1. Photorefractive Keratectomy in the Navy/Marine Corps

2. PRK Works For… Myopia (near-sightedness) Astigmatism Hyperopia (far-sightedness)

3. Results of the Initial Navy PRK Study Everyone at least 20/20 uncorrected vision at 12 months post-op Excellent performance results (marksmanship) No vision-threatening complications Decreased glare and halos on average One patient with night-driving complaints

4. Results from a Recent Study on Aviators Naval Medical Center San Diego Six months after surgery, 15% of patients still needed glasses for 20/20 vision. (100% needed glasses before surgery.) After surgery 15% of patients couldn't see as well with glasses as they could before surgery with glasses. All 382 patients were able to return to flight status - 96% after 8 weeks and 100% after 12 weeks. Six months after surgery, 4 eyes were not able to see 20/20, even with glasses

5. PRK in the U.S. Military - The Time Line 26 DEC 1995 - CNSWC requests that BUMED remove PRK from list of conditions disqualifying for NSW 15 May 1997 - BUMED msg 151501Z removes PRK as a disqualification for NSW and diving 29 May 1997 - BUMED establishes waiver policy for refractive surgery in accessions to USN/USMC 29 Sep 1999 - BUMED relaxes waiver policy December 1999 - CNO directs Navy-wide implementation of PRK

6. BUMED PRK Policy Msg September 1999 PRK waiverable for: Aviation Submarines Surface warfare USMC PRK not disqualifying only for SEALs and divers

7. Priority System for USN PRK Not dependent on rank or rate Priority to Warfare Designated Personnel Based on Commanders assessment of: Operational need Probability of enhancing mission performance Personal safety in performance of duties

8. Aviation Community Ineligible for this program Separate study in progress - for details click herehere

9. Priority System for USN PRK (does not apply to Aviation study) Priority 1 - Sailor/Marine's duties require work in extreme physical environments without question, frequently and regularly. Contact lenses/spectacles incompatible Priority 2 - Duties require work in extreme physical environments frequently. Contact lenses/spectacles impractical Priority 3 - Duties require work in extreme physical environments not typically, but periodically. Priority 4 - Duties require work in extreme physical environments rarely. Contact lenses/spectacles acceptable

10. PRK - the Process Command approval for surgery and assignment of priority by Commander Screening exam at USN Hospital Okinawa, MCAS Futenma Branch Medical Clinic or Hansen Branch Medical Clinic Patient forwards packet for scheduling to NMC San Diego for aviators and to NMC San Diego, NMC Portsmouth or NNMC (Bethesda) or any combination thereof for non-aviators. Fax numbers are: San Diego (619) 524-1731 Portsmouth (757) 953-6136 Bethesda (301) 295-4751 Note: all three centers will accept the San Diego consult form found at the end of this presentation Notify NH Okinawa Eye Clinic (643-7797) of surgery date Travel at personal expense for surgery Surgery performed at NMC San Diego, NMC Portsmouth or NNMC (Bethesda) Return to Okinawa when directed by operating surgeon Follow-up at NH Okinawa/MCAS Futenma BMC/Hansen Branch Clinic

11. Post-op Time-frame Expect Return to command - 1 week post-op Expect Return to full Duty - 1 month for myopes/4 months for hyperopes Follow-up appointments at a minimum: 2 weeks, 1 month, 3 months, 6 months, 12 months

12. PRK - the Risks Corneal infection (rare) Need for re-operation Loss of best-corrected visual acuity (1% at 1 year) Disqualification from special duty Increased intraocular pressure (2% at 6 mos) Corneal haze Increased halos Increased glare Ghost images Night driving problems Drooping of eyelid Double vision

13. You Should NOT Have PRK if You... Have a history of keloid formation Have an autoimmune diseases Have significantly dry eyes Have a corneal ectasia (keratoconus, etc) Are currently pregnant or plan to be soon You are more than 12 diopters myopic, 4 diopters astigmatic or 6 diopters hyperopic

14. PRK - No Surprises You may still need glasses after your PRK You will still need glasses to read in your forties and beyond after having PRK!

15. So How Do I Sign Up? Click here to see the check list!here