Warfighter Refractive Eye Surgery Program Pre-Operative Brief

Army Refractive Surgery

Refractive Surgery in the Army was started here at Fort Liberty; it has now expanded to over 14 locations. About 25,000 procedures are performed every year with advanced, state-of-the-art laser platforms. 

Why Offer Refractive Surgery?

The military offers refractive surgery to help you see better to do your job, with the nice benefit that you can see better to do everything else in your life as well. 

Spectacles Have Limitations

Glasses have obvious limitations in a combat environment. They can get lost, broken, fall off, or fog up.

What Makes A Good Candidate?

Not everyone is a great candidate for LASIK or PRK. We like for your glasses prescription to be stable, you not to have any underlying eye diseases, and not have predisposing risk factors that we know can cause poor outcomes:

• thin corneas
• warping of corneas (ectasia/keratoconus)
• dry eye
• large pupils
• trauma, prior eye infections, or prior eye surgery

Refractive Eye Surgery Options

The options for refractive surgery include:

• Photorefractive Keratectomy (PRK)
• Laser Assisted In-Situ Keratomileusis (LASIK)
• Implantable Contact Lens (ICL)
• Clear Lens Exchange (replace natural lens with artificial one)

You can also remain the way you are, in glasses or contacts, or change your mind anytime until the procedure.  

PRK

Disadvantages

• Discomfort: large scratch to the eye; expect to use narcotics
• Haze: can blur vision and cause glare, mitigated by drops and UV sunglasses
• Slow recovery: vision is blurry at first; smoother skin must be replaced 2-3 time to get final clarity 

Advantages

• One surgical procedure; no flap cut
• Faster and requires less cooperation from the patient
• Anatomically it's as close to your pre-operation eye as possible, more stable and in most cases trauma does not affect it

LASIK

Disadvantages 

• Two procedures, more delicate, and more cooperation from the patient is needed
• Until the flap is sealed down, the eye is not as stable and minor trauma may require a return to the laser suite

Advantages

• Less pain
• Fast recovery: driving in one or two days, back to full duty in two to three days
• Better visual outcomes for some patients and east to re-treat

What Are The Risks? 

It's common to experience some symptoms after LASIK and PRK surgery. These are usually temporary but very rarely can be long term and cause significant disability. 

Specifically, these include:

• pain or discomfort
• dry eye
• light sensitivity
• blur
• glare
• halos
• starburts
• double vision

Post-Operation Regression

A common misconception is that LASIK or PRK can wear off, however the laser treatment is permanent. Your prescription may change a little over time, and that is due to changes in the natural lens in your eye.  We all go through this process and will benefit from a small glasses prescription and certainly reading glasses in our early to mid-forties. 

Post-Operation Ectasia

Our screening process involves a very advanced ocular imaging work up. This helps us identify patients who are at risk for problems after surgery. One of those problems is called Post-Operative Corneal Ectasia. 

The issue here is that some corneas can warp - thinning or bumping out like a bald spot on a tire. This can interfere with your vision, cause blurry vision, or even require further surgery. Even under ideal screening programs, warping or ectasia can still occur. It's important to understand this is a potential risk factor from having corneal refractive surgery, like LASIK or PRK. 

Post-Operative Pain and Infection

After surgery, whether LASIK or PRK, discomfort is common. For PRK, discomfort typically lasts three to five days while the skin on the surface of the eye heals. Don't plan on doing a lot of visually demanding work in the first post-operative week. 

For LASIK, the discomfort is usually transient, usually lasting only a number of hours. Typically by post-operative day one you are feeling and seeing great. 

Infection is incredibly uncommon but can occur in both LASIK or PRK patients. This can be visually devastating and it is extremely important to present for care. This is why we emphasize  seeing you for your post-operative visits. 

Signs of infection can include: 

• worsening of vision
• increasing redness or pain

If you suspect a problem, please walk into our clinic or call us for an urgent exam. 

Limitations of Refractive Surgery

Refractive surgery can be an amazing and life changing experience, however there are limitations. Our primary mission here is to enhance your readiness on the battlefield by reducing your dependency on corrective lenses. Surgery does not eliminate your need for glasses in the long term. When on operations, you need to wear eye protection and sunglasses are recommended for UV protection. We will all need reading glasses when we reach our early to mid-forties. As already mentioned, a prescription to fine tune your vision can be expected. 

Follow Up Appointments

It's important that we see you on your follow up appointments to see that you are healing appropriately and to address any issues that come up immediately. 

We would like to see you for the following appointments:

• 1 day
• 1 week
• 1 month
• 3, 6, and 12 months