TRAVIS AIR FORCE BASE, Calif. – Aviation applicants and current aircrew members no longer need a waiver for duties if they have laser-assisted in situ keratomileusis or photorefractive keratectomy surgery once their vision has stabilized, according to a recent policy change. Individuals also no longer need waiver recertification every three years.
The change affects about 300 aircrew members and some 500 applicants annually, according to Dr. Steve Wright, Air Force School of Aerospace Medicine at Wright-Patterson Air Force Base, Ohio.
“Historically, LASIK and PRK waivers for aircrew members actively flying were required to ensure the member's vision had fully recovered and was stable before returning to flight and that the member had no complications that would require further treatment or follow up,” said Wright. “The primary reason for discontinuing the waiver was due to the high success rate of the procedures.”
LASIK and PRK surgery help patients suffering from nearsightedness, farsightedness and astigmatism to have sharper vision. Most patients undergoing LASIK or PRK achieve somewhere between 20/20 and 20/40 vision without the need for contact lenses or glasses, according to a 2014 Navy research study.
“The Food and Drug Administration approved PRK in December 1995 and the Air Force approved it for accessions with a waiver in 1999,” said Lt. Col. (Dr.) Richard Rubin, 60th Medical Group deputy chief of aerospace medicine and senior flight surgeon at Travis AFB, California.
Air Force approved PRK for aviation and special-duty personnel in 2000 with a waiver; however, LASIK was not approved for aviation and special-duty personnel with a waiver until 2007, said Rubin.
PRK is the most requested refractive surgery procedure in the Air Force, said Lt. Col. (Dr.) Jared Kelstrom, 60th Medical Group, Warfighter Refractive Surgery Center director.
“A patient may request LASIK, but not be a good candidate for it, but may be able to have PRK instead,” he said.
With PRK, a thin outer layer of the cornea – called the epithelium – is removed and discarded before the corneal tissue is reshaped with an excimer laser. Protective soft contact lenses are applied after the treatment and left in place for several days while the epithelium heals.
“It takes several weeks for the patient’s vision to stabilize and the patient will be on steroid drops from one to four months,” said Kelstrom.
With LASIK, the epithelium is left intact. A surgeon uses a special knife – called a femtosecond laser – to cut a thin flap on the outer layer of the cornea, leaving a hinge at one end. The flap is folded back to reveal corneal tissue. An excimer laser cuts and reshapes the cornea and the flap is replaced.
“The patient’s vision is usually 20/20 the next day, but the patient will be on a profile for a week,” said Kelstrom.
Initially, Air Force surgeons were concerned with corneal-flap related complications, especially for pilots and aircrew members who might have to eject at high altitudes. However, studies showed there was little to no effect.
“The administrative burden of requiring a waiver for LASIK and PRK was not commensurate with the number of cases where a waiver was critical in making the decision to return to flight or when to allow an applicant to come into flight training,” said Wright.
Although the change is relatively transparent to aircrew, “it means they can potentially return to flight days to weeks earlier,” he said.