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Sailors, Marines eye free Lasik

By October, the Navy expects to have provided up to 70,000 sailors and Marines the “Cadillac” of vision enhancement surgery — wavefront guided Lasik with IntraLase — free of charge.

The surgery, which costs between $5,000 and $7,000 in the civilian world, will be provided to service members at seven naval hospitals, according to Capt. Christopher Armstrong, director of aerospace medicine for the Navy.

In addition, Armstrong said Bureau of Medicine and Surgery officials are in the final administrative stages of approving the surgery for Navy and Marine pilots and aviation candidates.

“I expect to be recommending waivers for Lasik [for Navy and Marine aviators] during the fall,” Armstrong said.

While there is money in the budget to perform the 70,000 surgeries for sailors and Marines before the fiscal year ends in September, Armstrong cautioned that number could be limited by factors such as the difficulty of scheduling multiple appointments for each member before and after the surgery is performed. The basic surgery takes 10 minutes.

Retirees and dependents are not included in the program.

Armstrong said any nearsighted or farsighted sailor or Marine could put his name on a wait list, but when he receives the surgery will depend on the mission he performs.

“If you are some special operations kind of person, and you are on your way to some combat zone, you are going to be at the top of the list,” he said. “If you were some guy who worked at an office … you could get it, but you were at the bottom of the list,” Armstong said. “It is based on one’s military occupational specialty and one’s current assignment.”

Armstrong said those who are not served by the program this year will have the opportunity to have the surgery next year; he could not provide an estimate for how many surgeries the Navy will fund in fiscal 2008.

The surgery will be voluntary.

Armstrong said he did not know how many vision-enhancement surgeries have been performed at naval hospitals using PRK, an older surgery that requires much longer recovery periods and usually involves more discomfort.

Helping aviators see clearly

Armstrong said the waivers for pilots would allow Navy doctors to continue a lengthy evaluation of the short- and long-term effects of Lasik by tracking the health and performance of pilots who have had the surgery.

Most waiver applications should be approved, he said, unless medical complications are found or command objections are raised.

Before 2000, any vision enhancement surgery, whether before or during military service, was automatically disqualifying for Navy and Marine pilots. But since 2000, the Bureau of Medicine and Surgery has granted waivers to pilots for PRK. During the surgery, the cornea’s protective covering is rubbed off and it is reshaped by a laser, bringing distant vision into focus. The patient is then released from care and must wait for the protective covering to grow back on its own — an often-painful process that can last several days. Navy or Marine pilots who have undergone PRK have been grounded for at least three months, Armstrong said.

Over the past decade, PRK has fallen out of favor in the civilian world and now accounts for less than 3 percent of vision-enhancement surgeries worldwide.

Lasik, first performed in 1991, has taken its place and now accounts for more than 95 percent of all surgeries.

During Lasik, surgeons cut a small circular flap in the cornea’s protective covering, reshape the cornea and then reattach the flap.

Because the protective covering does not have to grow back on its own, Lasik patients experience less pain and recover more quickly, Armstrong said, adding that pilots who receive Lasik could be grounded for less than a month.

Fears that harsh environments endured by pilots — Armstrong mentioned gravitational forces, low oxygen levels, wind blasts and dry air — could loosen the flap, effectively blinding the pilot, have made Navy doctors reluctant to allow waivers for Lasik.

But after years of studies, Navy doctors have found that the flap is stable in flight and has only been dislodged by direct manual pressure on the eye.