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To the Editor
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I read with interest the cover story titled “Experts retrospectively review case complicated by infection” in the Dec. 25, 2017, issue of Ocular Surgery News.
The apparent reason for proceeding with this PRK, with its well-described benefits vs. possible, and apparently actual, complication, was because the individual in question “wants to become a bus driver,” and the finding of corneal inferior steepening may have limited glasses correction, although the preoperative correctable acuity is not noted in this report.
I am a retired ophthalmologist, myopic, with acuity correcting to 20/15- in both eyes back when I was employed by the Cleveland Transit Authority (now called RTA) in the late 1960s as a city bus driver, which helped me to pay my college tuition at Case Western Reserve University. My glasses correction was quite adequate for this line of work and “commercial driving” licensure.
Reviewing the CDL vision requirements now posted for Ohio, one finds that “in order to qualify for a CDL a driver must ... have a minimum acuity of 20/40 in each eye with or without lenses.” Various jurisdictions may have somewhat different requirements.
It may well be advisable for the ophthalmologist to give this information, perhaps already done by the operating surgeon in the above noted report, that could allow deferring/avoiding surgery while still permitting successful bus driving application and employment, if the corneal inferior steepening was not the preoperative limiting factor.
Stuart M. Terman, MD
Orange Village, Ohio
- Reference:
- CDL testing. www.bmv.ohio.gov/dl-cdl-testing.aspx.
Response:
Many occupations require not only a best corrected visual acuity but also a minimal uncorrected visual acuity. These occupations include many branches of the military, police officers, firefighters, corrections officers and drivers.
Laser vision correction has been the answer for many individuals’ lifelong dreams that have been limited in the past by poor uncorrected visual acuity. In the case presented, the patient’s BCVA was adequate but the UCVA did not reach the occupational visual threshold. Laser vision correction was performed for occupational reasons. I agree with Dr. Terman that in some cases BCVA is all that is needed for certain employment opportunities, and in these cases, laser vision correction may be appreciated by the individual but is not necessary. That was not the case with this individual.
Eric D. Donnenfeld, MD
OSN Cornea/External Disease Board Member