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PUBLICATION EXCLUSIVE: Military refractive surgery enhances ophthalmic knowledge, service members’ readiness
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I became interested in laser corneal refractive surgery in 1985. I sent my then-fellow Ralph Zabel, MD, to England to work with Prof. John Marshall for a year. Ralph, while initially skeptical, became a believer after about 6 months and co-authored the first publication on excimer laser PRK in the rabbit, describing the healing response that included subepithelial fibrosis with corneal haze and compensatory epithelial hyperplasia. He returned to Minnesota for a second year of fellowship, and we decided to get an excimer laser at the Phillips Eye Institute in Minneapolis, starting with Taunton Technologies, which later merged with Visx. It took 8 years of clinical trials to achieve FDA approval for the Summit excimer laser in 1995 and Visx excimer laser in 1996.
Most of us busy refractive surgeons had been doing automated lamellar keratoplasty for high myopia for several years and immediately favored LASIK over PRK even though this procedure was off label. In the first year after FDA approval, approximately 100,000 procedures were performed in the U.S. Five years later that number rose to 1.4 million, which remains the high-water mark for annual number of excimer laser corneal refractive procedures in the U.S.
My friend, Steve Schallhorn, MD, a former Top Gun Navy pilot, was leading the ophthalmology division at the Navy Medical Center in San Diego when PRK received FDA approval. He immediately recognized the potential benefit the correction of refractive error, especially myopia and astigmatism, might have on his Navy colleagues. While one could not become a Navy jet fighter plane pilot with vision less than 20/20, many well-trained, highly experienced pilots became myopic during their careers. The cost to train a naval aviator who can land a jet fighter on an aircraft carrier at night approaches $6 million each. To ground these well-trained pilots because they developed myopia was unthinkable, but glasses and contact lens correction were less than ideal. The same was true for other highly valued personnel including Navy SEALs.
- Click here to read the full publication exclusive, Lindstrom's Perspective, published in Ocular Surgery News U.S. Edition, July 10, 2017.