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WPMC - Warfighter Laser Surgery FAQ

* DISCLAIMER: The following "FAQs" are strictly for informational purposes only. They do not explicitly or implicitly guarantee your eligibility or outcome with refractive surgery. These FAQs are not exhaustive and do not replace the required pre-operative informational briefings or informed consent. More detailed information is available from your local military eye doctor.
What is the "Warfighter Laser Surgery Center" ?
Are there others in the DOD? The Warfighter Laser Surgical Center is a specific military medical facility which has been designated, staffed, and funded to perform laser corneal refractive surgery (PRK/ LASIK) for primarily active duty personnel. The goal is to enhance performance of military personnel by using corneal refractive surgery (PRK/ LASIK) to reduce or eliminate their need for glasses or contact lenses. The USAF Warfighter Laser surgery Centers are located at Wright-Patterson AFB, Lackland AFB, Travis AFB, US Air Force Academy, and Keelser AFB. Several major Army and Navy facilities also have been designated.

What is corneal laser refractive surgery?
Corneal laser refractive surgery is a specialized treatment by an ophthalmologist (eye physician and surgeon) in which an excimer laser is used to reduce or eliminate a person's need for glasses/ contact lenses. This is done by altering the shape/contour of the cornea (front clear central part of the eye) by very carefully and precisely removing very small amounts of tissue.

What is PRK?
PRK is photorefractive keratectomy. The surface "skin" of the eye is carefully and painlessly removed, then excimer laser energy is used to treat the "bare" surface of the cornea. The "skin" then regrows and recovers the surface of the cornea.

What is LASIK?
LASIK is laser in situ keratomileusis. The surface "skin" is not removed. Rather, a partial thickness cut is made in the cornea, causing a "hinge-flap" which is then lifted. The excimer laser energy is then directed at the exposed cornea. The flap is then laid back down in its original position.

What are the basic similarities and differences between PRK and LASIK?
Similarities. Both: use the same laser machine; are performed by ophthalmologists; require similar preoperative evaluations; outcomes are very similar for the average patient wearing glasses or contact lenses.

Differences: PRK directs laser energy at the exposed surface of the cornea; LASIK directs laser energy at the flap-exposed middle portion of the cornea; PRK requires more healing time, has slightly more discomfort postoperatively than LASIK, and does not produce a corneal flap; LASIK requires minimal healing time, has less discomfort postoperatively, and produces a corneal flap.

Current USAF policy prohibts certain AFSC's from having LASIK surgery. Please review this policy and/or discuss which surgery is best for you with your military eye doctor before having any surgery.

How are these different from RK?
RK is radial keratotomy. This procedure is totally different in that it does NOT use a laser at all, and no tissue is removed. Small knife cuts are made radially in the cornea to cause it to flatten. This procedure is rarely used currently and has been almost totally replaced by laser refractive surgery.

Who is eligible/ not eligible for these procedures? Do I have to have this surgery, if I don't want to?

All active duty members are potentially eligible. They must meet the eye and medical criteria, understand and accept the risks of the surgery, as well as receive chain of command approval. In addition, aviation and special duty personnel (controlled with an AF Form #1042 -- both active and inactive) or anyone considering applying for these programs) have additional restrictions/ requirements which must be met. (See Flight Surgeons Office or your military eye doctor). Refractive surgery is ELECTIVE; active duty members do NOT have to have this surgery.

What are the eye criteria/requirements?
1. No significant eye disease (if you only see your eye doctor for routine spectacle/contact lens evaluations, you are probably OK).

2. *Nearsightedness (myopia)/ astigmatism: The amount of eyeglass correction that can be treated depends on your eye and the type of surgery being considered. See your eye doctor for more information.

3. *Farsightedness (hyperopia)/ astigmatism: The amount of eyeglass correction that can be treated depends on your eye and the type of surgery being considered. See your eye doctor for more information.

4. Stable refractive error (i.e. no big changes in strength of spectacle/contact lenses in the preceding year or so). (*Actual parameters may vary per patient and as criteria evolve - see your military eye doctor for specific details)

What are the medical disqualifiers? * (*see your local military eye care specialist for specific details)

1. Definite disqualifiers: age less than 18 yrs; pregnant or nursing; immune or auto immune diseases (systemic lupus, rheumatoid arthritis, immune deficiencies, etc.); regular use of certain medications (Accutaneâ/isotretinoin, Imitrexâ/sumatriptan, Cordaroneâ/amiodarone, prednisone/steroids, anti-metabolites).

2. Possible disqualifiers: diabetes, wound healing disorders (keloids, excessive scarring), use of hormone replacement therapy or antihistamines, possibly other medications.

Will I need my commander's permission? How about my supervisor or mobility officer?
Yes to all three. This is critical! As a military member, you must obtain chain of command approval as well as clearance from your mobility officer. Evaluations, treatments, and postoperative appointments take time and will require convalescent leave (typically a week), profile restrictions preventing deployment from 4-16 weeks post treatment, and may involve unit funds, orders, and travel time for those from other locations. Proper coordination and approval is essential! To assist this process, the new USAF policy includes a "Commander's Authorization" letter which your supervisor, mobility officer (if on mobility), and unit commander must sign prior to your initial screening appointment (you should bring the signed letter to your screening appointment). You may download this letter from our home page under "Documents". Prioritization is performed by your commander. Remember, priority 1 is for aviators (active or inactive) or other special duty personnel (such as combat controllers, pararescue personnel, etc.) who are medically managed by the local Flight Surgeon's office via USAF form 1042 (or other service equivalent forms). Once signed, the letter is good for 90 days; however, commanders always have the right to rescind authorization as dictated by the needs of the unit.

What if I am not stationed at WPAFB, can I still go there to get it done?
Yes. WPAFB serves as a regional laser center for the DOD and may provide this treatment for personnel from Army or Navy units as well as from other USAF bases. Your local Commander's approval and referring command's acceptance of the TDY costs and time requirements are critical for personnel coming from other bases. In addition, you will have to have your local PRK trained military eye doctor examine you to determine if you are a good candidate for refractive surgery. The eye doctor will then refer/ forward your information to the Warfighter Laser Surgery Center at WPAFB. The laser center personnel will then schedule you for your visit to WPAFB. Please visit other portions of our web site for additional information.

What priority am I?
Attachment 2 of the policy letter delineates the priority categories. Your commander assigns your priority on the authorization letter. Remember, priority 1 refers to aviators (active or inactive) and other special duty personnel (such as combat controllers, pararescue personnel, etc.) who are medically managed by the local Flight Surgeon's office via USAF form 1042 (or other service equivalent forms). If your medical care has never been through the Flight Surgeon's office or you have never heard of a USAF Form 1042 (or "grounding/ clearance" form for other services), you are not priority 1. Note: all priority 1 USAF personnel require special clearance from the Aeromedical Consultation Service at Brooks AFB prior to treatment, see below. Other priority categories are self-explanatory as listed in the policy.

If I am an active duty pilot, can I get my surgery done at WPAFB? What about navigators or other air crew?
Administratively active and inactive aviators, anyone considering applying for aviation training, or anyone else requiring AF Form 1042 clearance from the Flight Surgeons office have more specific evaluation and treatment guidelines and restrictions (see your Flight Surgeon and local military eye doctor for details). All pilot, student pilot, and "boom operators" may be treated only at Wilford Hall Med Center in San Antonio, Texas. Other aviators/ special operational duty personnel may be treated at WPAFB once they have met the special guidelines.

What do aviators / special duty personnel (priority 1) do that is different from others interested in this surgery?

Our web site posts the policy and forms for this program also. First, these personnel should read the program policy and see their Flight Surgeon who will explain the program in detail to them and review their record for eligibility and brief them on program requirements. If eligible and with unit commander authorization, the member makes an appointment for an initial optometry screening exam, the examining optometrist completes a special form (aviation/special duty form, posted on website under this program; actually requires two visits to complete the examination requirements) which must be forwarded back to the Flight Surgeon. If still eligible, the local Flight Surgeon then forwards the completed "package" to the Aeromedical Consultation Service (ACS) at Brooks AFB, TX. (Note: these aviation / special duty forms/ "packages" are NOT sent to the Warfighter Laser Center until AFTER permission to proceed is given by the ACS.) If the member is cleared by the ACS to obtain the surgery, then a "permission to proceed" letter is returned to the referring Flight Surgeon (this may also be fax'd to the appropriate laser center). The final preoperative evaluation may then be scheduled at the appropriate laser center. Please note that certain aviators can only be treated at Wilford Hall Medical Center at Lackland AFB, TX (see policy).

Are dependents of military personnel or retirees eligible for this treatment?
As the "Warfighter" name implies, this program is intended for active duty personnel only at this time. Retirees and dependents may be treated in the future if space permits.

If I am routinely having difficulty with my glasses or contact lenses, is this treatment likely to reduce or eliminate my dependence on glasses or contact lenses?

Yes. This is the expected benefit for most people. This treatment is intended to benefit the military by enhancing your on-the-job performance by reducing or eliminating your dependence on glasses or contact lenses.

If I am doing fine with my glasses and/or contact lenses, should I consider this procedure?
Maybe depending on your expectations. The realistic expectation of these procedures is to reduce (possibly eliminate) the requirement for glasses or contact lenses after accepting some risks associated with the surgery. Unrealistic expectations include: "I want to be guaranteed that I will never have to wear glasses or contact lenses again." Or " I expect and demand 'perfect' vision after absolutely risk-free surgery." Clarify your expectations and then get information. Refractive surgery is not for everyone!

Will I need to arrange time off from work?
Personnel will typically be given up to 1 week of convalescent leave. There will be additional time requirements ( e.g.: pre-operative exam, consent briefing, etc) in addition to the week for convalescent leave. All preoperative and postoperative appointments need to by coordinated and approved through your chain of command as noted above. You may return to your local PRK trained military eye doctor (if available) for follow up appointments required after the first post operative week.

Is this treatment reversible?
No. Once the treatment is done, it cannot be undone. Modifications or "enhancements" of the original procedure may be done if required.

Is this treatment painful?
No. The procedure itself is not painful (topical anesthetic is used). Postoperative healing for PRK does have some discomfort (generally mild to moderate for a few days). This discomfort is transient and pain relievers are provided. LASIK postoperative healing is generally painless.

What is the cost to the patient for this treatment?
Active duty: none.

What are the outcomes of this treatment?
It depends on the time period after the surgery. At one year (the vast majority of patients' outcomes are stable well before this), typically, 75% or more patients are able to see the "20/20" line without glasses or contact lenses and 95% or more are able to drive legally without glasses or contact lenses.

Can I lose my best corrected vision (best vision with glasses or contact lenses)? How likely is that?

Possibly. Published reports indicate up to 1% of patients may end up with a small decrease in their vision. For example: best corrected pre-operative vision of 20/20 could drop to 20/30, 20/40, or worse). For reference purposes: driving without glasses requires about 20/40 vision, while reading requires about 20/50 vision.

Do you treat both eyes at once?
Typically, both eyes will be done the same day ("simultaneous"). Occasionally, a "sequential" treatment will be done in which the surgeries are done several days or more apart. Some people who are over 40 years old and/or wearing reading glasses may opt to have only one eye treated in hopes of decreasing their dependence on reading glasses. This technique is called "monovison". See your eye doctor if you think this applies to you.

How long does this treatment take?
The actual time in the treatment chair takes only a few minutes and is done on an outpatient basis (no hospitalization required). However, you will definitely need an escort to take you home the day of surgery and the day after surgery. NO ONE WILL BE ALLOWED TO OPERATE A MOTOR VEHICLE OR DANGEROUS MACHINERY AFTER LASER EYE SURGERY UNTIL IT IS SAFE. (usually a few days)

Will I ever have to use glasses or contact lenses afterwards?
Maybe. The goal is to make you less dependent on glasses or contact lenses. The treatment may even eliminate your need for glasses, but that is NOT guaranteed. As patients approach the early 40s, they usually will need to start wearing reading glasses. Laser refractive surgery will not eliminate the need for reading glasses; however, some patients may elect a "monovision" option (mentioned above) which may reduce or eliminate their dependence on reading glasses (see your local military eye doctor for details).

Is this the same as "cataract surgery"?
No. Cataract surgery is entirely different in that it removes a cloudy lens and replaces it with a clear artificial "implant" lens. Corneal reshaping is not the goal of cataract surgery and laser energy is not typically used.

Will I have to take eye drops afterwards?
Yes. Most patients will typically be on at least four different eye drop medications. These drops will decrease rapidly to only one type of drop during the month after surgery. Individual postoperative courses and treatments may vary.

How do I get myself screened for surgery to see if I am a good candidate?
You will need to make an appointment with your local military optometrist who will perform a detailed eye exam to see if you meet the qualifications for laser eye surgery. In preparation for that appointment, you should:

- not wear any contact lenses for 4 weeks prior to the appointment (and keep them out until the surgery);
- download and read (and ask your commander to read) the policy as posted at our website;
- attend an informational briefing locally (1st/ 3rd Tuesdays 1300-1400hrs, Med Ctr auditorium, WPAFB, if local);
- bring the signed authorization letter to your appointment;
- bring a copy of your most recent (but must be at least 1 year old) optometric/ophthalmic eye evaluation or spectacle prescription (to ensure stability of your eyes) to your appointment;
- bring a driver and sunglasses, as you will undergo a "long" dilation.
- After your initial screening evaluation your local military optometrist will refer / forward your information to the Warfighter Laser Surgery Center for review and scheduling of your preoperative/ final examination. As mentioned above, aviator or special operational duty personnel will have additional evaluation and approval requirements, as dictated by policy.

How may I find out more information about refractive laser surgery?
Local WPAFB: Basic informational briefings will be held the first and third Tuesdays of the month in the Medical Center auditorium (Bldg 830, room BNN1) from 1300 to 1400 hours. This free briefing is open to any interested individual but is required for all patients considering refractive surgery at the Warfighter Laser Surgery Center.

Other area Bases/ Posts: Look for scheduled informational briefings in your base/post paper and / or other official communications media.

How long do I have to discontinue my contact lenses prior to screening?
Four weeks. This is sometimes a limiting factor for screening because each person must entirely discontinue use of contact lenses for four weeks prior to their initial optometry evaluation. Even soft contact lenses can slightly reshape the cornea and throw-off the detailed measurements we do. This can result in unexpected variations in the treatment outcome. If you want to be ready for your screening appointment, be sure you stop all contact lens wear at least four weeks prior to the evaluation.

I'm active duty. If I get laser refractive surgery, is there a minimum commitment / retainability for continued active service before I can retire or separate?
Yes. According to current AF Instructions, To ensure a return on investment for the Air Force, a Wafighter Program Patient will have six months retainability on active duty from the date of surgery. In addition, patients controlled by the "Aviation / Special Duty Policy" are required to have one year of retainability after their date of PRK surgery.

Can I travel to WPAFB on Permissive TDY status or must I be on orders or leave?
Yes. Current policy does authorize the use of PTDY to have refractive surgery at an approved Warfighter Laser Surgery Center.

These are just a few "frequently asked questions". More detailed information is available from your local military eye doctor - ophthalmologist or optometrist. More information is also provided in local informational briefings and in preoperative evaluations.

From the staff of the WPAFB Optometry Clinic's Warfighter Laser Surgery Center