SAN DIEGO (Feb. 17, 2010) - Capt. (Dr.) David J. Tanzer, Specialty Leader, Navy Refractive Surgery and Naval Medical Center San Diego's Director, Refractive Surgery, performs a Photorefractive keratectomy (PRK) at Naval Training Center. PRK performs the laser ablation at the outer surface of the cornea. (U.S. Navy photo by Mass Communication Specialist 2nd Class Chad A. Bascom/HIPAA complete)
SAN DIEGO (Feb. 17, 2010) - Capt. (Dr.) David J. Tanzer, Specialty Leader, Navy Refractive Surgery and Naval Medical Center San Diego's Director, Refractive Surgery, performs a Photorefractive keratectomy (PRK) on a Navy Sailor at Naval Training Center. PRK performs the laser ablation at the outer surface of the cornea. (U.S. Navy photo by Mass Communication Specialist 2nd Class Chad A. Bascom/HIPAA complete)
SAN DIEGO (Feb. 17, 2010) - Capt. (Dr.) David J. Tanzer, Specialty Leader, Navy Refractive Surgery and Naval Medical Center San Diego's Director, Refractive Surgery, does an immediate post operative examination with a Marine after performing laser-assisted in situ keratomileusis (LASIK). (U.S. Navy photo by Mass Communication Specialist 2nd Class Chad A. Bascom/HIPAA complete)
SAN DIEGO (NNS) -- Naval Training Center (NTC) San Diego's Refractive Surgical Center performed more than 2,750 vision correcting refractive procedures in 2009, providing service members improved functional vision.
Active duty and Reservists on active duty status are eligible for refractive eye surgery. This surgery can allow service members to focus on assigned tasks without contact lenses or glasses while deployed. Glasses or contact lenses are designed to compensate for the eye's imperfections, while laser surgery aims to permanently change and improve the focusing power of the eye by reshaping the cornea.
The NTC clinic offers three types of refractive surgical procedures, including photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK) and implantable collamer lenses (ICL).
"I was privileged to perform the first laser vision corrective surgery on a Navy pilot who then went on to carrier qualify aboard an aircraft carrier," said Capt. David J. Tanzer, division head for NTC Refractive Surgery. "Six weeks after receiving his refractive eye surgery he flew out to a aircraft carrier with the commander of the carrier air wing in his back seat and performed a daytime landing aboard the USS Abraham Lincoln (CVN 72). This aviator’s first nighttime landings aboard the carrier following PRK were with me in his backseat."
"The pilot relayed to me while I was flying with him that he had never seen the carrier landing lights better than when he was flying the first time after he had had the surgery, which was a huge relief for me," Tanzer said. "I took great pride in the fact that the procedure that I was able to perform for him resulted in him having better functional vision than before he had the surgery."
If the cornea has imperfections, the image on the retina may be blurry or somewhat distorted, a refractive error known as nearsightedness, farsightedness and astigmatisms. These refractive errors are usually easy to correct through virtually painless procedures, resulting in 95 percent improved visual accuracy.
PRK is completed with the use of an excimer laser that uses a cool ultraviolet light beam to precisely remove small amounts of tissue from the surface of the cornea in order to reshape any irregularities. Correctly reshaping the cornea focuses light into the eye and onto the retina, improving vision. LASIK uses the same excimer laser as PRK but is focused on the cornea under a partial thickness flap that has been created, usually with another type of laser called a femtosecond laser. Once th e excimer laser has reshaped the cornea, the LASIK flap is repositioned where it heals naturally. LASIK and PRK procedures generally take less than 10 minutes to complete and the patient remains awake throughout the procedure.
Unlike the LASIK or PRK, ICL does not involve the removal of eye tissue but rather, implants permanent contacts. During the procedure, a surgeon administers topical anesthesia to minimize discomfort. Though painless, patients have reported feeling pressure on their eyes during the procedure. At the beginning of the surgery, one or two small openings at the base of the cornea are used to position the lens. A gel-like substance is placed inside the eye to protect it while the lens is placed behind the iris. ICL surgery takes approximately 15 minutes.
All three are ambulatory procedures so the patient can leave immediately after, although patients are advised to have a driver following the procedure. There can be some discomfort or dryness of the eye after the numbing drops wear off, although this is minimal and can subside quickly. Post surgery prescriptions generally include antibiotics to prevent infection, anti-inflammatory medication to ease any swelling that may arise and eye drops to keep the eyes moist and comfortable. Patients should not swim, however, for eight weeks following the operation to avoid damage or irritation from the water that could easily enter the eyes.
"The recovery times for the procedures are fairly fast," said Tanzer. "Convalescent leave is granted for 2 days for LASIK and ICL surgery and 7 days for PRK. The Navy Surgeon General policy states that Naval personnel can deploy as soon as 1 month following LASIK and ICL surgery and 3 months following PRK."
With a commanding officer's approval, active duty personnel have the option of seeing civilian practitioners for visual acuity improving procedures, but cannot use military refractive centers for follow up care if they do so. Naval personnel on flight status must have their refractive surgery performed by a Department of Defense refractive surgery center; they are prohibited from seeking this treatment by civilian providers. Doing so may place their flight status in jeopardy.
Beneficiaries interested in receiving the procedures are required to go through their TRICARE provider. Currently, refractive surgery is not a benefit covered by TRICARE. Active duty or Reserve personnel should contact any military optometry department to schedule an appointment for a refractive surgery consultation.
"I have had the privilege over the last 15 years of taking care of thousands of people in all aspects of ophthalmology," said Tanzer. "Be it cataract surgery, cornea transplantation or the myriad of other procedures we perform as ophthalmologists, I derive my greatest sense of satisfaction in being able to perform laser vision corrective surgery on war fighters, allowing them to focus on their jobs and be able to carry out their functions without the need for glasses or contacts."
For more information regarding NMCSD’s ophthalmology click here: Ophthalmology Clinic.