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Navy investigators 'cautiously' allowing IntraLase LASIK for aviators
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After promising results in a series of studies, Navy officials have chosen to proceed cautiously with a program allowing LASIK with IntraLase flap creation in naval aviators. To date, PRK has been the preferred method of refractive surgical correction for Navy pilots.
"We treated the first aviator about 2 months ago using the best of this technology ... in a very slow, progressive fashion," said Steven C. Schallhorn, MD, of the Naval Medical Center in San Diego, speaking at Hawaiian Eye 2007 in Koloa, Hawaii.
Previously, PRK was the only refractive surgical option for Navy aviators due to concerns over the quality of vision from conventional LASIK, Dr. Schallhorn said.
The military initially was reluctant to allow LASIK based on results of a study comparing conventional PRK to conventional LASIK, he said. In that study, both procedures caused a slight decrease in contrast sensitivity, which PRK patients recovered by 6 months postop, but LASIK patients did not.
"This is the reason we haven't done LASIK in aviators," Dr. Schallhorn said. "Everyone asks me, 'Why don't you do LASIK in aviators? Is it because of flap stability?' No, we published studies on flap stability years ago ... . It was really the quality of vision with conventional LASIK," he said.
Dr. Schallhorn has been involved in numerous studies of refractive surgery in Navy pilots, including a study conducted in the early 1990s, which examined the in-flight effects of PRK on vision in 785 active aviators.
"The results were quite excellent in them. Not without complications, but we had an overall excellent clinical result," Dr. Schallhorn said. "This study changed our Department of Defense vision standards. It has changed the standards of most countries' departments of defense."
Dr. Schallhorn noted that the "Achilles' heel" of PRK is the slow visual recovery period.
"The minimum down time for an aviator after PRK is 3 months. There's no question that LASIK offers faster visual recovery," he said.
Technological innovations have improved the efficacy of LASIK, and the military is now reconsidering its policy of favoring PRK, Dr. Schallhorn added. He noted that a large series comparing conventional to wavefront-guided LASIK found that the addition of the wavefront technology resulted in induction of fewer higher-order corneal aberrations and thus better postop vision.
Another study found better quality vision and faster visual recovery using the IntraLase FS laser for flap creation compared with mechanical microkeratomes, he said.
Dr. Schallhorn was involved in both studies, and as a result of those efforts the military has decided to proceed cautiously with a program allowing LASIK with IntraLase on Navy aviators.