Military laser refractive surgery offers positive experiences for civilian surgeons

Issue: March 25, 2010

ByRichard L. Lindstrom, MD

Richard L. Lindstrom

The significant and highly successful use of laser refractive surgery to enhance the performance of our military personnel in all branches — including the exclusive NASA astronauts, Navy and Air Force top-gun fighter pilots, and Army special forces soldiers — is an important story. While we in private practice are struggling with a poor economy and negative press, dampening enthusiasm for LASIK and PRK, the demand for these procedures from our military personnel is exploding.

While visiting the Naval Medical Center San Diego on the way to spend 2 days on a nuclear-powered aircraft carrier, I was told by an admiral that the ability to see better than the enemy, day and night, is one of the significant competitive advantages enjoyed by Americans in combat as opposed to their enemies. Later, while on the USS John C. Stennis, I was amazed at the number of Navy personnel who had undergone laser refractive surgery, from the commander of the vessel through the pilots and on to the crew.

While refractive surgery as an alternative to glasses and contact lenses for the combat soldier slugging it out in Iraq or Afghanistan is, to me, an easy choice, these Navy personnel were in a fairly clean environment. They chose the procedure to enhance visual performance and quality of life, more like our civilian patients. Those that I spoke with were unanimous in their satisfaction with the procedure and very vocal about the positive impact it had on their ability to perform their duties and also on their quality of life.

The facts around the military’s experience are nothing short of astounding: 23 actively treating centers and 312,000 personnel treated to date with more than a decade of activity. At Hawaiian Eye 2010, we heard from both David Tanzer, MD, and Scott Barnes, MD, that patient satisfaction is extremely high in the military. In one cohort reported, there was only one significantly dissatisfied patient in more than 100,000 treated. Regarding LASIK for the naval aviator study, outcomes were 20/20 in 100% of patients and 20/16 in 96%, with 100% patient satisfaction for a demanding cohort of patients.

These results are very reassuring to those of us in the private sector who find ourselves under attack daily by individuals and groups who challenge the safety and efficacy of laser refractive surgery. Clearly, based on the military experience, when properly performed, LASIK and PRK are safe and effective, enhance performance and generate extraordinarily high rates of patent satisfaction.

There is much we refractive surgeons in private practice can learn from our military colleagues, and we all appreciate them taking time from their busy schedules to share their pearls and outcomes. It is worth noting that they perform a higher number of PRKs and that their medical treatment regimens are standardized and carefully monitored for compliance. Their equipment is current, and they routinely utilize wavefront-driven or optimized treatments, and in LASIK, use femtosecond laser technology for the flap creation.

Of special importance, in my opinion, they monitor their outcomes carefully and continuously review them with the goal of improving their results. This continuous analysis of results and incremental improvement in Japan is called “kaizen,” and it is a powerful tool in taking good to great.

Laser refractive surgery today seems destined to remain a lightning rod for controversy and debate in the private sector, but in the military, it is an accepted and important tool for enhancing performance in the most demanding environments imaginable. The U.S. military experience will be an important positive factor for laser refractive surgery as we enter the next decade.