Thousands of military personnel receive PRK or LASIK every year. Among Air Force personnel, the procedures have proven to be remarkably safe and effective. Based on a 1-year case review conducted by four ophthalmologists deployed to Afghanistan and eight deployed to Iraq, the most common complication was patients deploying too soon after having had refractive surgery performed.
Dr. Reilly, chief of cornea/external disease and refractive surgery, Wilford Hall Medical Center, San Antonio, TX, spoke at the annual meeting of the American Society of Cataract and Refractive Surgery. He also has served as chief of the Joint Warfighter Refractive Surgery Center at Lackland Air Force Base in San Antonio and as consultant for refractive surgery to the Air Force surgeon general.
"I had the honor of going over and serving as the deployed ophthalmologist in Afghanistan in 2007 and 2008," Dr. Reilly said. "As the consultant for refractive surgery in the Air Force, I was interested primarily in what kinds of complications we were seeing in the patients [on] whom we perform refractive surgery, both before and after we get them deployed."
The most common complication found was deploying too soon after surgery.
"We'd have personnel who went home on a break, had refractive surgery performed, and then redeployed within 2 weeks," Dr. Reilly said. "That was the most significant complication, as you might imagine. Putting steroid eye drops in your eye while you're dodging bullets from the enemy is not a good idea."
Corneal haze was a complication for patients who underwent PRK. In the two combat theaters, the ophthalmologists identified eight patients who had undergone PRK and had haze. In four of the patients, the haze was significant enough that the patients had to be returned stateside.
"Keeping that in perspective, we had many, many more patients returned to the [United] States for basketball injuries than for PRK," Dr. Reilly said.
The haze generally is new-onset and is more commonplace in Afghanistan because of the high environmental ultraviolet radiation levels, higher elevations, and dry climate, he added.
A number of troops suffered significant eye trauma, such as corneal foreign bodies and corneal burns, yet during the 1-year study, Dr. Reilly and his colleagues found no traumatic flap dislocations among patients who underwent LASIK. "The bottom line is that we found a remarkable record of safety and efficacy," he said.
Dr. Reilly added a reminder that these data summarize the Air Force experience for 1 year, and Air Force personnel may be at lower risk for traumatic flap dislocations than ground personnel.
"LASIK is approved in the Air Force even for our fighter pilots. I have performed it on a number of fighter pilots, particularly using a femtosecond laser, and our experience shows us there really isn't a danger of flap dislocations," he said. "However, our Air Force guys aren't the ones out there running around in the bushes as much. Most of our guys are flying jets or on the flight line. If they're para-rescue or special forces, or if they are into mixed martial arts, I much prefer PRK."
The Army, he added, recently released a policy letter stating that personnel cannot deploy for 90 days following PRK, and he said he believes that the policy is a good one.
"Many of our civilian colleagues are offering free refractive surgeries to our military members, and that's a great thing," Dr. Reilly said. "Just keep in mind that you shouldn't do that within 3 months of their planned deployment. If military personnel come to you wanting surgery, and they're going to deploy within a month or a couple weeks, just say 'no.' Send them with their glasses and their contacts."