EW SHOW DAILY
32
ASCRS Symposia
Tuesday, April 17, 2018
Military continued from page 30
because it requires so many postop
visits.
Corneal clarity at 1 month
postop is more variable and typically
hazier compared to PRK, Dr. Mc-
Clellan said. Patients must remain
in the area and are generally not
deployable for at least 6 months
postop. He recommends establishing
a standardized postop protocol for
patients who are followed outside of
a military treatment facility.
Commander John Cason, MD,
San Diego, described the Navy's
experience thus far with the KAMRA
corneal inlay (AcuFocus, Irvine, Cal-
ifornia) to treat presbyopia. So far,
he has seen mostly positive patient
and surgeon reports, especially if the
patient was miserable with presby-
opia before surgery. But patients and
the Department of Defense (DOD)
should be aware that recovery is
slow, and patients require a lot of
drops and experience decreased con-
trast sensitivity, he said.
Colonel Bruce Rivers, MD, Fort
Belvoir, Virginia, discussed imple-
mentation of SMILE in the DOD.
All refractive surgeries require a
recovery period, but for the military,
any factor that can cause a delay in
visual recovery may have a signif-
icant force-wide impact on cost,
productivity, and combat readiness,
according to Dr. Rivers. Any proce-
dure that could hasten the recovery
time and reduce the risk of postop
complications would be valuable
in enhancing military readiness, he
said.
The Army predominantly treats
patients with PRK, which requires
a 90-day waiting period before
patients can be deployed. LASIK
requires a 30-day postop waiting
period. SMILE could reduce deploy-
ment waiting times if more patients
elect it over PRK, but the procedure's
effects on military task performance
are yet to be determined, Dr. Rivers
said.
Lieutenant Roxana Godiwalla,
DO, San Diego, presented results of a
study evaluating long-term refractive
outcomes of PRK and LASIK in the
armed forces. The DOD started per-
forming LASIK and PRK procedures
on military personnel in 1994, and
nearly half a million patients have
undergone refractive surgery in the
military since 2000.
Many studies have evaluated
the short-term safety and efficacy of
refractive procedures, but long-term
refractive outcomes in the armed
forces are yet to be assessed, Dr.
Godiwalla said. In the new study, re-
searchers evaluated long-term refrac-
tive stability 4–14 years post-LASIK
and PRK in a veteran population.
The study found patients be-
come about 1 D more myopic every
year after surgery, but the authors
attribute these refractive changes to
natural lenticular aging and axial
length elongation. They conclude
that refractive surgery has so far pro-
vided excellent long-term benefits
to operational personnel, as patients
have good vision and do not require
glasses or contacts during deploy-
ment, Dr. Godiwalla said. EW
Editors' note: The physicians have no
financial related to their comments. The
views expressed here are the physicians'
and not those of the Department of
Defense.
