Photorefractive Keratectomy in Experienced U.S. Naval Aviators: A Prospective Evaluation.

PURPOSE: To report on the prospective evaluation of photorefractive keratectomy (PRK) in experienced ametropic naval aviators that led to the approval of refractive surgery for military pilots. METHODS: This was the first study evaluating refractive surgery in naval aviators. Return to flight status after PRK and clinical outcomes and subjective and objective flight performance were evaluated. RESULTS: A total of 785 U.S. naval aviators were enrolled in the study. Average preoperative refraction was -2.92 ± 1.73 diopters (D) (range: +5.25 to -9.13 D). By 6 months, 85.9% of eyes were within ±0.50 D and 96.4% were within ±1.00 D of emmetropia. 94.4% of eyes achieved 20/20 or better, 74.3% had 20/16 or better, and 45.2% had 20/12.5 or better uncorrected distance visual acuity (UDVA) at 6 months. A total of 78.5% of aviators met return-to-flight criteria by 4 weeks, 83.3% by 8 weeks, and 90.8% by 12 weeks following PRK. All aviators eventually returned to full flight status. Cumulative flight experience included logging more than 48,000 flight hours and 19,500 landings in the 6 months following PRK. Psychometric questionnaire results showed that 78% reported improved ability to detect other aircraft and 92% reported improved ability to land on an aircraft carrier (82% significantly improved) compared to wearing corrective lenses. No one felt their vision was worse in these dynamic environments. All aviators indicated they would undergo the procedure again and would recommend it to a fellow aviator. CONCLUSIONS: This prospective study in U.S. naval aviators determined PRK to be safe and effective in a unique patient population operating in a visually demanding and hazardous environment. The program continues to be enthusiastically supported by aviators and PRK is now allowed in all branches of the military and for National Aeronautics and Space Administration astronauts. [J Refract Surg. 2024;40(6):e371-e380.].

Photorefractive Keratectomy in Student Naval Aviators: Outcomes of the U.S. Navy Accessioning Study.

PURPOSE: To present the outcomes of the U.S. Navy photorefractive keratectomy (PRK) accessioning study conducted between 2000 and 2005 that helped lead to the acceptance of laser vision correction within the U.S. aviation industry. METHODS: In this prospective masked study, a total of 301 students who had PRK and underwent naval flight training were compared to 4,368 untreated peers. Three training pipelines were compared: propeller/jet transport, jet fighters, and helicopters. The evaluated metrics were flight and academic performance (assessed for the primary and advanced stage of the training as normalized Navy Standard Score [NSS]), as well as the student attrition rate from training. RESULTS: The attrition rate was lower in the PRK group compared to controls (15.9% vs 23.2%; P = .004). In the primary stage of training, students who had PRK outperformed controls in flight training performance in the propeller/jet transport pipeline (average NSS after PRK: 52.4 ± 7.5 vs controls: 50.7 ± 6.4, P = .02), but the flight performance in the jet fighter and helicopter pipelines was comparable between the two groups. Academic performance in the primary stage of training was approximately 7% to 13% higher in students who had PRK for all training pipelines. During the advanced training stage, there was no difference in the flight performance between the groups in any of the presented pipelines. Academic performance was significantly better for students who had PRK in the helicopter pipeline (51.2 ± 11.0 vs 46.7 ± 11.7 P < .001) but comparable between the two groups in the remaining pipelines. CONCLUSIONS: Refractive surgery did not have adverse effects on flight performance metrics. Pilots who had PRK had comparable or better outcomes than their untreated peers. [J Refract Surg. 2024:40(3):e173-e181.].

Satisfaction of 13,655 patients with laser vision correction at 1 month after surgery.

PURPOSE: To assess the level of laser vision correction patient satisfaction achieved by a large corporate provider of refractive surgery. METHODS: A computer-based, interactive survey was used to query patients regarding their satisfaction with the services, experience, and results of their laser vision correction procedure. RESULTS: Responses from 13,655 consecutive patients who completed their 1-month postoperative examination were analyzed in this study. A very high level of satisfaction was observed both for the quality of postoperative care provided (98.6%) and for the visual results obtained (95.0%). Most patients (94.2%) indicated that the surgery improved their life, and most would recommend both laser vision correction (96.5%) and the corporate provider (97.5%) to friends and family. CONCLUSIONS: Patients report a high level of satisfaction with laser vision correction performed by a large corporate provider.

An evidence-based approach to patient selection for laser vision correction.

PURPOSE: To describe the process used by Optical Express, a large corporate refractive surgery provider, to develop evidence-based patient selection guidelines for laser vision correction. METHODS: The evaluation of patient selection criteria for laser vision correction is part of a larger corporate process of continuous quality improvement and clinical due diligence. The procedures used to evaluate patient selection criteria are described in detail and the benefits of this process are explained. The criterion review process involves the company's International Medical Advisory Board (IMAB) and includes an evaluation of the published literature and analyses generated from the large Optical Express clinical outcomes database. This article offers a case study in which the IMAB used the criterion review process to examine the upper limit for estimated postoperative keratometry in hyperopic laser vision correction. RESULTS: The patient selection criteria undergo continuous scrutiny and are modified whenever medical evidence indicates that change is appropriate. CONCLUSIONS: Using an established protocol for reviewing patient selection criteria, Optical Express continuously measures its patient selection criteria against both external (published) and internal data sources. This process ensures that decisions about patients' suitability for surgery are based on the best-available current medical evidence.

Effect of keratometry on visual outcomes 1 month after hyperopic LASIK.

PURPOSE: To determine whether preoperative, postoperative, or change in keratometry can be used to predict visual outcomes in hyperopic LASIK. METHODS: A retrospective analysis was conducted on hyperopic eyes treated at Optical Express clinics. All eyes were targeted for emmetropia and treated using wavefront-guided LASIK (VISX S4, Abbott Medical Optics [AMO]), with flaps created using a femtosecond laser (IntraLase FS-60 [AMO]). A total of 1659 consecutive eyes of 895 patients met the study inclusion criteria: preoperative sphere > or = 1.00 diopter, complete 1-month follow-up data, and availability of pre- and postoperative keratometry measurements. Factors associated with 1-month visual results were evaluated with multivariate analysis. RESULTS: Preoperative sphere was strongly correlated with visual outcomes. Higher levels of correction were associated with a greater loss of best spectacle-corrected visual acuity (BSCVA), a lower percentage of eyes achieving 20/20 BSCVA, and a lower percentage of eyes achieving 20/20 uncorrected visual acuity. For a given level of preoperative sphere, however, no statistically significant correlation was observed between visual outcomes and either pre- or postoperative keratometry. CONCLUSIONS: Preoperative, calculated postoperative, or 1-month postoperative keratometry values do not correlate with visual acuity outcomes following hyperopic LASIK.