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The U.S. Navy's Doctrine of Laser Eye Surgery
Journal written by anaesthetica (596507) and posted by
timothy
on Tue Jun 20, 2006 12:00 PM
from the woodchipper-surgery dept.
from the woodchipper-surgery dept.
The New York Times reports that laser eye surgery — now performed on nearly a third of every new class of midshipmen — is transforming Naval careers. Navy doctors are performing these operations with "assembly-line efficiency," allowing older pilots to continue flying, and those who might otherwise have been disqualified to pursue flight school. The number of procedures has reportedly climbed from 50 to 349 over the past five years. The Navy uses a different procedure than that used on civilians — grinding the cornea rather than cutting a flap — out of fears that the flap could come loose in supersonic combat.
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Grinding your eyeball? (Score:5, Insightful)
Re:Grinding your eyeball? (Score:5, Insightful)
Sure, eye surgery can solve these problems and it's not very likely that the surgery will "backfire". But that just is not a risk I would like to take with my eyesight.
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Re:Grinding your eyeball? (Score:5, Insightful)
Can't the same be said about every medical condition/procedure?
Sure, the remedies aren't going to be 100%, but if we waited for them to be perfect, we'd still have extremely short life expectancies.
-dave
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Re:Grinding your eyeball? (Score:5, Insightful)
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Re:Grinding your eyeball? (Score:5, Insightful)
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Re:Grinding your eyeball? (Score:5, Funny)
> I would much rather loose appendages or other sensory organs
It looks like it's too late to save your spelling organ.
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Re:Grinding your eyeball? (Score:5, Interesting)
Sure, eye surgery can solve these problems and it's not very likely that the surgery will "backfire". But that just is not a risk I would like to take with my eyesight.
Like lots of things, I think it's a risk/reward question. In my case, I wear glasses and will continue to wear glasses, but my vision isn't that bad so the reward I'd get from eye surgery isn't all that great. The glasses sharpen my vision and make it easier for me to read road signs, but I can actually get along just find without them.
My wife, on the other hand, was blind as a bat without her glasses, to the point that she had to carefully place her glasses in the same place next to the bed each evening, because she had to find them by touch in the morning. She could not see them. She got Lasik about three years ago, and it has significantly improved her life. Before the surgery, for example, she didn't dare participate in any sort of water sports because losing her contacts or glasses would leave her completely blind. Now she SCUBA dives and I expect to get her up on water skis this summer. Even more important is the sense of freedom she has, being able to see without assistance. After the surgery, her sight was 20/20, but has gradually declined to where she is contemplating getting glasses again to sharpen her vision a bit. She could have the surgery re-done (for free, even, since a followup was included in the original price) instead of getting glasses, but it's no longer worth the pain or the risk.
I know others with similar stories, and I can definitely see how someone who'd like to fly military jets would perceive the risk/reward tradeoff as a good deal. Heck, I'd get the surgery if it meant someone would let me fly an F-14.
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Re:Grinding your eyeball? (Score:5, Funny)
ObCliffClavin:
It's a little-known fact that bats actually have very good eyesight. The echolocation isn't compensatory.
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the flap? (Score:5, Funny)
there's a circumsicion joke there somewhere
Dammit (Score:5, Funny)
Full Article Text (Score:5, Informative)
Nearly a third of every 1,000-member Naval Academy class now undergoes the procedure, part of a booming trend among military personnel with poor vision. Unlike in the civilian world, where eye surgery is still largely done for convenience or vanity, the procedure's popularity in the armed forces is transforming career choices and daily life in subtle but far-reaching ways.
Aging fighter pilots can now remain in the cockpit longer, reducing annual recruiting needs. And recruits whose bad vision once would have disqualified them from the special forces are now eligible, making the competition for these coveted slots even tougher.
But the surgery is also causing the military some unexpected difficulties. By shrinking the pool of people who used to be routinely available for jobs that do not require perfect eyesight, it has made it harder to fill some of those assignments with top-notch personnel, officers say.
When Ensign Michael Shaughnessy had the surgery in his junior year at the Naval Academy, his new 20-20 vision qualified him for flight school. And that is where he decided to go after graduating last month ranked in the top 10 percent of his class, rather than pursuing a career as a submarine officer.
"The cramped environment in submarines is something that turned me off," Ensign Shaughnessy, 22, said.
For generations, Academy graduates with high grades and bad eyes were funneled into the submarine service. But in the five years since the Naval Academy began offering free eye surgery to all midshipmen, it has missed its annual quota for supplying the Navy with submarine officers every year.
Officers involved say the failure to meet the quota is due to many factors, including the perception that submarines no longer play as vital a national security role as they once did. But the availability of eye surgery to any midshipman who wants it is also routinely cited.
"Some of the guys with glasses who would have gone to submarines or become navigators are getting the chance to do something they'd rather do, and the communities that are losing the people are not as happy about it as the aviation community, which is gaining better candidates," said Cmdr. Joseph Pasternak, the ophthalmologist who oversees the program at the National Naval Medical Center in Bethesda.
In the Naval Academy's class of 2006, 349 of the 993 midshipmen had the surgery, up from 50 five years ago, according to Naval Academy records. Fewer than 30 percent of the academy students whose eyes qualify for the surgery choose not to get it, and the number of holdouts is dropping every year, Commander Pasternak said.
Last week, a little after 10:40 a.m., Colin Carroll, a 21-year-old midshipman from Olney, Md., put anesthetic drops in his eyes and lay down under the laser as Capt. Kerry Hunt, a Navy doctor, and two assistants prepared to begin. "We're locking the laser on now," Captain Hunt told him.
Midshipman Carroll had originally hoped to enter flight school but discovered not only that his eyes were not good enough, but also that he was prone to kidney stones, ruling him out of aviation entirely. He said he was "resigned" to entering the Marine Corps or becoming an officer on a surface ship, neither an assignment requiring perfect vision.
But he decided to get the surgery anyway.
By 10:49, both eyes were done, though extremely bloodshot, and Mr. Carroll walked out wearing sunglasses, declaring he could already see better.
The procedure used by the Navy, photorefractive keratectomy, or PRK, is different from the one used on most civilians. That approach, known as laser-in situ keratomileusis, or Lasik, requires cutting a flap in the surfa
PRK (Score:5, Informative)
While taking a week or more off work is tough for some - YOU'RE PUTTING FRIKKIN' LASERS IN YOUR EYES in either way. Why not take the more permanent / durable approach? Don't chose 'Hi Dr. Nick' budget solution either. That's just stupid.
They've been doing this in the Army for a while... (Score:5, Interesting)
I got out quite a few years ago, before this was possible. My cousin however is still in, and he got the surgery done, for free. They offer it to everyone, and encourage you to do it. It makes all aspects of being a soldier - particularly an infantryman, much easier. Now you can wear off the shelf eye protection, no longer are gas masks a pain in the ass to put on, nightvision goggle, scopes, sights in a tank, are all easier to use.
I think it's a great idea, myself.
Aging pilots (Score:5, Funny)
PRK Experience (Score:5, Informative)
The only drawback was the day of "oh-my-god-what-have-I-done-get-these-icepicks-ou
Best money I ever spent, and I'd do it again in a heartbeat.
Re:PRK Experience (Score:5, Interesting)
Exam notes:
It was intresting. I had filled out the eye history sheet before I went
in. They gave me a quick eye exam, but it wasn't like a normal one.
First up was the typical Big E projected on the wall (no glasses!)
"Nope, can't see it."
Next up they took two pictures of each eye. It was a weird device, it
was cone shapped, and I was looking into the big end of it. The inside
was black, with many concentric circles of purple light, with a lens at
the center. It made a topographical map of my corneas.
Next up was a device that measured my perscription. I had to stare at
a little picture while it zoomed in and out of focus. Apparently this
determines my exact perscription, none of that "Is this better, or that"
lens swapping. I wonder why eye doctors don't use this all the time.
Last of the inital measurements was another corenal mapper. Nothing to
see, just a red light.
Then I got a 10 minute vides summerizing LASIK. I knew all that stuff
already from my research.
Then I got to speak with the doctor. She did a few more measurements,
including measuring the thickness of my corenas. Then we got down to
the nitty gritty.
I am NOT a good canidate for LASIK. The corena mappings reveal that
they're buldging on the lower sides, kinda pear shapped. LASIK can be
done, but by pealing back the flap, my corenas loose some of their long
term strength, and I risk having them thin so much I may need a corena
transplant in the years to come.
However....I am an exceptional canidate for PRK, which is basicly LASIK,
but with no flap, they just burn off the extra portions of the cornea.
The recovery time is a bit more involved, and would likely be unable to do
much of anything for a couple of days. I'd have to wear contacts as
bandages while the areas where tissue was removed healed.
Lots of questions with the doctor, but generally very optimistic about
my final result being 20/40 or better. Like 95%+
Then I was off to the office manager for the bottom line. $3700, for
both eyes, all the pre and post care (7 appointments!), and any
additional corrections for life. This about what I expected. And
that's with 15% off from my insurance. I asked, normally they'd give a
cash discount, but I can't combine it with my insurance. Then she gave
me several consent forms and whatnot to review.
4 hours post op:
Well, I did it, and I'm not blind.
It went very smoothly. Arrived, filled out a couple (more) consent forms, one last cornea mapping, and had a last minute chat with the doc. Got a perscription for some vicoden, and got my final post-op instructions. Paid the nice lady, and she gave me some Advil and a valium. Back to the waiting room for 10 minutes.
The proceedure itself I can't really describe, as most of the time I was staring at a bright light 6" from my face. But, they gave me a stylish hair net, and ploped me in a dentist like chair. Leaned me back, and it slid me under the light/laser/camera.
They gave me a half dozen eye drops in each eye and let me sit for a few minutes. I know one of them was an anastetic, hence the wait. They put a plastic shield over my left eye, and taped it in place. Then they tapped my eyelashs/eyelids open on the right eye. They put in the thingy that holds my eye open, which wasn't as uncomfortable as I thought it would be. Few more drops, and then they (according to C) put a little white disk over my cornea. I couldn't see anything, but after they lifted it, I could see the q-tip removing the outer layer of my cornea. Then, he used what looked to be a ice scrapper, I swear. Couple more drops, and then "Don't move, stare at the light" Then they fired up the laser, it made a clicking noise for about 40 seconds. The light went from really blurry to mostly blury, and then they popped in a "bandage" contact, and removed the thingy and left ey
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PRK is most popular in Europe (Score:5, Interesting)
Long Term Effects of Lasik (Score:5, Interesting)
Last time I asked (I'm around -4.5 in both eyes), they were worried about the long terms of removing part of the lens in either eye. Apparently, part of the lens is also removed as a treatment for cataracts, and they had some worry that
a) Laser eye surgery could remove enough of the lens to make cataract treatment later in life difficult or impossible, and, also
b) There weren't any large scale long term (20+ yrs) studies on the rusults of the surgery.
As I said, this is secondhand... perhaps if there's a MD or a Optometrist on these boards they could comfirm/deny/just explain better?
How many eye doctors do this do themselves? (Score:5, Insightful)
Their explanation in both cases was the same: we really don't know the long-term effects of PRK/LASIK/LASEK. It could have side effects (triggering glaucoma, etc) that would render you near blind in 30 years. Is it really worth that risk?
So I'm sticking with glasses. For one thing, I'm over 40 and while I'm still nearsighted, normal age-related presbyopia is setting in. I can deal with it by simply removing my glasses to look at things that are up close. If I had LASIK, I'd need to carry reading glasses with me all the time, so there's not much of a win.
Re:Let's get it out of the way. (Score:5, Funny)
Eye-eye, sir!
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Re:Navy? (Score:5, Funny)
Because we rarely attack Canada and Mexico. Everyplace else is easier to reach by aircraft carrier.
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Re:Let a military doc operate on my eye? (Score:5, Informative)
Also, the doctors who treat the President are from the Navy, and Bethesda Naval and Walter Reed are known to be very good medical centers. So I think your post is basically quoting people who have some slant against the military.
-dave
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Re:Let a military doc operate on my eye? (Score:5, Interesting)
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Re:Let a military doc operate on my eye? (Score:5, Informative)
They must have, if your opinion was ever valid in the first place. I was an operating room tech (Surgeon: "Scalpel." Me: Passes scalpel) at Naval Hospital San Diego in the mid '90s, and the surgery they were doing was absolutely first class. We had lots of famous visitors - a friend of mine got to scrub in on a chest case with Dr. DeBakey [wikipedia.org] - and we performed a lot of routine operations that you're only now seeing in the civilian world.
I won't say that there aren't any bad doctors in the military, but there are plenty of brilliant ones to bring up the average. I wouldn't have thought twice about getting medical care for me or my family from the Navy.
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Re:Grinding? PRK is available to consumers. (Score:5, Informative)
Photorefractive Keratectomy (PRK) is available to consumers and is actually a better procedure than LASIK, but is more expensive, requires a longer healing period and fewer physicians are trained to perform it (takes longer to get certified, LASIK certs can be obtained via short, vendor classes).
In PRK, the outer surface of the cornea is ablated by the laser (on an lower power) and then reshaped at a higher power. A protective contact lens is applied to patient and remains on for about 5 days, then is removed by the doctor. The patient applies drops to the eye several times a day for about a month while the outer cornea heals.
The benefits of PRK are the lack of any "flap" problems (incorrect cut, complete cut [ouch], misalignment, dislodgment, halo effects, etc...) and ability to correct some visioin situations not correctable via LASIK.
While my wife wasn't a good candidate for the procedure and didn't have it performed, I highly recommend the physician who evaluated her, Dr. Bruce Bodner [vec2020.com] Associate Professor of Ophthalmology at EVMS [evms.edu].
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