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New Laser Eye Surgery Gives Navy Pilots Eagle Eyes

New Laser Eye Surgery Gives Navy Pilots Eagle Eyes

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Runways, other planes, dozens of tiny instrument dials…add in the deadly complications of combat flying, and you have a job where ‘vision’ is not a corporate buzzword – it’s a life-saving requirement. United States military pilots face some of the most exacting physical standards of any position, with the pilots’ vision being perhaps the most important. It’s not uncommon, therefore, for vision irregularities to ground potential flyers. The United States Navy reports that, until recently, more personnel were disqualified from flying due to vision problems than for any other reason. Recent technological advances in laser eye surgery may, however, give prospective pilots a chance to attain the sharp vision they need to hit the skies.

In May 2007, the U.S. Navy Bureau of Medicine and Surgery announced that it had approved the use of LASIK (Laser-Assisted In-Situ Keratosis) surgery on its pilots. Although every branch of the military, as well as NASA, has approved the procedure for most of its members, it had been thought that the results achieved through the surgery could become compromised under the extreme conditions pilots face. However, a new, ‘bladeless’ LASIK procedure has given the Navy cause to reconsider its opinion.

Laser eye surgery works by using a low-energy pulse to reshape the cornea, the part of the eye responsible for focusing incoming light. However, the cornea is protected by a thin layer of tissue; surgeons must make an incision in this protective layer in order to create a hinged flap, which is then folded back to expose the corneal tissue underneath. After the cornea has been suitably reshaped, the flap is replaced, and it acts as a natural, self-adhering bandage.

Military doctors expressed concern that the wind blast from an ejection, combined with complications from the high ‘G’ forces endured by pilots, might cause the flap to re-open. This would expose the delicate cornea to almost certain damage from wind and debris and permanently impair the pilot’s vision. Military doctors were also concerned about the risk, albeit a slim one, that the surgery could irreparably harm pilots’ eyesight instead of improving it.

With the IntraLASIK procedure, surgeons can use a tiny laser to create the flap, as opposed to the traditional steel blade. While the blade used in traditional LASIK is highly precise, its use can sometimes result in an irregular flap, leading to vision problems after the operation. In addition, the blade cannot be used safely on patients who have thin corneas. The laser, however, creates a thinner, more precise flap than the blade. As a result, Navy doctors believe, the flap is more likely to heal properly, giving the surface of the eye the strength needed to stand up to the wind and ‘G’ forces faced by pilots. IntraLASIK also has a lower rate of vision-impairing complications after the surgery than traditional LASIK, due to the precision the laser is able to achieve.

“The blade [can have] a very large variation in the thickness of the flap for instance, or even the diameter of the flap,” says Dr. Alan Faulkner, one of the first doctors in the United States to perform IntraLASIK. “The laser is capable of creating a flap just as the surgeon wants it. He can dial in the parameters of the thickness and the diameter, and he knows with assurance that he is going to get the flap that he planned.” Faulkner says the results of initial Navy studies of IntraLASIK were “so good,” with improved vision for the test subjects and little evidence of flap detachment, that they started the pilot program. The Navy approved IntraLASIK for pilots just six months after it was first tested on a naval aviator.

“If I was on the fence, the chance for free laser eye surgery would certainly make the military more attractive,” says William Hatfield, currently deciding between enlisting in the Marine Corps or the Navy as an aviator. When asked if he would consider IntraLASIK if he fails the vision tests, Hatfield replied that he was “not sure,” and “would need to do some research” on the procedure and its results. “A mistake could be pretty costly,” he said. “But the military moves so slowly to do anything new, it’s got to be safe, right?”

In terms of the overall safety of the procedure, “no other surgery anywhere in medicine approaches the safety record of LASIK,” says Dr. Glenn Cook, a laser eye surgeon in San Diego. “Physicians that are skeptical of the long-term safety of the procedure… are becoming less and less common. Clearly we have learned from our prior mistakes.” Cook has been performing LASIK for more than 12 years, and emphasizes that the key to the success of laser eye surgery is addressing “appropriate pre-operative parameters” – in other words, carefully determining whether a patient is a proper candidate for the procedure. With IntraLASIK, patients who might have been precluded from undergoing traditional LASIK may now find themselves to be excellent candidates for the procedure.

And pilots who might previously have been grounded because of their poor eyesight may have a new lease on vision.

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