is +0.25. Also, the drying and blurry night vision were attributed to my plugs being expired at 6-months, so he put new ones in and said everything looks great, and should continue to improve.

Thanks, again.

[Guest goducks]

I had my 6-month post-PRK this morning, and had 20/20 lt, 20/20 rt, and 20/15 both. Doc said that the reason that my right eye feels different is because he corrected at -0.25 in the right eye, so that I could "see the dashboard when I am 40" -not too sure what this means exactly. He said he only corrects professional baseball players at +0.25 in both eyes. My left eye is +0.25. Also, the drying and blurry night vision were attributed to my plugs being expired at 6-months, so he put new ones in and said everything looks great, and should continue to improve.

Thanks, again.

I think your doc is splitting hairs. He's basically telling you that your right eye ended up a little bit undercorrected. -0.25 is the least amount we can measure so it isn't much, but the technology (and the healing of human tissue) isn't so precise that a surgeon can pick a target and hit it every time. It's about like leaving a 20 foot putt 6 inches short. It happens, but isn't necessarily a bad outcome.

Sounds like you're in good shape.

GD

Edited May 22, 2009 by goducks

[Guest jbino17]

I've been looking up information on the USAF Refractive Surgery Program and haven't seen any specific answers to a few questions I have:

Background: I was given a Nav slot to start with because of 20/100 vis acuity and then DQ'ed after(DQ'ed for depth perception issues).

Anyways, I am going to try again from the active duty side after getting surgery and doing eye therapy (for the DP), but I was wondering if you are allowed to get surgery done by a civilian doctor while on AD without getting approval from the AF first? As in, can you just go get it done and show up with good eyes one day?

I've read that if you aren't given "permission to proceed" on the AF side (for the Warfighter program) then you aren't allowed to pursue surgery by military OR civilian. This kind of makes sense since the AF owns you, but on the very off chance the AF denied me, am I completely out of the game?

Lastly, does anyone know the waiting time for the current warfighter RS program? Thanks!

-J

[Guest goducks]

I've been looking up information on the USAF Refractive Surgery Program and haven't seen any specific answers to a few questions I have:

Background: I was given a Nav slot to start with because of 20/100 vis acuity and then DQ'ed after(DQ'ed for depth perception issues).

Anyways, I am going to try again from the active duty side after getting surgery and doing eye therapy (for the DP), but I was wondering if you are allowed to get surgery done by a civilian doctor while on AD without getting approval from the AF first? As in, can you just go get it done and show up with good eyes one day?

I've read that if you aren't given "permission to proceed" on the AF side (for the Warfighter program) then you aren't allowed to pursue surgery by military OR civilian. This kind of makes sense since the AF owns you, but on the very off chance the AF denied me, am I completely out of the game?

Lastly, does anyone know the waiting time for the current warfighter RS program? Thanks!

-J

jbino,

Even as a Warfighter (ie. non-aircrew) you still must get permission to proceed. If get surgery from the USAF, it basically entails having your commander authorize it, then getting approved for treatment from your USAF surgical center of choice. If you go civilian, it's more complicated as you now have to not only get your commander and USAF medical folks to approve it, but you also have to get your MTF commander (or his representative) to "counsel" you on the potential risks of complications and the impact they might have on your USAF career. If you aren't given approval to proceed, then you aren't supposed to seek treatment. More info can be found at the USAF refractive surgery website:

https://airforcemedicine.afms.mil/idc/group...name=CTB_070655

or Google "USAF refractive surgery"

Last I heard the waiting time is variable between the centers. Wilford-Hall in San Antonio rarely has much of a wait beyond a few weeks. Don't know much about the others- Wright-Patt, Keesler, USAFA, and Travis.

Hope that helps.

GD

[Guest jbino17]

goducks,

Do you know of anything that says if you're DQ'ed from an FC1A physical that you can't get surgery (PRK or LASIK) and reapply for pilot and pass an FC1 physical?

[Guest goducks]

goducks,

Do you know of anything that says if you're DQ'ed from an FC1A physical that you can't get surgery (PRK or LASIK) and reapply for pilot and pass an FC1 physical?

I don't believe any such rule exists. Many people have been DQ'd from FCI, gotten the issue fixed, and re-applied successfully. The bigger issue is that you have to re-apply for a slot and that's problematic for some people.

[Bayou_Eagle_Driver]

................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.

Just an update for everyone on this subject. The Pre-Surgery Hyperopia (Farsightedness) limits have been up'd as of Oct 2009 from

Less than or equal to +0.50

to

Less than or equal to +3.00

Not sure if this has been posted yet. This information is available from the Oct2009 Waiver Guide which I have attached.

Also - here's a great statistic from the new Waiver Guide:

"AIMWTS review in Sep 2009 revealed 1712 total cases with a waiver disposition.

There were 412 FC I/IA cases, 687 FC II cases and 612 FC III cases and one case labeled “UAS”.

Within the FC I/IA group, 163 later had a disposition for FC II which is not reflected in the FC II total above.

There were a total of 80 disqualifications; 25 were FC I/IA, 20 were FC II, and there were 35 in the FC III category.

There was also one FC I case that was granted an ETP.

Within the population of those disqualified, about 60% were for vision-related problems, excessive presurgical refractive error, or side effects from the procedure such as haze, and the remainder were disqualified for other medical conditions or administrative issues."

[Guest Jayrome]

Hey guys, I'm a long time follower of this topic. I'm at the 6-month mark with my SBK-Lasik and my vision is a little better than 20/20. I'm a civilian looking for a pilot slot in the Reserves. I've looked all over this forum but I couldn't find the exact process of obtaining a vision waiver. I know I have to wait 12 months but where do I go and who do I get it from? I want to this the most time effective way possible. Sorry in advance if this was answered already.

[Bayou_Eagle_Driver]

Get sponsored by a AFRC unit. After that, they hand you off to the Officer Recruiter, who gets your paperwork in order and gets you a date with Brooks. Once you get to brooks, you will start the waiver process.

Focus on getting sponsored/hired by a unit first.

[Guest Jayrome]

Get sponsored by a AFRC unit. After that, they hand you off to the Officer Recruiter, who gets your paperwork in order and gets you a date with Brooks. Once you get to brooks, you will start the waiver process.

Focus on getting sponsored/hired by a unit first.

Ok, thanks for the advice. I just wanted to make sure that this wasn't something I needed to do on my own.

[Guest ZEvans]

I am new to this thread and have read most of it closely looking for answers to my questions. Here is my situation:

I am in AFROTC. When I received my scholarship I was Potentially Pilot Qualified through DoDMERB. So, I guess I was better then 20/70. Problem is that was three years ago and now I believe that my eyesight has gotten a little worse. Early next year (Feruary 2009) I am categorizing for my pilot slot. Since I am cleared by DoDMERB I know that I am cleared and good to go. Problem is that I am deathly afraid of going to Brooks later on down the road and being DQed for having vision that is a little worse than 20/70.

At this point it is to late for me to get Lasik surgery before I categorize since I found out that you have to be three months into the Checklist before the categorization package deadline. So here are my questions:

Can I get the surgery after I get my pilot slot (hypothetical situation), then wait one year, get my waiver and then go to Brooks? I have read that I need to get my FC I one year after being selected for pilot or before commissioning, whichever one comes first. So, will I have enough time to get the surgery in March, wait one year and then go to Brooks? My commissioning date is June 2011.

If I were to choose not to get the surgery: How strict is the 20/70 mark at the FC I physical. Can I get a waiver if my vision is a little bit worse then that mark especially since it was once recently under that mark? Right now I am -1.25 in one eye and -1.75 in the other. Would I be automatically disqualified would I have an option for a waiver?

Thank you so much for the help. I am sweating bullets here and finding information is extremely hard.

[Guest goducks]

I am new to this thread and have read most of it closely looking for answers to my questions. Here is my situation:

I am in AFROTC. When I received my scholarship I was Potentially Pilot Qualified through DoDMERB. So, I guess I was better then 20/70. Problem is that was three years ago and now I believe that my eyesight has gotten a little worse. Early next year (Feruary 2009) I am categorizing for my pilot slot. Since I am cleared by DoDMERB I know that I am cleared and good to go. Problem is that I am deathly afraid of going to Brooks later on down the road and being DQed for having vision that is a little worse than 20/70.

At this point it is to late for me to get Lasik surgery before I categorize since I found out that you have to be three months into the Checklist before the categorization package deadline. So here are my questions:

Can I get the surgery after I get my pilot slot (hypothetical situation), then wait one year, get my waiver and then go to Brooks? I have read that I need to get my FC I one year after being selected for pilot or before commissioning, whichever one comes first. So, will I have enough time to get the surgery in March, wait one year and then go to Brooks? My commissioning date is June 2011.

If I were to choose not to get the surgery: How strict is the 20/70 mark at the FC I physical. Can I get a waiver if my vision is a little bit worse then that mark especially since it was once recently under that mark? Right now I am -1.25 in one eye and -1.75 in the other. Would I be automatically disqualified would I have an option for a waiver?

Thank you so much for the help. I am sweating bullets here and finding information is extremely hard.

Look at the first pinned thread in Aviation Medicine and you'll find more information than you ever wanted to know about vision standards and waiver limits. Here are some links:

Bottom line is that you're in good shape. You don't need LASIK.

GD

Edited December 18, 2009 by goducks

[Chump]

I am new to this thread and have read most of it closely looking for answers to my questions. Here is my situation:

I am in AFROTC. When I received my scholarship I was Potentially Pilot Qualified through DoDMERB. So, I guess I was better then 20/70. Problem is that was three years ago and now I believe that my eyesight has gotten a little worse. Early next year (Feruary 2009) I am categorizing for my pilot slot. Since I am cleared by DoDMERB I know that I am cleared and good to go. Problem is that I am deathly afraid of going to Brooks later on down the road and being DQed for having vision that is a little worse than 20/70.

At this point it is to late for me to get Lasik surgery before I categorize since I found out that you have to be three months into the Checklist before the categorization package deadline. So here are my questions:

Can I get the surgery after I get my pilot slot (hypothetical situation), then wait one year, get my waiver and then go to Brooks? I have read that I need to get my FC I one year after being selected for pilot or before commissioning, whichever one comes first. So, will I have enough time to get the surgery in March, wait one year and then go to Brooks? My commissioning date is June 2011.

If I were to choose not to get the surgery: How strict is the 20/70 mark at the FC I physical. Can I get a waiver if my vision is a little bit worse then that mark especially since it was once recently under that mark? Right now I am -1.25 in one eye and -1.75 in the other. Would I be automatically disqualified would I have an option for a waiver?

Thank you so much for the help. I am sweating bullets here and finding information is extremely hard.

I just went through brooks early November, and was in the same situation with my eyes... i was 20/70 in my left and 20/100 in my right, as long as you are 20/200 or better you have nothing to worry about its a simple waiver that goes through AETC. Good Luck

Edited December 18, 2009 by Chump

[Guest goducks]

Quick question. So regarding all the pre and post-op information that Brooks will need later, is this something I'll need to ask the doctor for or are patients usually provided with written information automatically?

Also, does the following seem to be within the limits?

OD -2.50 -0.50 35

OS -3.25 -0.50 135

Thanks!

You will likely need to request your records from the doc. Specifically what the AF needs to see is pre-op cycloplegic refractive error, surgical record and post-surgical follow up notes.

You are within the limits for PRK or LASIK and you likely wouldn't qualify for a vision/refractive error waiver without getting refractive surgery.

GD

[Guest goducks]

Having a hard time deciding between PRK and LASIK. Interesting to see that even though LASIK is allowed, most people on here seem to still be opting for PRK.

Some of this may simply be an historical holdover from the time that PRK was the only approved procedure, however, there are also some arguments that PRK may be a better choice when you're talking about an elective procedure that can make or break your career choice.

PRK is a safer procedure in terms of things that can go wrong that cannot be fixed. Significant haze is the only realistic complication and that can nearly always be managed with steroid drops, or worst case, with an epithelium scrape and Mitomycin C. With LASIK, there are lots of complications associated with making the flap- too thin, folds in the flap, inflammation under the flap (DLK), having the flap dislocate due to trauma at a later time. Many of these issues may ultimately be addressed with the femtosecond laser (e.g. Intralase), however, I would guess that most refractive surgeons are still using the handheld micro-keratome.

Another subtle difference is the phenomenon of inducing high order aberrations. All refractive procedures cause this, hence the progression to wavefront guided techniques that attempt to correct some of the aberrations already present in the system. These procedures still induce aberrations, but the net increase is reduced. While I don't have the data available for comparison, it only makes sense that the less invasive a procedure is, the fewer aberrations are going to get induced. PRK is definitely less invasive.

Finally, there is the issue of what is called "corneal melt." This refers to treating an eye is is prone to a degenerative condition in the first place and accelerating the degeneration. Usually, this can be avoided by doing careful screening prior to the surgery, looking for abnormal corneal topography or unusually thin corneal thickness. However, screening tools aren't perfect and there are cases where you don't know what the cornea is going to do. In situations like this, most surgeons agree that LASIK is more apt to promote degeneration vs. PRK, again because of the invasive nature of LASIK.

Having said all this, there is no clearcut "better" choice. Personally, I would probably choose LASIK myself (but I'm not getting refractive surgery) because of my prescription. When you get to an Rx above somewhere around -4.00 to -4.50, PRK starts to become less predictable in terms of getting the Rx on the money. Surgeons that do both PRK and LASIK will typically recommend PRK up to about -2.50, go either way with Rx's from -2.50 to -4.50, then prefer LASIK with Rx's above that. This is a huge generalization, but gives you the idea.

Although you don't see it in the advertisements, there has been somewhat of a resurgence in PRK. Historically PRK was the first available refractive procedure, becoming FDA approved around 1995. (I'm not counting RK because I cringe to think about it). When LASIK was approved several years later, surgeons jumped on it because of the quick recovery and, hence, patient satisfaction. However, after years of doing LASIK and observing the potential for visually significant complications (infrequent, but a realistic possibility), some surgeons are starting to migrate back to PRK.

Femtosecond lasers look like they have the potential to address many of the problems associated with traditional LASIK. The flap can be cut more accurately and in a much more repeatable fashion. The laser can create a locking type interface at the edge of the flap that may reduce the potential for dislodging. There may be less inflammation under the flap as there is not physical contact between a blade and the tissue. It's still not a perfected product, but it's very promising.

GD

[Guest goducks]

That's interesting that despite the possible complications, you'd still go for LASIK (if you were to have the surgery). Is that because of the quick recovery?

I'm looking at two places right now and one of them offers the Intralase option you mentioned above. At -3.50 and -2.75 I guess I'm good to go for both options. So if I had the intralase option should I go for LASIK?

Thanks for the detailed explanation!

I'd go for LASIK because my eyes are in the higher myopia range. I've seen too many cases of over-correction by PRK with eyes like mine. If I had your eyes, I'd be somewhat impartial, but probably go PRK/LASEK/Epi-LASIK.

[Guest goducks]

Went to a free consultation and the doctor suggested custom LASEK and the cut is made with a laser versus a blade. Don't know if he was BSing me, but I told him that I was doing this for the AF and he said sometime ago he performed LASEK on another guy who was also going for a pilot slot in the AF. He said he didn't think LASIK would be as good because of the flap and something else to do with the pressure messing up your vision when at hight altitudes (for LASIK people). Had never heard that one before but he convinced me.

Gonna come out to $5200. That's more than my ing car is worth.

As far as I'm aware, we don't know exactly what altitude and pressure changes will do to eyes post-LASIK.

The Navy did an unpublished study where they looked at vision and refractive changes in post-LASIK subjects at the top of Pike's Peak (about 14,000 feet) and didn't find any issues. I suspect that is the basis for the original USAF restriction about which pilots were eligible for LASIK. Airframes whose cockpit pressure were not always maintained at the equivalent of 14,000 feet or less were restricted from LASIK. That requirement has since been dropped.

The USAF is currently trying to get a study done with post-LASIK subjects in a chamber to validate the safety to higher altitudes, perhaps also looking at other factors such as rapid decompression vs. long term exposure, but I don't know the specifics. Until then, it's only a guess.

[Bayou_Eagle_Driver]

Good luck man! And dont' do like I did and watch a surgery on the TV in the waiting room of the guy going before me. Not fun.

[Bayou_Eagle_Driver]

congrats on a uneventfull surgery!

[Guest goducks]

This is the best investment I've ever made. They changed it to PRK in the last minute (not sure why), but that's what I wanted in the first place. Monday during the pre-op, my vision was at 20/400. Today, for the post-op, I missed only 2 or 3 on the 20/20 line. There has also been practically no discomfort (knock on wood). But they said that may change as the epithelium starts pushing the contacts.

Thanks for all the help goducks!

Happy to hear that. Be aware, however, that PRK is often characterized by noticeable vision fluctuations morning to evening, day to day, etc. This is due to changes in refractive error, tear film quality, corneal tissue re-organization. So, if you go back and aren't doing as well, don't sweat it. When I see people after PRK, with rare exceptions, I don't worry too much about anything until at least 3-6 months post surgery.

But, it's great to be off to a good start.

[contraildash]

Congrats man! How'd ya like the smell? I had mine done back in 2002, been loving it ever since. Keep those drops handy and going regularly and you'll be in good shape.

[Guest goducks]

One of the doctors told me something they usually make up to 8mm in other patients, they made 8.5mm to make sure there would be no glare, etc. Any idea what that was about?

8.5 mm refers to the ablation zone, ie. the size of the actual laser treatment. The bigger the better, as light passing through the edge of the zone or outside of it will give you all sorts of night problems. That was the big problem back in the 1990's when we were only doing 6 mm ablations, which was as big as they could be made back then due to limitations in technology.

[Guest dropkick_9]

Just some PRK Recovery Notes:

I had mine done at Fort Hood in 2007, so everything free of charge (hooray). I was not as cautious initially with post-op mainly because I was on vicadin and had never been on pain killers before, so needless to say I was not limiting my eyes from lights etc. First couple days I thought it was awesome, working out, watching tv, etc (I was on convalescent leave). Well on day 4 when I ran out of magic pills, the pain came on and I spent the next three days in my darkened bedroom with a bag of frozen peas over my eyes.

FWIW, follow your post-op instructions, use your eye drops, don't smoke, and be careful and you will most likely have excellent results. Despite my bone-head mistakes my eyes turned out great with a 20/15 and an astigmatism correction in my right eye also.

My wife had Lasik done at our cost, and I believe in the PRK even with the additional pain and recovery.

[Insubordinate & Churlish]

My wife had Lasik done at our cost, and I believe in the PRK even with the additional pain and recovery.

Care to elaborate as to why?