Womack Army Medical Center Warfighter Refractive Eye Surgery Program

Womack Army Medical Center Warfighter Refractive Eye Surgery Program Pre-Operative Brief 1 Committed To Those We Serve

Womack Army Medical Center Why offer refractive surgery? 20/400 20/400 w/o w/o astigmatism astigmatism Soldiers need to see! 2 20/400 20/400 w/2D w/2D astigmatism astigmatism XX 45 45 Committed To Those We Serve

Womack Army Medical Center Spectacles have limitations Can get lost / misplaced / broken / never ordered! Can slide down your nose with sweat Can fog up at the worst times Can get knocked off in combat 3 Committed To Those We Serve

Womack Army Medical Center Army Refractive Surgery Established at Ft. Bragg in 2000, now in 14 locations Nearly 250,000 treatments performed since inception 25,000 procedures per year Army wide All centers are state-of-the-art with advanced laser platforms 4 Committed To Those We Serve

Womack Army Medical Center Refractive Eye Surgery Options PRK (Photorefractive Keratectomy) LASIK (Laser Assisted In-Situ Keratomileusis) ICL (Implantable Contact Lens) Clear Lens Exchange (replace natural lens with artificial one) You may also: Remain the way you are (do nothing/specs and contacts) Change your mind at anytime until the laser starts 5 Committed To Those We Serve

Womack Army Medical Center The Cornea The cornea is the clear tissue at the front of your eye that you see through – where you put your contact lens Epithelium: laser energy is not effective here Stroma: laser energy has a permanent effect here Front View Cross-section View For a lasting correction, the laser needs to be applied to the stroma, but the epithelium is in 6 the way! Committed To Those We Serve

Womack Army Medical Center PRK n PRK, the epithelium is removed with a circular brush. 7 Committed To Those We Serve

Womack Army Medical Center PRK Second, the laser removes tissue to reshape the eye. 8 Committed To Those We Serve

Womack Army Medical Center PRK Post-op Third, a bandage contact lens is placed on the eye to reduce postoperative pain. 9 Committed To Those We Serve

Womack Army Medical Center PRK End Result One week later, the bandage contact lens is removed. Cornea is flatter and thinner, but otherwise looks as if you never had surgery. 10 Committed To Those We Serve

Womack Army Medical Center LASIK Starts with the same anatomy as PRK, but in LASIK the surgeon just moves the epithelium rather than 11 removes it. Committed To Those We Serve

Womack Army Medical Center LASIK Flap Creation The epithelium, or skin, is too fragile to move by itself without tearing, so a flap is created from stroma and skin Hinge Point Flap is cut with a laser. It is disk-shaped, like a man-hole cover, except it remains connected at one point (the 12 hinge). Committed To Those We Serve

Womack Army Medical Center LASIK Flap Lift A tool can then be inserted to break any remaining adhesions / connect the perforations. The flap is 13 Committed To Those We Serve lifted, exposing stroma.

Womack Army Medical Center LASIK The laser treatment is identical to PRK. 14 Committed To Those We Serve

Womack Army Medical Center LASIK The flap is repositioned and smoothed out. The eye is inspected to make sure there is no debris under flap and there are no folds are in the flap. Flap settles into position over the next several 15 days. Committed To Those We Serve

Womack Army Medical Center Who makes a good candidate? Correction is stable No underlying eye conditions (glaucoma, cataracts, corneal dz) Normal medical history and medication use (particularly as it relates to poor wound healing) No predisposing risk factors of bad outcomes: – – – – – Thin corneas Warping of cornea (ectasia / keratoconus) Dry eye Large pupils Trauma, prior eye infections or prior eye surgery 16 Committed To Those We Serve

Womack Army Medical Center How will I see after surgery? 17 Committed To Those We Serve

Womack Army Medical Center What are the risks? These are irreversible SURGICAL procedures There are RISKS associated with the procedures Realistic expectations are necessary 18 Committed To Those We Serve

Womack Army Medical Center Post Laser Refractive Surgery After either PRK or LASIK you will experience some problems with your eyes these are usually mild and temporary, but may become permanent and debilitating. Specifically, these – Dry Eye – Light Sensitivity – Blur – Glare – Halos – Starbursts – Double Vision 19 Committed To Those We Serve

Womack Army Medical Center Post-op Visual Aberrations Glare / Halo surrounding a point source of light at night Starbursts, often seen with a soft halo, usually at night 20 Committed To Those We Serve

Womack Army Medical Center Post-op Visual Aberrations “Double vision” or “ghosting” of images 21 Committed To Those We Serve

Womack Army Medical Center Post-op Regression The laser treatment is permanent – But with time you may need to wear glasses again – The crystalline lens changes shape over time – Presbyopia in your 40s 22 Committed To Those We Serve

Womack Army Medical Center Post-op Ectasia Some corneas are prone to warp, causing blurry vision, surgery would worsen this – no-go for surgery Even under the best screening programs, ectasia or warping can still occur 23 Committed To Those We Serve

Womack Army Medical Center Post-op Pain and Infection For PRK, pain usually worst at day 2-3. Don’t plan on doing a lot of visually demanding work the first week For LASIK there is less pain post-op. You may have bleeding or bruising on the eye. In either case, infection can be visually devastating! – Signs of infection include: worsening vision, increasing redness, increased pain (or there is significant asymmetry between eyes) – If you suspect a problem, come to the clinic ASAP as a walk-in for an urgent exam! 24 Committed To Those We Serve

Womack Army Medical Center Limitations of Refractive Surgery Our goal is to enhance soldier readiness and battlefield performance by REDUCING your dependency on corrective lenses Surgery does NOT eliminate the need for glasses. – – – – Eye Protection / Eye Armor Sunglasses (UV Protection) Reading glasses when 45 years old Thin glasses to fine tune vision for some patients 25 Committed To Those We Serve

Womack Army Medical Center Limits: Eye Protection 26 Committed To Those We Serve

Womack Army Medical Center Limits: Expectations Common Misconceptions: 1. Everyone who has refractive surgery will achieve perfect 20/15 vision 2. If I’m 20/20 after refractive surgery, my vision will be perfect 3. If I’m not 20/20 after surgery, I will be unhappy 27 Committed To Those We Serve

Womack Army Medical Center Military Criteria Units commanders authorize soldiers to apply No flags or adverse personnel actions pending Con leave for the day of surgery 5 days Non-deployable and a temporary profile for one month Non-deployable to CENTCOM AO for 3 months Air Force needs Special Approval Waiver for HALO / SCUBA 28 Committed To Those We Serve

Womack Army Medical Center Follow-up Appointments 1 Day 1 Week 1 Month 3, 6, and 12 months If you are from out of town and have made arrangements for a local optometrist to remove your bandage contact lens, a comanagement agreement will need to be signed and on file before we can perform surgery on you. 29 Committed To Those We Serve

Womack Army Medical Center Specific PRK Pro / Con Disadvantages: – Discomfort – big scratch to eye, expect to use narcotics – Haze – can blur vision and cause glare, mitigated by drops and UV sunglasses (you have to take your meds!) – Slow recovery – skin is rough at first, so blurry; must be replaced with smoother skin 2-3 times to get final clarity Advantages: – One surgical procedure, no flap to cut – Faster and requires less cooperation from patient – Anatomically, it’s as close to your pre-op eye as possible, more stable and in most cases trauma does not affect it 30 Committed To Those We Serve

Womack Army Medical Center Specific LASIK Pro / Con Disadvantages: – Two procedures, more delicate, need more cooperation – Until the flap is sealed down, a poke to the eye could require a return to the laser suite Advantages: – Less pain, typically an ache or scratchy feeling for a few days – Fast recovery – driving in 1-2 days, back to full duty in 2-3d – Better visual outcomes for some patients; easy to re-treat 31 Committed To Those We Serve

Womack Army Medical Center Questions Please write down any questions you may have and bring them to your appointment to discuss with your provider. 32 Committed To Those We Serve