1. Laser Exposure to Aircrew CAPT Matt Rings Aerospace Ophthalmology

2. Disclosure Statement CAPT Rings has investments in the following companies who manufacture military laser systems:  General Dynamics  Northrup Grumman Corp  Coherent Inc.  II-VI inc.

3.  Handheld Laser Pointers - (Red/Green/Blue)  CAS lasers (vis/IR)  Airborne lasers – targeting and countermeasures (vis/IR)  Anti-personnel lasers (Green)

7. Tahrir Square - Egypt

8.  Glare “Dazzle”  Flash-blindness  Irritation  Photophobia  Headache & eye pain  Sub-clinical tissue damage  Visible retina and ocular damage  Retinal hemorrhage

9.  Surprise / Startle effect  Distraction  Inability to discern instruments and landing lights  Mission compromise or failure  Loss of aviator temporarily or permanently to flight

10. Approach, Nov/Dec 2012

12.  “Friendly fire” from ground targeting lasers:  “Since November 2008, [we have] had 64 laser incidents reported in Iraq, resulting in 45 documented injuries to soldiers. Two of those injuries were permanent — one soldier is now legally blind in one eye, Hayes said.”  “Usually, the damage is temporary,” he said, “but they have to be evaluated by a retina specialist in the States.”  (Stars & Stripes, June 14, 2009)

13.  2012  79 Aviation Laser Incidents reported via Hotline  20 HAZREPS  Abnormal Eye Exams (~10% rate)

14. Note: Multiple persons per incident is frequent

15.  2004: 46 incidences  2008: 988 incidences  11% reported distraction, glare, afterimage, ops interference,  2% pain/injury  69% on final approach  92% green lasers, 5% red lasers  7PM to 11PM (70%) The Illumination of Aircraft at Altitude by Laser Beams: A 5-Year Study Period (2004-2008 - FAA

16.  OPNAV 3710 : annual LEP / laser training  Review reports of any laser activity in the area reported to ATC (concerts, pireps, intel)  Consider Laser Eye Protection (LEP) based on theater threat intelligence  Discuss in-flight laser exposure procedures  Carry small Amsler grid (if significant threat)  LEP must be worn if “significant laser threat” exists (per OPNAV 3710.7U)

17.  Look Away & shield eyes (don LEP if available)  DO NOT rub the eyes – increases irritation  Turn up instrument lights  Mark the position, time, and report to ATC  Unexposed co-pilot gets on instruments  Query other crew members for exposure  Self-examination using small print or Amsler grid (if available)  ‘Self-triage’ vision  able to read small print,  check individual eyes,  check pocket Amsler grid, nav charts, HUD or MFD for any visual defects  Determine mission viability, if significant vision symptoms prevent safe continuance

18.  Notify Chain of Command  Notify Flight Surgeon & Laser Safety System Officer ( per OPNAVINST 5100.27B)  Undergo eye exam by Flight Surgeon as soon as practicable  Complete HAZREP  Complete FAA laser exposure web report http://www.faa.gov/aircraft/safety/report/laserinfo/  Call DoD Laser Hotline (24/7) Toll-free: 800-473-3549

22.  United States Air Force School of Aerospace Medicine Laser Injury Guidebook: http://www.dtic.mil/dtic/tr/fulltext/u2/a559312.pdf http://www.dtic.mil/dtic/tr/fulltext/u2/a559312.pdf Appendix C: Laser Incident Questionnaire Appendix D: Amsler grid

23.  Complete the ‘Laser Incident Questionnaire’ (Appendix C of Laser Injury Guidebook)  Obtain complete history of events  List ocular symptoms  Document LEP or eyewear worn (e.g. NVGs)

24.  Visual Acuity (with correction)  Amsler Grid test  Pupil exam  Stereopsis testing  Color Vision  Slit Lamp – corneal abrasions/burns, lens opacity, conjunctival injection.

25. Dilated Retinal Exam Evaluate for retinal changes, blood, burns, white lesions

26.  Does laser eye exam reveal significant visual or ocular findings? If yes, consult ASAP to ophthalmology or aerospace optometrist  Navy/USMC: OPNAV 5100.27: **ALL exposures get consult exam**  Make recommendation on Fitness for Aviation Duty or further medical management

27.  99%+ of exposures will not cause permanent injury– may return to flight if no persistent symptoms, normal vision testing and normal exam. Document follow-up in 1-3 days.  Actual injuries or persistent symptoms:  “Down” chit for flight pending further workup  Ophthalmology/Optometry consult (aerovac as needed)  Laser Hotline advice on ALL exposures

28.  HOTLINE Toll-free: 800-473-3549  Comm: 937-938-3764  USAFSAM Ophthalmology: 937-938-2675  NAMI Ophthalmology: 850-452-2933  Pubs (unclassified): http://tinyurl.com/Naval-Laser-Safety-Info