11 Pros and cons of Lasik Reduced haze Increased ablation area Painless Bowman’s layer preservedIncreased ablation areadecentration less problemHigher myopes treatedPainlessNo de-epithelialisationFlap loss / damageEjection riskTrauma riskUnknown time to flap stabilityRetinal detachmentSuction ringSands of SaharaDiffuse Lamellar Keratitis - Non-severe forms have been estimated to occur in 1% of cases; severe cases comprise only about 1 in 5,000 surgeries.5 A number of names including Sands of the Sahara have been used to describe this condition, which is characterized by an accumulation of inflammatory cells under the flap. The condition usually appears at one to three days after LASIK. However, there have been recent reports of late onset DLK.6-7 Multiple causes have been hypothesized, but no single explanation accounts for all cases. Rx intensive topical steroids.5. Steinert, RF. Swami, AU. Diffuse Interface Keratitis. Review of Refractive Surgery, January6. Yeoh J, Moshegor CN. Delayed diffuse lamellar keratitis after laser in situ keratomileusis. Clin Experiment Ophthalmol 2001 Dec;29(6): Chang-Godinich A, Steinert RS, Wu HK. Late occurrence of diffuse lamellar keratitis after laser in situ keratomileusis. Arch Ophthalmol 2001 Jul;119(7):1074-6
12 LASIK vs. PRK Flap decentration of lasik Raised IOP of lasik Pain of PRKEqual correction of myopia 1-3 dioptresLasik more accurate 3-6 dioptresSE of glare, halos, reduced night visionDifferent proportions but equal effects
13 US Navy Experience 30/30 naval aviators av –3.25d All achieved 20/20 unaidedGlare / halo transientNight vision worse (1 declined other eye)No effects on NFL of PRKAfrican Americans have excellent outcomesNo effect on PRK from ejectionNFO S-3B VikingSchallhorn SC et al. Preliminary results of PRK in active duty United States Navy personnel. Ophthalmology 1996 Jan;103(1):5-27.
14 USN PRK Study 2002 1035 patients 84% no gls 4 weeks 95% 6/6 or better 150 pilotsTarget recognition98% better2% worse82% better carrier landing98% better instrument readingSchallhorn S, Tanzer D, Fulton D. Update on refractive surgery in Naval aviation. Presented at the Aerospace Medical Association 73rd annual meeting, Montreal, Canada, May 2002.
15 USAF PRK study 80 subjects 20 controls 20% required correction postop Aimed for –0.5d postop refractionNo effect from altitudeNo effect from G loadingNo decrease in HUD readabilityTredici T, Ivan D Results and conclusions of the USAF Photorefractive Keratectomy (PRK) study. Presented at the Aerospace Medical Association 73rd annual meeting, Montreal, Canada, May 2002.
16 Other Techniques Clear lens extraction Phakic intraocular lenses LASEK For high myopesDanger of RDPhakic intraocular lensesMay cause lens opacitiesLASEKPRK without the pain
17 Current State of Play for Civilian Applicants JAR class 1 certificationPreoperative refraction to dioptresMust be examined by eye specialist at CAA medical div Gatwick1 year before certificationJAR class 2 certificationPreoperative refraction to dioptresOphthalmic report about surgery and its results to AME
18 Current Pilots – When Can They Fly? JAR class 1 recertificationMust be examined by eye specialist at CAA medical div GatwickStable refraction6/12 to 1 year before certificationClass 2 recertificationOphthalmic report about surgery and its results to AME
19 RAF Refractive Surgery (Currently!) Cost to be borne by the individualTo be performed under conditions of strict audit by DMS consultantsTo incorporate latest wavefront technologyGrounded for 6/12-1 year until refraction stableNot accepted in recruitsAircrew are normally recruited before ocular maturity and at an age when CRS may not provide long-term refractive stability.Furthermore, the long-term outcome of CRS in trained aircrew needs to be evaluated before considering the procedure for potential aircrew.
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